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51c7367 | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 | Service Lookups,Unnamed_1,Unnamed_2,Unnamed_3,Apply Ded?,Cost Sharing,Copay,Apply Ded?_1,Cost Sharing_1,Copay_1,Apply Ded?_2,Cost Sharing_2,Copay_2
InpHospital,Inp,"Facility
Inpatient",Hospital,1,2,350.0,2,1,,1,2,350.0
InpSurgery,Inp,,Surgery,2,1,,2,1,,2,1,
InpMHSA,Inp,,MHSA,1,2,350.0,2,1,,1,2,350.0
InpSNF,Inp,,SNF,1,2,350.0,2,1,,1,2,350.0
InpNH,Inp,,NH,2,1,,2,1,,2,1,
OutER,Out,"Facility
Outpatient",ER,1,2,150.0,1,2,150.0,1,2,200.0
OutUC,Out,,UC,1,2,25.0,1,2,25.0,1,2,30.0
OutSurgery,Out,,Surgery,1,2,250.0,1,1,,1,2,300.0
OutMHSA,Out,,MHSA,2,1,,2,1,,2,1,
OutRx,Out,,Rx,2,1,,2,1,,2,1,
OutX-ray/Lab,Out,,X-ray/Lab,1,2,0.0,2,1,,1,2,0.0
OutAdv Rad,Out,,Adv Rad,1,2,0.0,2,1,,1,2,0.0
OutAll Other,Out,,All Other,2,1,,2,1,,2,1,
ProfessionalPCP,Professional,Professional Services,PCP,1,2,25.0,1,2,25.0,1,2,30.0
ProfessionalSCP,Professional,,SCP,1,2,35.0,1,2,35.0,1,2,30.0
ProfessionalMaternity,Professional,,Maternity,1,2,350.0,2,1,,1,2,350.0
ProfessionalOff Surgery,Professional,,Off Surgery,1,2,35.0,1,2,35.0,1,2,30.0
ProfessionalPCP Facility,Professional,,PCP Facility,2,1,,2,1,,2,1,
ProfessionalSCP Facility,Professional,,SCP Facility,2,1,,2,1,,2,1,
ProfessionalRx,Professional,,Rx,1,2,0.0,1,2,0.0,1,2,0.0
ProfessionalX-ray/Lab,Professional,,X-ray/Lab,1,2,0.0,2,1,,1,2,0.0
ProfessionalAdv Rad,Professional,,Adv Rad,2,1,,2,1,,2,1,
[MISSING],Professional,,MHSA,1,2,25.0,1,2,25.0,1,2,30.0
ProfessionalPhyTh/SpTh/OccTh,Professional,,PhyTh/SpTh/OccTh,1,2,25.0,2,1,,1,2,30.0
ProfessionalChiro,Professional,,Chiro,1,2,25.0,1,2,25.0,1,2,30.0
ProfessionalVis/Hear/Sp,Professional,,Vis/Hear/Sp,1,2,,1,2,,1,2,
ProfessionalAll Other,Professional,,All Other,1,2,,1,2,,1,2,
OtherAmbulance,Other,Other,Ambulance,1,2,,1,2,,1,2,
OtherHHC,Other,,HHC,2,1,,2,1,,2,1,
OtherDME,Other,,DME,1,2,,1,2,,1,2,
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