TAX ID1|TAX ID2|TAX ID3|TAX ID4|REV CODE|LEVEL OF CARE|PER DIEM|NOTE 58-2658683|81-1467358|14-1842263|75-2999825|191|Level 1|1910|Stop-loss: $95000.00 1st dollar - reverting to 72% of billed charges. 58-2658683|81-1467358|14-1842263|75-2999825|192|Level 2|2175|Stop-loss: $95000.00 1st dollar - reverting to 72% of billed charges. 58-2658683|81-1467358|14-1842263|75-2999825|193|Level 3|2440|Stop-loss: $95000.00 1st dollar - reverting to 72% of billed charges.