| 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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