{"text_format":"1","workbook":"xlsx","n_sheets":14,"sheets":["Line Item Diabetes","Line Item Maternity","Color Key","Starting Screen","Manual Entry","Automated Import","Diabetes Timeline","Maternity Timeline","Manual Results","Automated Results","Orig Scenario","Import","Import Entry","Import Results"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":0,"defined_names":247,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Line Item Diabetes","index":0,"n_rows":31,"n_cols":8,"rows_kept":31,"cut":false,"hidden":true,"merged":[]}
["Unique\nKey","Diagnosis Code \n(ICD-9)","CPT©, HCPCS, or\nOther Billing Code","Provider\nType","Category"," Descriptor","Allowed\nAmount","Notes"]
[1,"250.00, V58.66, V58.67",2803101,"Pharmacy Retail","Pharmacy","Glucagon Emergency Kit",153]
[2,"250.00, V58.66, V58.67",36415,"Primary","Laboratory tests","Routine Venipuncture",4.1312550556999996]
[3,"250.00, V58.66, V58.67","53885014201","Pharmacy Retail","Medical equipment and supplies","OneTouch Delica Lancing Device ",18]
[4,"250.00, V58.66, V58.67",53885024510,"Pharmacy Retail","Medical equipment and supplies","OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ",123.6]
[5,"250.00, V58.66, V58.67",53885039310,"Pharmacy Retail","Medical equipment and supplies","OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]",9]
[6,"250.00, V58.66, V58.67","53885041601","Pharmacy Retail","Medical equipment and supplies","OneTouch Ultra Control Solution (2 vials/box)",6.02]
[7,"250.00, V58.66, V58.67",53885044801,"Pharmacy Retail","Medical equipment and supplies","OneTouch Ultra 2 Blood Glucose Meter Kit",66]
[8,"250.00, V58.66, V58.67",80053,"Primary","Laboratory tests","Comprehen Metabolic Panel",18.130348149]
[9,"250.00, V58.66, V58.67",80061,"Primary","Laboratory tests","Lipid panel",19.234491976000001]
[10,"250.00, V58.66, V58.67",80069,"Primary","Laboratory tests","Renal Function Panel",14.302656536000001]
[11,"250.00, V58.66, V58.67",81003,"Primary","Laboratory tests","Urinalysis Auto W/O Scope",3.1785047792999999]
[12,"250.00, V58.66, V58.67",82043,"Primary","Laboratory tests","Microalbumin Quantitative",8.3096516433000005]
[13,"250.00, V58.66, V58.67",82570,"Primary","Laboratory tests","Assay of Urine Creatinine",7.1686463557]
[14,"250.00, V58.66, V58.67",8290328279,"Pharmacy Retail","Medical equipment and supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]",8.4]
[15,"250.00, V58.66, V58.67",82947,"Primary","Laboratory tests","Assay Glucose Blood Quant",6.4317604084999997]
[16,"250.00, V58.66, V58.67",83036,"Primary","Laboratory tests","Glycosylated Hemoglobin Test",14.074362869]
[17,"250.00, V58.66, V58.67",88222033,"Pharmacy Retail","Pharmacy","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]",119.2]
[18,"250.00, V58.66, V58.67",93104801,"Pharmacy Retail","Pharmacy","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]",34.369999999999997]
[19,"250.00, V58.66, V58.67",93743801,"Pharmacy Retail","Pharmacy","Ramipril 10mg (Rx) [1 QD; #30 pills/month]",53.81]
[20,"250.00, V58.66, V58.67",97803,"Dietician","Office visits & procedures","Med Nutrition Indiv Subseq",63.127764974000002]
[21,"250.00, V58.66, V58.67",98960,"Diabetes Educator","Office visits & procedures","Self-mgmt educ & train 1 pt",80.526112889000004]
[22,"250.00, V58.66, V58.67",99204,"Ophthalmology","Office visits & procedures","Office/Outpatient Visit New",157.61130740999999,"Annual eye exam"]
[23,"250.00, V58.66, V58.67",99204,"Podiatry","Office visits & procedures","Office/Outpatient Visit New",157.61130740999999,"Annual foot exam"]
[24,"250.00, V58.66, V58.67",99214,"Primary","Office visits & procedures","Office/Outpatient Visit Est",102.47359376999999]
[25,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Medical equipment and supplies","Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]",3]
[26,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Pharmacy","Aspirin 81mg (OTC - bottle 100) [usage = 1 QD; #30 pills per month]",8]
[27,"V03.82",90471,"Primary","Vaccines, other preventive","Immunization Admin ADMIN",13.436576236000001]
[28,"V03.82",90472,"Primary","Vaccines, other preventive","Immunization admin each add ",13.436576236000001]
[29,"V03.82",90669,"Primary","Vaccines, other preventive","Pneumococcal vacc 7 val im",98.218151268]
[30,"V04.81",90656,"Primary","Vaccines, other preventive","Flu Vaccine No Preserv 3 & >",15.03511905]

{"sheet":"Line Item Maternity","index":1,"n_rows":37,"n_cols":8,"rows_kept":37,"cut":false,"hidden":true,"merged":[]}
["Unique\nKey","Diagnosis Code \n(ICD-9)","CPT©, HCPCS, or\nOther Billing Code","Provider\nType","Category"," Descriptor","Allowed\nAmount","Notes"]
[1,null,378710401,"Pharmacy Retail","Pharmacy","Oxycodone/APAP 5mg/325mg (Rx) [1 pill Q6H PRN; 15 pills]",5.21]
[2,null,591346601,"Pharmacy Retail","Pharmacy","Ibuprofen 800mg (Rx) [1 pill Q8H PRN; 60 pills]",17.52]
[3,"650, V27.0","S9443","Inpatient Facility","Education","Lactation class",0,"Included in hospital rate**"]
[4,"650, V27.0, Proc: 73.59","**(DRG) 795","Inpatient Facility","Hospital charges (baby)","Normal newborn",851.56]
[5,"650, V27.0, Proc: 73.59",1967,"Anesthesiology","Anesthesia","Anesth/analg vag delivery",905.62]
[6,"650, V27.0, Proc: 73.59","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Obstetrical Care",2084.2829046000002,"59400 - Global OB package description/code"]
[7,null,"OTC","Pharmacy Retail","Pharmacy","Docusate sodium (OTC) [1 pill QD]",30]
[8,null,"OTC","Pharmacy Retail","Pharmacy","Prenatal Vitamins (OTC - Bottle of 100) [1 pill daily; 30 pills/month]",30]
[9,null,"S9442","Alternative Provider","Education","Birthing class",0]
[10,"V04.81",90471,"OBGYN","Vaccines, other preventive"," Immunization Admin",20.038710250000001]
[11,"V04.81",90656,"OBGYN","Vaccines, other preventive","Flu Vaccine N0 Preserv 3 & >",15.03511905]
[12,"V22.0",36415,"OBGYN","Laboratory tests","Routine Venipuncture",4.1312550556999996,"Cystic fibrosis screen"]
[13,"V22.0",76805,"Radiology","Radiology","OB US >/= 14 WKS SNGL FETUS",176.11339355000001]
[14,"V22.0",80055,"OBGYN","Laboratory tests","Obstetric Panel",54.239906423000001,"80055 - Global OB panel code"]
[15,"V22.0",82105,"OBGYN","Laboratory tests","Alpha-fetoprotein serum",27.859090028000001,"Maternal serum quad screen"]
[16,"V22.0","82677","OBGYN","Laboratory tests","Alssay of estriol",26.628776623,"Maternal serum quad screen"]
[17,"V22.0",82947,"OBGYN","Laboratory tests","Assay Glucose Blood Quant",6.4317604084999997]
[18,"V22.0",82950,"OBGYN","Laboratory tests","Glucose Test",6.9532965180000001]
[19,"V22.0",83891,"OBGYN","Laboratory tests","Molecule isolate nucleic",7.1985144897,"Cystic fibrosis screen"]
[20,"V22.0",83900,"OBGYN","Laboratory tests","Molecule nucleic ampli 2 seq",31.840380951,"Cystic fibrosis screen"]
[21,"V22.0","83901 x13","OBGYN","Laboratory tests","Molecule nucleic ampli addon",129.52352633000001,"Cystic fibrosis screen"]
[22,"V22.0",83909,"OBGYN","Laboratory tests","Nucleic acid high resolute",18.976676401999999,"Cystic fibrosis screen"]
[23,"V22.0",83912,"OBGYN","Laboratory tests","Genetic examination",11.780489834999999,"Cystic fibrosis screen"]
[24,"V22.0","83914 x32","OBGYN","Laboratory tests","Mutation ident ola/sbce/aspe",50.061243402999999,"Cystic fibrosis screen"]
[25,"V22.0","84702","OBGYN","Laboratory tests","Chorionic gonadotropin test",21.473647412999998,"Maternal serum quad screen"]
[26,"V22.0",85025,"OBGYN","Laboratory tests","Complete cbc w/auto diff wbc",12.282662974999999]
[27,"V22.0","86336","OBGYN","Laboratory tests","Inhibin A",22.502594885000001,"Maternal serum quad screen"]
[28,"V22.0",86701,"OBGYN","Laboratory tests","HIV-1",12.935806004]
[29,"V22.0",87653,"OBGYN","Laboratory tests","Strep B DNA Amp Probe",40.612070811000002]
[30,"V22.0","87801 x2","OBGYN","Laboratory tests","Detect agnt mult dna ampli ",9.4479524864000002,"Gonorrhea / Chlamydia screen"]
[31,"V22.0",88164,"OBGYN","Laboratory tests","Cytopath TBS C/V Manual",14.735122969000001,"Pap smear"]
[32,"V22.0","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est",2084.2800000000002]
[33,"V24.2","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est",2084.2800000000002,"Post partum visit"]
[34,"V30.00","**(DRG) 775","Inpatient Facility","Hospital charges (mother)","Vaginal delivery w/o complicating diagnoses",2714.26]
[35,"V72.42",81025,"OBGYN","Laboratory tests","Urine Pregnancy Test",8.8680026237000007]
[36,null,null,"Inpatient Facility","Hospital charges (bundle)","Inpatient Maternity Bundle (Bundled line items 4, 5, 34)",{"$f":"G5+G6+G35","v":4471.4400000000005},"see individual line items on Line Item Maternity tab"]

{"sheet":"Color Key","index":2,"n_rows":9,"n_cols":3,"rows_kept":9,"cut":false,"hidden":true,"merged":[]}
[]
[]
[null,null,"= Input Data provided by Insurer"]
[]
[]
[null,null,"= Scenario data provided by HHS"]
[]
[]
[null,"Formula","= Derived from formula"]

{"sheet":"Starting Screen","index":3,"n_rows":19,"n_cols":9,"rows_kept":19,"cut":false,"hidden":false,"merged":[[0,1,0,3],[10,3,11,3],[18,8,18,10]]}
[]
[null,"    Welcome to the Coverage Scenarios Cost Sharing Calculator"]
[]
[]
[]
[null,"All insurer data entry fields will be highlighted in orange:"]
[]
[null,"There are two methods to use this tool:"]
[]
[]
[null,null,null,"AUTOMATED",null,"Imported data from a Comma Separated Value (CSV) file"]
[null,null,null,null,null,"You can process multiple plans at one time with this method"]
[]
[]
[null,null,null,"MANUAL",null,"Manually enter information about one plan"]
[]
[]
[]
[null,null,null,"      How would you like to use the tool?",null,null,null,null,"Automated"]

{"sheet":"Manual Entry","index":4,"n_rows":28,"n_cols":16,"rows_kept":28,"cut":false,"hidden":true,"merged":[[0,11,1,11]]}
[null,"MANUAL ENTRY INSTRUCTIONS",null,null,null,null,null,null,null,null,null,"Switch to:"]
[null,"Fill in the coverage details for one plan in the orange cells using numbers only."]
[null,"If the category is not covered or included in the plan, leave the cell blank."]
[null,"Click the 'Run the Calculator' button to compute the cost sharing for the scenarios."]
[]
[null,null,null,null,null,null,null,null,null,"Selection",null,"$ OR %",{"$f":"COUNTIF(M7:M14,\"Please enter a value\")+COUNTIF(M7:M14,\"Please correct\")","v":0},"rngShare Type","rngPlanDeduct","Cost_Sharing_List_4"]
[{"$f":"Share_DME","v":"No Cost Sharing"},null,"COST SHARING",null,"Durable Medical Equipment",null,null,null,null,{"$f":"INDEX(Cost_Sharing_List_4,K7)","v":"No Cost Sharing"},3,"",{"$f":"IF(AND(OR(Share_DME=\"Coinsurance\",Share_DME=\"Copayment\"),Value_DME=\"\"),\"Please enter a value\",IF(OR(AND(Share_DME=\"Coinsurance\",Value_DME>1),AND(Value_DME<>\"\",OR(Share_DME=\"Not Covered\",Share_DME=\"No Cost Sharing\"))),\"Please correct\",\"\"))","v":""},"rngShareValue","rngPlanLimit","Copayment"]
[{"$f":"Share_RX","v":"Copayment"},null,null,null,"Generic Prescriptions",null,null,null,null,{"$f":"INDEX(Cost_Sharing_List_4,K8)","v":"Copayment"},1,10,{"$f":"IF(AND(OR(Share_RX=\"Coinsurance\",Share_RX=\"Copayment\"),Value_RX=\"\"),\"Please enter a value\",IF(OR(AND(Share_RX=\"Coinsurance\",Value_RX>1),AND(Value_RX<>\"\",OR(Share_RX=\"Not Covered\",Share_RX=\"No Cost Sharing\"))),\"Please correct\",\"\"))","v":""},null,null,"Coinsurance"]
[{"$f":"Share_Hospital","v":"Coinsurance"},null,null,null,"Hospital Care, Inpatient & Anesthesia",null,null,null,null,{"$f":"INDEX(Cost_Sharing_List_4,K9)","v":"Coinsurance"},2,0.3,{"$f":"IF(AND(OR(Share_Hospital=\"Coinsurance\",Share_Hospital=\"Copayment\"),Value_Hospital=\"\"),\"Please enter a value\",IF(OR(AND(Share_Hospital=\"Coinsurance\",Value_Hospital>1),AND(Value_Hospital<>\"\",OR(Share_Hospital=\"Not Covered\",Share_Hospital=\"No Cost Sharing\"))),\"Please correct\",\"\"))","v":""},"Manual_Scenario:","Dia","No Cost Sharing"]
[{"$f":"Share_Lab","v":"No Cost Sharing"},null,null,null,"Laboratory",null,null,null,null,{"$f":"INDEX(Cost_Sharing_List_4,K10)","v":"No Cost Sharing"},3,"",{"$f":"IF(AND(OR(Share_Lab=\"Coinsurance\",Share_Lab=\"Copayment\"),Value_Lab=\"\"),\"Please enter a value\",IF(OR(AND(Share_Lab=\"Coinsurance\",Value_Lab>1),AND(Value_Lab<>\"\",OR(Share_Lab=\"Not Covered\",Share_Lab=\"No Cost Sharing\"))),\"Please correct\",\"\"))","v":""},null,null,"Not Covered"]
[{"$f":"Share_Rad","v":"Coinsurance"},null,null,null,"Radiology (Ultrasound)",null,null,null,null,{"$f":"INDEX(Cost_Sharing_List_4,K11)","v":"Coinsurance"},2,0.3,{"$f":"IF(AND(OR(Share_Rad=\"Coinsurance\",Share_Rad=\"Copayment\"),Value_Rad=\"\"),\"Please enter a value\",IF(OR(AND(Share_Rad=\"Coinsurance\",Value_Rad>1),AND(Value_Rad<>\"\",OR(Share_Rad=\"Not Covered\",Share_Rad=\"No Cost Sharing\"))),\"Please correct\",\"\"))","v":""}]
[{"$f":"Share_Obst","v":"Copayment"},null,null,null,"Routine Obstetric Care (Bundled)",null,null,null,null,{"$f":"INDEX(Cost_Sharing_List_5,K12)","v":"Copayment"},1,40,{"$f":"IF(AND(OR(Share_Obst=\"Coinsurance\",Share_Obst=\"Copayment\",Share_Obst=\"Deductible\"),Value_Obst=\"\"),\"Please enter a value\",IF(OR(AND(Share_Obst=\"Coinsurance\",Value_Obst>1),AND(Value_Obst<>\"\",OR(Share_Obst=\"Not Covered\",Share_Obst=\"No Cost Sharing\"))),\"Please correct\",\"\"))","v":""},null,"rngBal","Cost_Sharing_List_5"]
[{"$f":"Share_Vaccine","v":"No Cost Sharing"},null,null,null,"Vaccine & Preventive",null,null,null,null,{"$f":"INDEX(Cost_Sharing_List_4,K13)","v":"No Cost Sharing"},3,"",{"$f":"IF(AND(OR(Share_Vaccine=\"Coinsurance\",Share_Vaccine=\"Copayment\"),Value_Vaccine=\"\"),\"Please enter a value\",IF(OR(AND(Share_Vaccine=\"Coinsurance\",Value_Vaccine>1),AND(Value_Vaccine<>\"\",OR(Share_Vaccine=\"Not Covered\",Share_Vaccine=\"No Cost Sharing\"))),\"Please correct\",\"\"))","v":""},null,null,"Copayment"]
[{"$f":"Share_Visit","v":"Copayment"},null,null,null,"Visits & Procedures",null,null,null,null,{"$f":"INDEX(Cost_Sharing_List_4,K14)","v":"Copayment"},1,40,{"$f":"IF(AND(OR(Share_Visit=\"Coinsurance\",Share_Visit=\"Copayment\"),Value_Visit=\"\"),\"Please enter a value\",IF(OR(AND(Share_Visit=\"Coinsurance\",Value_Visit>1),AND(Value_Visit<>\"\",OR(Share_Visit=\"Not Covered\",Share_Visit=\"No Cost Sharing\"))),\"Please correct\",\"\"))","v":""},"Prior Usage","Balance Remaining","Coinsurance"]
[null,null,null,null,"Individual Out-of-Pocket (OOP) Limit",null,null,null,null,null,null,"",null,{"$f":"INDIRECT(Manual_Scenario&\"_Prior_OOP\")","v":1512.4247456259998},{"$f":"IF(OR(ISBLANK(Value_OOP),Value_OOP=\"\"),0,Value_OOP-Prior_OOP)","v":0},"Deductible"]
[null,null,"DEDUCTIBLES",null,"Overall Plan Deductible",null,null,null,null,null,null,1000,null,{"$f":"INDIRECT(Manual_Scenario&\"_Prior_Deduct_Overall\")","v":999.99995185600005},{"$f":"IF(ISBLANK(Value_Deduct_Overall),0,Value_Deduct_Overall-Prior_Overall)","v":4.8143999947569682E-5},"No Cost Sharing"]
[null,null,null,null,"Durable Medical Equipment",null,null,null,null,null,null,"",null,{"$f":"INDIRECT(Manual_Scenario&\"_Prior_Deduct_DME\")","v":0},{"$f":"IF(ISBLANK(Value_Deduct_DME),0,Value_Deduct_DME-Prior_DME)","v":{"$error":"#VALUE!"}},"Not Covered"]
[null,null,null,null,"Generic RX",null,null,null,null,null,null,100,null,{"$f":"INDIRECT(Manual_Scenario&\"_Prior_Deduct_RX\")","v":100},{"$f":"IF(ISBLANK(Value_Deduct_RX),0,Value_Deduct_RX-Prior_RX)","v":0}]
[null,null,null,null,"Hospital Care, Inpatient & Anesthesia",null,null,null,null,null,null,"",null,{"$f":"INDIRECT(Manual_Scenario&\"_Prior_Deduct_Hospital\")","v":0},{"$f":"IF(ISBLANK(Value_Deduct_Hospital),0,Value_Deduct_Hospital-Prior_Hospital)","v":{"$error":"#VALUE!"}}]
[null,null,null,null,"Routine Obstetric Care (Bundled) ",null,null,null,null,null,null,{"$f":"IF(Share_Obst=\"Deductible\",Value_Obst,\"\")","v":""},null,0,{"$f":"IF(Share_Obst=\"Deductible\",Value_Deduct_Obst,0)","v":0}]
[null,null,null,null,"Vaccine & Preventive",null,null,null,null,null,null,"",null,{"$f":"INDIRECT(Manual_Scenario&\"_Prior_Deduct_Vaccine\")","v":0},{"$f":"IF(ISBLANK(Value_Deduct_Vaccine),0,Value_Deduct_Vaccine-Prior_Vaccine)","v":{"$error":"#VALUE!"}}]
[null,null,"LIMITS","MATERNITY","Generic Prescriptions # Limit Per Month",null,null,null,null,null,null,"",null,0,{"$f":"IF(Manual_Scenario<>\"Mat\",0,IF(Manual_Scenario<>\"Mat\",\"NA\",IF(ISBLANK(Limit_Mat_RX_Month),0,Limit_Mat_RX_Month-Prior_Mat_RX_Month)))","v":0}]
[null,null,null,null,"Generic Prescriptions # Limit Per Year",null,null,null,null,null,null,"",null,{"$f":"IF(Manual_Scenario<>\"Mat\",\"\",INDIRECT(Manual_Scenario&\"_Prior_Limit_RX_Year\"))","v":""},{"$f":"IF(Manual_Scenario<>\"Mat\",0,IF(ISBLANK(Limit_Mat_RX_Yr),0,Limit_Mat_RX_Yr-Prior_Mat_RX_Yr))","v":0}]
[null,null,null,"DIABETES","Generic Prescriptions # Limit Per Month",null,null,null,null,null,null,"",null,0,{"$f":"IF(Manual_Scenario<>\"Dia\",0,IF(ISBLANK(Limit_Dia_RX_Month),\"0\",Limit_Dia_RX_Month-Prior_Dia_RX_Month))","v":{"$error":"#VALUE!"}}]
[null,null,null,null,"Generic Prescriptions # Limit Per Year",null,null,null,null,null,null,"",null,{"$f":"IF(Manual_Scenario<>\"Dia\",\"\",INDIRECT(Manual_Scenario&\"_Prior_Limit_RX_Yr\"))","v":0},{"$f":"IF(Manual_Scenario<>\"Dia\",0,IF(ISBLANK(Limit_Dia_RX_Yr),0,Limit_Dia_RX_Yr-Prior_Dia_RX_Yr))","v":{"$error":"#VALUE!"}}]
[null,null,null,null,"Durable Medical Equipment # Limit Per Month",null,null,null,null,null,null,"",null,0,{"$f":"IF(Manual_Scenario<>\"Dia\",0,IF(ISBLANK(Limit_Dia_DME_Month),0,Limit_Dia_DME_Month-Prior_Dia_DME_Month))","v":{"$error":"#VALUE!"}}]
[null,null,null,null,"Durable Medical Equipment # Limit Per Year",null,null,null,null,null,null,"",null,{"$f":"IF(Manual_Scenario<>\"Dia\",\"\",INDIRECT(Manual_Scenario&\"_Prior_Limit_DME_Yr\"))","v":0},{"$f":"IF(Manual_Scenario<>\"Dia\",0,IF(ISBLANK(Limit_Dia_DME_Yr),0,Limit_Dia_DME_Yr-Prior_Dia_DME_Yr))","v":{"$error":"#VALUE!"}}]
[null,null,null,null,"Visits & Procedures # Limit Per Year",null,null,null,null,null,null,"",null,{"$f":"IF(Manual_Scenario<>\"Dia\",\"\",INDIRECT(Manual_Scenario&\"_Prior_Limit_Visit_Yr\"))","v":0},{"$f":"IF(Manual_Scenario<>\"Dia\",0,IF(ISBLANK(Limit_Dia_Visit_Yr),0,Limit_Dia_Visit_Yr-Prior_Dia_Visit_Yr))","v":{"$error":"#VALUE!"}}]

{"sheet":"Automated Import","index":5,"n_rows":9,"n_cols":10,"rows_kept":9,"cut":false,"hidden":true,"merged":[[7,10,9,10],[0,9,1,10]]}
[null,"AUTOMATED IMPORT INSTRUCTIONS",null,null,null,null,null,null,null,"Switch to:"]
[null,"Close any previous CSV files that may be open."]
[null,"Click the 'Import & Run' button to compute the cost sharing for the different plans and export results to a CSV file."]
[]
[]
[]
[]
[]
[null,null,null,null,"Process multiple plans from a CSV import file:"]

{"sheet":"Diabetes Timeline","index":6,"n_rows":402,"n_cols":53,"rows_kept":402,"cut":false,"hidden":false,"merged":[[0,8,0,15],[0,17,0,30],[0,31,0,42],[0,43,0,51]]}
[null,null,null,null,null,null,null,null,"CATEGORIES",null,null,null,null,null,null,null,null,"COSTS",null,null,null,null,null,null,null,null,null,null,null,null,null,"DEDUCTIBLES",null,null,null,null,null,null,null,null,null,null,null,"LIMITS"]
["Date of Service","Diabetes Claim\nUnique Key","Diagnosis Code \n(ICD-9)","CPT©, HCPCS, or\nOther Billing Code","Provider\nType","Category"," Descriptor","Notes","DME","Generic RX","Hospital Care","Lab","Radiology","Obstetric","Vaccines","Visits","Amount Allowed","Insurer Expense","Running Insurer","Exclusions","Running Excl","Limitations","Running Limit","Deductible","Running Deduct","Copayment","Running Copay","Coinsurance","Running Coinsur","OOP Expense","Running OOP","Overall","Running Overall","DME","Running DME","Generic RX","Running RX","Hospital Care","Running Hospital","Obstetric","Running Obst","Vaccines","Running Vaccine","Dia RX per month","Running Dia RX Month","Dia RX per year","Running Dia RX Yr","DME\nper month","Running Dia DME Month","DME\nper year","Running Dia DME Yr","Visits\nper year","Running Visit Yr"]
["2011-01-03",25,{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,2,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,2,FALSE))","v":"250.00, V58.66, V58.67"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,3,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,3,FALSE))","v":"OTC"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,4,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,4,FALSE))","v":"Pharmacy Retail"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,5,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,5,FALSE))","v":"Medical equipment and supplies"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,6,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,6,FALSE))","v":"Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,8,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,8,FALSE))","v":""},{"$f":"IF(Dia_Col_Category=\"Medical equipment and supplies\",1,\"\")","v":1},{"$f":"IF(AND(Dia_Col_Category=\"Pharmacy\",Dia_Col_BillCode<>\"OTC\"),1,\"\")","v":""},{"$f":"IF(AND(Dia_Col_Category=\"Anesthesia\",Dia_Col_Provider<>\"Inpatient facility\"),1,\"\")","v":""},{"$f":"IF(Dia_Col_Category=\"Laboratory tests\",1,\"\")","v":""},{"$f":"IF(Dia_Col_Category=\"Radiology\",1,\"\")","v":""},{"$f":"IF(Dia_Col_BillCode=\"Bundled in global OB package - 59400\",1,\"\")","v":""},{"$f":"IF(Dia_Col_Category=\"Vaccines, other preventive\",1,\"\")","v":""},{"$f":"IF(Dia_Col_Category=\"Office visits & procedures\",1,\"\")","v":""},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,7,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,7,FALSE))","v":3},null,{"$f":"R3","v":0},3,{"$f":"T3","v":3},null,{"$f":"V3","v":0},null,{"$f":"X3","v":0},null,{"$f":"Z3","v":0},null,{"$f":"AB3","v":0},{"$f":"Dia_Col_Deduct+Dia_Col_Copay+Dia_Col_Coinsur","v":0},{"$f":"AD3","v":0},null,{"$f":"AF3","v":0},null,{"$f":"AH3","v":0},null,{"$f":"AJ3","v":0},null,{"$f":"AL3","v":0},null,{"$f":"AN3","v":0},null,{"$f":"AP3","v":0},null,{"$f":"AR3","v":0},null,{"$f":"AT3","v":0},null,{"$f":"AV3","v":0},null,{"$f":"AX3","v":0},null,{"$f":"AZ3","v":0}]
["2011-01-03",14,"250.00, V58.66, V58.67",8290328279,"Pharmacy Retail","Medical equipment and supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","",1,"","","","","","","",8.4,8.4,{"$f":"R4+S3","v":8.4},null,{"$f":"T4+U3","v":3},null,{"$f":"V4+W3","v":0},null,{"$f":"X4+Y3","v":0},null,{"$f":"Z4+AA3","v":0},null,{"$f":"AB4+AC3","v":0},0,{"$f":"AD4+AE3","v":0},null,{"$f":"AF4+AG3","v":0},null,{"$f":"AH4+AI3","v":0},null,{"$f":"AJ4+AK3","v":0},null,{"$f":"AL4+AM3","v":0},null,{"$f":"AN4+AO3","v":0},null,{"$f":"AP4+AQ3","v":0},null,{"$f":"AR4+AS3","v":0},null,{"$f":"AT4+AU3","v":0},null,{"$f":"AV4+AW3","v":0},null,{"$f":"AX4+AY3","v":0},null,{"$f":"AZ4+BA3","v":0}]
["2011-01-03",5,"250.00, V58.66, V58.67",53885039310,"Pharmacy Retail","Medical equipment and supplies","OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","",1,"","","","","","","",9,9,{"$f":"R5+S4","v":17.399999999999999},null,{"$f":"T5+U4","v":3},null,{"$f":"V5+W4","v":0},null,{"$f":"X5+Y4","v":0},null,{"$f":"Z5+AA4","v":0},null,{"$f":"AB5+AC4","v":0},0,{"$f":"AD5+AE4","v":0},null,{"$f":"AF5+AG4","v":0},null,{"$f":"AH5+AI4","v":0},null,{"$f":"AJ5+AK4","v":0},null,{"$f":"AL5+AM4","v":0},null,{"$f":"AN5+AO4","v":0},null,{"$f":"AP5+AQ4","v":0},null,{"$f":"AR5+AS4","v":0},null,{"$f":"AT5+AU4","v":0},null,{"$f":"AV5+AW4","v":0},null,{"$f":"AX5+AY4","v":0},null,{"$f":"AZ5+BA4","v":0}]
["2011-01-03",3,"250.00, V58.66, V58.67","53885014201","Pharmacy Retail","Medical equipment and supplies","OneTouch Delica Lancing Device ","",1,"","","","","","","",18,18,35.4,null,3,null,0,null,0,null,0,null,0,0,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",7,"250.00, V58.66, V58.67",53885044801,"Pharmacy Retail","Medical equipment and supplies","OneTouch Ultra 2 Blood Glucose Meter Kit","",1,"","","","","","","",66,66,101.4,null,3,null,0,null,0,null,0,null,0,0,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",4,"250.00, V58.66, V58.67",53885024510,"Pharmacy Retail","Medical equipment and supplies","OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","",1,"","","","","","","",123.6,123.6,225,null,3,null,0,null,0,null,0,null,0,0,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",6,"250.00, V58.66, V58.67","53885041601","Pharmacy Retail","Medical equipment and supplies","OneTouch Ultra Control Solution (2 vials/box)","",1,"","","","","","","",6.02,6.02,231.02,null,3,null,0,null,0,null,0,null,0,0,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",26,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Pharmacy","Aspirin 81mg (OTC - bottle 100) [usage = 1 QD; #30 pills per month]","","","","","","","","","",8,null,231.02,8,11,null,0,null,0,null,0,null,0,0,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",1,"250.00, V58.66, V58.67",2803101,"Pharmacy Retail","Pharmacy","Glucagon Emergency Kit","","",1,"","","","","","",153,43,274.02,null,11,null,0,100,100,10,10,null,0,110,110,null,0,null,0,100,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",17,"250.00, V58.66, V58.67",88222033,"Pharmacy Retail","Pharmacy","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","","",1,"","","","","","",119.2,109.2,383.21999999999997,null,11,null,0,0,100,10,20,null,0,10,120,null,0,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",18,"250.00, V58.66, V58.67",93104801,"Pharmacy Retail","Pharmacy","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]","","",1,"","","","","","",34.369999999999997,24.369999999999997,407.59,null,11,null,0,0,100,10,30,null,0,10,130,null,0,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",19,"250.00, V58.66, V58.67",93743801,"Pharmacy Retail","Pharmacy","Ramipril 10mg (Rx) [1 QD; #30 pills/month]","","",1,"","","","","","",53.81,43.81,451.4,null,11,null,0,0,100,10,40,null,0,10,140,null,0,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",15,"250.00, V58.66, V58.67",82947,"Primary","Laboratory tests","Assay Glucose Blood Quant","","","","",1,"","","","",6.4317604084999997,6.4317604084999997,457.83176040849997,null,11,null,0,null,100,null,40,null,0,0,140,null,0,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",13,"250.00, V58.66, V58.67",82570,"Primary","Laboratory tests","Assay of Urine Creatinine","","","","",1,"","","","",7.1686463557,7.1686463557,465.00040676419997,null,11,null,0,null,100,null,40,null,0,0,140,null,0,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",8,"250.00, V58.66, V58.67",80053,"Primary","Laboratory tests","Comprehen Metabolic Panel","","","","",1,"","","","",18.130348149,18.130348149,483.13075491319995,null,11,null,0,null,100,null,40,null,0,0,140,null,0,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",16,"250.00, V58.66, V58.67",83036,"Primary","Laboratory tests","Glycosylated Hemoglobin Test","","","","",1,"","","","",14.074362869,14.074362869,497.20511778219998,null,11,null,0,null,100,null,40,null,0,0,140,null,0,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",9,"250.00, V58.66, V58.67",80061,"Primary","Laboratory tests","Lipid panel","","","","",1,"","","","",19.234491976000001,19.234491976000001,516.43960975819994,null,11,null,0,null,100,null,40,null,0,0,140,null,0,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",12,"250.00, V58.66, V58.67",82043,"Primary","Laboratory tests","Microalbumin Quantitative","","","","",1,"","","","",8.3096516433000005,8.3096516433000005,524.74926140149989,null,11,null,0,null,100,null,40,null,0,0,140,null,0,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",10,"250.00, V58.66, V58.67",80069,"Primary","Laboratory tests","Renal Function Panel","","","","",1,"","","","",14.302656536000001,14.302656536000001,539.05191793749987,null,11,null,0,null,100,null,40,null,0,0,140,null,0,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",2,"250.00, V58.66, V58.67",36415,"Primary","Laboratory tests","Routine Venipuncture","","","","",1,"","","","",4.1312550556999996,4.1312550556999996,543.18317299319983,null,11,null,0,null,100,null,40,null,0,0,140,null,0,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",11,"250.00, V58.66, V58.67",81003,"Primary","Laboratory tests","Urinalysis Auto W/O Scope","","","","",1,"","","","",3.1785047792999999,3.1785047792999999,546.36167777249989,null,11,null,0,null,100,null,40,null,0,0,140,null,0,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-03",24,"250.00, V58.66, V58.67",99214,"Primary","Office visits & procedures","Office/Outpatient Visit Est","","","","","","","","",1,102.47359376999999,0,546.36167777249989,null,11,null,0,102.47359376999999,202.47359376999998,0,40,null,0,102.47359376999999,242.47359376999998,102.47359376999999,102.47359376999999,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-04",21,"250.00, V58.66, V58.67",98960,"Diabetes Educator","Office visits & procedures","Self-mgmt educ & train 1 pt","","","","","","","","",1,80.526112889000004,0,546.36167777249989,null,11,null,0,80.526112889000004,282.99970665899997,0,40,null,0,80.526112889000004,322.99970665899997,80.526112889000004,182.999706659,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-04",20,"250.00, V58.66, V58.67",97803,"Dietician","Office visits & procedures","Med Nutrition Indiv Subseq","","","","","","","","",1,63.127764974000002,0,546.36167777249989,null,11,null,0,63.127764974000002,346.12747163299997,0,40,null,0,63.127764974000002,386.12747163299997,63.127764974000002,246.127471633,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-06",23,"250.00, V58.66, V58.67",99204,"Podiatry","Office visits & procedures","Office/Outpatient Visit New","Annual foot exam","","","","","","","",1,157.61130740999999,0,546.36167777249989,null,11,null,0,157.61130740999999,503.73877904299997,0,40,null,0,157.61130740999999,543.73877904300002,157.61130740999999,403.73877904300002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-07",22,"250.00, V58.66, V58.67",99204,"Ophthalmology","Office visits & procedures","Office/Outpatient Visit New","Annual eye exam","","","","","","","",1,157.61130740999999,0,546.36167777249989,null,11,null,0,157.61130740999999,661.3500864529999,0,40,null,0,157.61130740999999,701.35008645300002,157.61130740999999,561.35008645300002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-01-31",17,"250.00, V58.66, V58.67",88222033,"Pharmacy Retail","Pharmacy","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","","",1,"","","","","","",119.2,109.2,655.56167777249993,null,11,null,0,0,661.3500864529999,10,50,null,0,10,711.35008645300002,null,561.35008645300002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-02-02",25,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Medical equipment and supplies","Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","",1,"","","","","","","",3,null,655.56167777249993,3,14,null,0,null,661.3500864529999,null,50,null,0,0,711.35008645300002,null,561.35008645300002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-02-02",14,"250.00, V58.66, V58.67",8290328279,"Pharmacy Retail","Medical equipment and supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","",1,"","","","","","","",8.4,8.4,663.96167777249991,null,14,null,0,null,661.3500864529999,null,50,null,0,0,711.35008645300002,null,561.35008645300002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-02-02",18,"250.00, V58.66, V58.67",93104801,"Pharmacy Retail","Pharmacy","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]","","",1,"","","","","","",34.369999999999997,24.369999999999997,688.33167777249992,null,14,null,0,0,661.3500864529999,10,60,null,0,10,721.35008645300002,null,561.35008645300002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-02-02",19,"250.00, V58.66, V58.67",93743801,"Pharmacy Retail","Pharmacy","Ramipril 10mg (Rx) [1 QD; #30 pills/month]","","",1,"","","","","","",53.81,43.81,732.14167777249986,null,14,null,0,0,661.3500864529999,10,70,null,0,10,731.35008645300002,null,561.35008645300002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-02-22",5,"250.00, V58.66, V58.67",53885039310,"Pharmacy Retail","Medical equipment and supplies","OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","",1,"","","","","","","",9,9,741.14167777249986,null,14,null,0,null,661.3500864529999,null,70,null,0,0,731.35008645300002,null,561.35008645300002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-02-22",4,{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,2,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,2,FALSE))","v":"250.00, V58.66, V58.67"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,3,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,3,FALSE))","v":53885024510},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,4,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,4,FALSE))","v":"Pharmacy Retail"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,5,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,5,FALSE))","v":"Medical equipment and supplies"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,6,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,6,FALSE))","v":"OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] "},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,8,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,8,FALSE))","v":""},{"$f":"IF(Dia_Col_Category=\"Medical equipment and supplies\",1,\"\")","v":1},{"$f":"IF(AND(Dia_Col_Category=\"Pharmacy\",Dia_Col_BillCode<>\"OTC\"),1,\"\")","v":""},{"$f":"IF(AND(Dia_Col_Category=\"Anesthesia\",Dia_Col_Provider<>\"Inpatient facility\"),1,\"\")","v":""},{"$f":"IF(Dia_Col_Category=\"Laboratory tests\",1,\"\")","v":""},{"$f":"IF(Dia_Col_Category=\"Radiology\",1,\"\")","v":""},{"$f":"IF(Dia_Col_BillCode=\"Bundled in global OB package - 59400\",1,\"\")","v":""},{"$f":"IF(Dia_Col_Category=\"Vaccines, other preventive\",1,\"\")","v":""},{"$f":"IF(Dia_Col_Category=\"Office visits & procedures\",1,\"\")","v":""},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,7,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,7,FALSE))","v":123.6},123.6,864.74167777249988,null,14,null,0,null,661.3500864529999,null,70,null,0,0,731.35008645300002,null,561.35008645300002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-02-28",17,"250.00, V58.66, V58.67",88222033,"Pharmacy Retail","Pharmacy","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","","",1,"","","","","","",119.2,109.2,973.94167777249993,null,14,null,0,0,661.3500864529999,10,80,null,0,10,741.35008645300002,null,561.35008645300002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-03-04",25,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Medical equipment and supplies","Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","",1,"","","","","","","",3,null,973.94167777249993,3,17,null,0,null,661.3500864529999,null,80,null,0,0,741.35008645300002,null,561.35008645300002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-03-04",14,"250.00, V58.66, V58.67",8290328279,"Pharmacy Retail","Medical equipment and supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","",1,"","","","","","","",8.4,8.4,982.34167777249991,null,17,null,0,null,661.3500864529999,null,80,null,0,0,741.35008645300002,null,561.35008645300002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-03-04",18,"250.00, V58.66, V58.67",93104801,"Pharmacy Retail","Pharmacy","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]","","",1,"","","","","","",34.369999999999997,24.369999999999997,1006.7116777724999,null,17,null,0,0,661.3500864529999,10,90,null,0,10,751.35008645300002,null,561.35008645300002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-03-04",19,"250.00, V58.66, V58.67",93743801,"Pharmacy Retail","Pharmacy","Ramipril 10mg (Rx) [1 QD; #30 pills/month]","","",1,"","","","","","",53.81,43.81,1050.5216777725,null,17,null,0,0,661.3500864529999,10,100,null,0,10,761.35008645300002,null,561.35008645300002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-03-28",26,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Pharmacy","Aspirin 81mg (OTC - bottle 100) [usage = 1 QD; #30 pills per month]","","","","","","","","","",8,null,1050.5216777725,8,25,null,0,null,661.3500864529999,null,100,null,0,0,761.35008645300002,null,561.35008645300002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-03-28",17,"250.00, V58.66, V58.67",88222033,"Pharmacy Retail","Pharmacy","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","","",1,"","","","","","",119.2,109.2,1159.7216777725,null,25,null,0,0,661.3500864529999,10,110,null,0,10,771.35008645300002,null,561.35008645300002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-03-28",24,"250.00, V58.66, V58.67",99214,"Primary","Office visits & procedures","Office/Outpatient Visit Est","","","","","","","","",1,102.47359376999999,0,1159.7216777725,null,25,null,0,102.47359376999999,763.82368022299988,0,110,null,0,102.47359376999999,873.823680223,102.47359376999999,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-04-03",25,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Medical equipment and supplies","Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","",1,"","","","","","","",3,null,1159.7216777725,3,28,null,0,null,763.82368022299988,null,110,null,0,0,873.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-04-03",14,"250.00, V58.66, V58.67",8290328279,"Pharmacy Retail","Medical equipment and supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","",1,"","","","","","","",8.4,8.4,1168.1216777725001,null,28,null,0,null,763.82368022299988,null,110,null,0,0,873.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-04-03",18,"250.00, V58.66, V58.67",93104801,"Pharmacy Retail","Pharmacy","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]","","",1,"","","","","","",34.369999999999997,24.369999999999997,1192.4916777725,null,28,null,0,0,763.82368022299988,10,120,null,0,10,883.823680223,null,663.823680223,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-04-03",19,"250.00, V58.66, V58.67",93743801,"Pharmacy Retail","Pharmacy","Ramipril 10mg (Rx) [1 QD; #30 pills/month]","","",1,"","","","","","",53.81,43.81,1236.3016777724999,null,28,null,0,0,763.82368022299988,10,130,null,0,10,893.823680223,null,663.823680223,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-04-13",5,"250.00, V58.66, V58.67",53885039310,"Pharmacy Retail","Medical equipment and supplies","OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","",1,"","","","","","","",9,9,1245.3016777724999,null,28,null,0,null,763.82368022299988,null,130,null,0,0,893.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-04-13",4,"250.00, V58.66, V58.67",53885024510,"Pharmacy Retail","Medical equipment and supplies","OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","",1,"","","","","","","",123.6,123.6,1368.9016777724999,null,28,null,0,null,763.82368022299988,null,130,null,0,0,893.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-04-25",17,"250.00, V58.66, V58.67",88222033,"Pharmacy Retail","Pharmacy","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","","",1,"","","","","","",119.2,109.2,1478.1016777724999,null,28,null,0,0,763.82368022299988,10,140,null,0,10,903.823680223,null,663.823680223,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-05-03",25,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Medical equipment and supplies","Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","",1,"","","","","","","",3,null,1478.1016777724999,3,31,null,0,null,763.82368022299988,null,140,null,0,0,903.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-05-03",14,"250.00, V58.66, V58.67",8290328279,"Pharmacy Retail","Medical equipment and supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","",1,"","","","","","","",8.4,8.4,1486.5016777725,null,31,null,0,null,763.82368022299988,null,140,null,0,0,903.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-05-03",18,"250.00, V58.66, V58.67",93104801,"Pharmacy Retail","Pharmacy","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]","","",1,"","","","","","",34.369999999999997,24.369999999999997,1510.8716777724999,null,31,null,0,0,763.82368022299988,10,150,null,0,10,913.823680223,null,663.823680223,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-05-03",19,"250.00, V58.66, V58.67",93743801,"Pharmacy Retail","Pharmacy","Ramipril 10mg (Rx) [1 QD; #30 pills/month]","","",1,"","","","","","",53.81,43.81,1554.6816777724998,null,31,null,0,0,763.82368022299988,10,160,null,0,10,923.823680223,null,663.823680223,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2012-05-23",5,"250.00, V58.66, V58.67",53885039310,"Pharmacy Retail","Medical equipment and supplies","OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","",1,"","","","","","","",9,9,1563.6816777724998,null,31,null,0,null,763.82368022299988,null,160,null,0,0,923.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-05-23",17,"250.00, V58.66, V58.67",88222033,"Pharmacy Retail","Pharmacy","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","","",1,"","","","","","",119.2,109.2,1672.8816777724999,null,31,null,0,0,763.82368022299988,10,170,null,0,10,933.823680223,null,663.823680223,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-02",25,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Medical equipment and supplies","Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","",1,"","","","","","","",3,null,1672.8816777724999,3,34,null,0,null,763.82368022299988,null,170,null,0,0,933.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-02",14,"250.00, V58.66, V58.67",8290328279,"Pharmacy Retail","Medical equipment and supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","",1,"","","","","","","",8.4,8.4,1681.2816777725,null,34,null,0,null,763.82368022299988,null,170,null,0,0,933.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-02",5,"250.00, V58.66, V58.67",53885039310,"Pharmacy Retail","Medical equipment and supplies","OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","",1,"","","","","","","",9,9,1690.2816777725,null,34,null,0,null,763.82368022299988,null,170,null,0,0,933.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-02",4,"250.00, V58.66, V58.67",53885024510,"Pharmacy Retail","Medical equipment and supplies","OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","",1,"","","","","","","",123.6,123.6,1813.8816777724999,null,34,null,0,null,763.82368022299988,null,170,null,0,0,933.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-02",18,"250.00, V58.66, V58.67",93104801,"Pharmacy Retail","Pharmacy","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]","","",1,"","","","","","",34.369999999999997,24.369999999999997,1838.2516777724998,null,34,null,0,0,763.82368022299988,10,180,null,0,10,943.823680223,null,663.823680223,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-02",19,"250.00, V58.66, V58.67",93743801,"Pharmacy Retail","Pharmacy","Ramipril 10mg (Rx) [1 QD; #30 pills/month]","","",1,"","","","","","",53.81,43.81,1882.0616777724997,null,34,null,0,0,763.82368022299988,10,190,null,0,10,953.823680223,null,663.823680223,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-20",26,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Pharmacy","Aspirin 81mg (OTC - bottle 100) [usage = 1 QD; #30 pills per month]","","","","","","","","","",8,null,1882.0616777724997,8,42,null,0,null,763.82368022299988,null,190,null,0,0,953.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-20",17,"250.00, V58.66, V58.67",88222033,"Pharmacy Retail","Pharmacy","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","","",1,"","","","","","",119.2,109.2,1991.2616777724998,null,42,null,0,0,763.82368022299988,10,200,null,0,10,963.823680223,null,663.823680223,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-27",15,"250.00, V58.66, V58.67",82947,"Primary","Laboratory tests","Assay Glucose Blood Quant","","","","",1,"","","","",6.4317604084999997,6.4317604084999997,1997.6934381809997,null,42,null,0,null,763.82368022299988,null,200,null,0,0,963.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-27",16,"250.00, V58.66, V58.67",83036,"Primary","Laboratory tests","Glycosylated Hemoglobin Test","","","","",1,"","","","",14.074362869,14.074362869,2011.7678010499997,null,42,null,0,null,763.82368022299988,null,200,null,0,0,963.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-27",10,{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,2,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,2,FALSE))","v":"250.00, V58.66, V58.67"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,3,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,3,FALSE))","v":80069},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,4,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,4,FALSE))","v":"Primary"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,5,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,5,FALSE))","v":"Laboratory tests"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,6,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,6,FALSE))","v":"Renal Function Panel"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,8,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,8,FALSE))","v":""},{"$f":"IF(Dia_Col_Category=\"Medical equipment and supplies\",1,\"\")","v":""},{"$f":"IF(AND(Dia_Col_Category=\"Pharmacy\",Dia_Col_BillCode<>\"OTC\"),1,\"\")","v":""},{"$f":"IF(AND(Dia_Col_Category=\"Anesthesia\",Dia_Col_Provider<>\"Inpatient facility\"),1,\"\")","v":""},{"$f":"IF(Dia_Col_Category=\"Laboratory tests\",1,\"\")","v":1},{"$f":"IF(Dia_Col_Category=\"Radiology\",1,\"\")","v":""},{"$f":"IF(Dia_Col_BillCode=\"Bundled in global OB package - 59400\",1,\"\")","v":""},{"$f":"IF(Dia_Col_Category=\"Vaccines, other preventive\",1,\"\")","v":""},{"$f":"IF(Dia_Col_Category=\"Office visits & procedures\",1,\"\")","v":""},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,7,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,7,FALSE))","v":14.302656536000001},14.302656536000001,2026.0704575859997,null,42,null,0,null,763.82368022299988,null,200,null,0,{"$f":"Dia_Col_Deduct+Dia_Col_Copay+Dia_Col_Coinsur","v":0},963.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-27",2,"250.00, V58.66, V58.67",36415,"Primary","Laboratory tests","Routine Venipuncture","","","","",1,"","","","",4.1312550556999996,4.1312550556999996,2030.2017126416997,null,42,null,0,null,763.82368022299988,null,200,null,0,0,963.823680223,null,663.823680223,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-27",11,"250.00, V58.66, V58.67",81003,"Primary","Laboratory tests","Urinalysis Auto W/O Scope","","","","",1,"","","","",3.1785047792999999,3.1785047792999999,{"$f":"R69+S68","v":2033.3802174209998},null,{"$f":"T69+U68","v":42},null,{"$f":"V69+W68","v":0},null,{"$f":"X69+Y68","v":763.82368022299988},null,{"$f":"Z69+AA68","v":200},null,{"$f":"AB69+AC68","v":0},0,{"$f":"AD69+AE68","v":963.823680223},null,{"$f":"AF69+AG68","v":663.823680223},null,{"$f":"AH69+AI68","v":0},null,{"$f":"AJ69+AK68","v":100},null,{"$f":"AL69+AM68","v":0},null,{"$f":"AN69+AO68","v":0},null,{"$f":"AP69+AQ68","v":0},null,{"$f":"AR69+AS68","v":0},null,{"$f":"AT69+AU68","v":0},null,{"$f":"AV69+AW68","v":0},null,{"$f":"AX69+AY68","v":0},null,{"$f":"AZ69+BA68","v":0}]
["2011-06-27",24,"250.00, V58.66, V58.67",99214,"Primary","Office visits & procedures","Office/Outpatient Visit Est","","","","","","","","",1,102.47359376999999,0,2033.3802174209998,null,42,null,0,102.47359376999999,866.29727399299986,0,200,null,0,102.47359376999999,1066.2972739930001,102.47359376999999,766.29727399299998,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-28",21,"250.00, V58.66, V58.67",98960,"Diabetes Educator","Office visits & procedures","Self-mgmt educ & train 1 pt","","","","","","","","",1,80.526112889000004,0,2033.3802174209998,null,42,null,0,80.526112889000004,946.82338688199991,0,200,null,0,80.526112889000004,1146.823386882,80.526112889000004,846.82338688200002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-28",20,"250.00, V58.66, V58.67",97803,"Dietician","Office visits & procedures","Med Nutrition Indiv Subseq","","","","","","","","",1,63.127764974000002,0,2033.3802174209998,null,42,null,0,63.127764974000002,1009.9511518559999,0,200,null,0,63.127764974000002,1209.951151856,63.127764974000002,909.95115185600002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-07-02",25,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Medical equipment and supplies","Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","",1,"","","","","","","",3,null,2033.3802174209998,3,45,null,0,null,1009.9511518559999,null,200,null,0,0,1209.951151856,null,909.95115185600002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-07-02",14,"250.00, V58.66, V58.67",8290328279,"Pharmacy Retail","Medical equipment and supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","",1,"","","","","","","",8.4,8.4,2041.7802174209999,null,45,null,0,null,1009.9511518559999,null,200,null,0,0,1209.951151856,null,909.95115185600002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-07-02",6,"250.00, V58.66, V58.67","53885041601","Pharmacy Retail","Medical equipment and supplies","OneTouch Ultra Control Solution (2 vials/box)","",1,"","","","","","","",6.02,6.02,2047.8002174209998,null,45,null,0,null,1009.9511518559999,null,200,null,0,0,1209.951151856,null,909.95115185600002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-07-02",18,"250.00, V58.66, V58.67",93104801,"Pharmacy Retail","Pharmacy","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]","","",1,"","","","","","",34.369999999999997,24.369999999999997,2072.170217421,null,45,null,0,0,1009.9511518559999,10,210,null,0,10,1219.951151856,null,909.95115185600002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-07-02",19,"250.00, V58.66, V58.67",93743801,"Pharmacy Retail","Pharmacy","Ramipril 10mg (Rx) [1 QD; #30 pills/month]","","",1,"","","","","","",53.81,43.81,2115.9802174209999,null,45,null,0,0,1009.9511518559999,10,220,null,0,10,1229.951151856,null,909.95115185600002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-07-18",17,"250.00, V58.66, V58.67",88222033,"Pharmacy Retail","Pharmacy","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","","",1,"","","","","","",119.2,109.2,2225.1802174209997,null,45,null,0,0,1009.9511518559999,10,230,null,0,10,1239.951151856,null,909.95115185600002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-07-22",4,"250.00, V58.66, V58.67",53885024510,"Pharmacy Retail","Medical equipment and supplies","OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","",1,"","","","","","","",123.6,123.6,2348.7802174209996,null,45,null,0,null,1009.9511518559999,null,230,null,0,0,1239.951151856,null,909.95115185600002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-08-01",25,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Medical equipment and supplies","Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","",1,"","","","","","","",3,null,2348.7802174209996,3,48,null,0,null,1009.9511518559999,null,230,null,0,0,1239.951151856,null,909.95115185600002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-08-01",14,"250.00, V58.66, V58.67",8290328279,"Pharmacy Retail","Medical equipment and supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","",1,"","","","","","","",8.4,8.4,2357.1802174209997,null,48,null,0,null,1009.9511518559999,null,230,null,0,0,1239.951151856,null,909.95115185600002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-08-01",18,"250.00, V58.66, V58.67",93104801,"Pharmacy Retail","Pharmacy","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]","","",1,"","","","","","",34.369999999999997,24.369999999999997,2381.5502174209996,null,48,null,0,0,1009.9511518559999,10,240,null,0,10,1249.951151856,null,909.95115185600002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-08-01",19,"250.00, V58.66, V58.67",93743801,"Pharmacy Retail","Pharmacy","Ramipril 10mg (Rx) [1 QD; #30 pills/month]","","",1,"","","","","","",53.81,43.81,2425.3602174209996,null,48,null,0,0,1009.9511518559999,10,250,null,0,10,1259.951151856,null,909.95115185600002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-08-15",17,"250.00, V58.66, V58.67",88222033,"Pharmacy Retail","Pharmacy","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","","",1,"","","","","","",119.2,109.2,2534.5602174209994,null,48,null,0,0,1009.9511518559999,10,260,null,0,10,1269.951151856,null,909.95115185600002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
[{"$f":"A66+50","v":"2011-08-16"},4,"250.00, V58.66, V58.67",53885024510,"Pharmacy Retail","Medical equipment and supplies","OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","",1,"","","","","","","",123.6,123.6,2658.1602174209993,null,48,null,0,null,1009.9511518559999,null,260,null,0,0,1269.951151856,null,909.95115185600002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-08-31",25,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Medical equipment and supplies","Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","",1,"","","","","","","",3,null,2658.1602174209993,3,51,null,0,null,1009.9511518559999,null,260,null,0,0,1269.951151856,null,909.95115185600002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-08-31",14,"250.00, V58.66, V58.67",8290328279,"Pharmacy Retail","Medical equipment and supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","",1,"","","","","","","",8.4,8.4,2666.5602174209994,null,51,null,0,null,1009.9511518559999,null,260,null,0,0,1269.951151856,null,909.95115185600002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-08-31",18,"250.00, V58.66, V58.67",93104801,"Pharmacy Retail","Pharmacy","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]","","",1,"","","","","","",34.369999999999997,24.369999999999997,2690.9302174209993,null,51,null,0,0,1009.9511518559999,10,270,null,0,10,1279.951151856,null,909.95115185600002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-08-31",19,"250.00, V58.66, V58.67",93743801,"Pharmacy Retail","Pharmacy","Ramipril 10mg (Rx) [1 QD; #30 pills/month]","","",1,"","","","","","",53.81,43.81,2734.7402174209992,null,51,null,0,0,1009.9511518559999,10,280,null,0,10,1289.951151856,null,909.95115185600002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-10",5,"250.00, V58.66, V58.67",53885039310,"Pharmacy Retail","Medical equipment and supplies","OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","",1,"","","","","","","",9,9,2743.7402174209992,null,51,null,0,null,1009.9511518559999,null,280,null,0,0,1289.951151856,null,909.95115185600002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-10",4,"250.00, V58.66, V58.67",53885024510,"Pharmacy Retail","Medical equipment and supplies","OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","",1,"","","","","","","",123.6,123.6,2867.3402174209991,null,51,null,0,null,1009.9511518559999,null,280,null,0,0,1289.951151856,null,909.95115185600002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-12",26,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Pharmacy","Aspirin 81mg (OTC - bottle 100) [usage = 1 QD; #30 pills per month]","","","","","","","","","",8,null,2867.3402174209991,8,59,null,0,null,1009.9511518559999,null,280,null,0,0,1289.951151856,null,909.95115185600002,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-12",17,"250.00, V58.66, V58.67",88222033,"Pharmacy Retail","Pharmacy","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","","",1,"","","","","","",119.2,109.2,2976.5402174209989,null,59,null,0,0,1009.9511518559999,10,290,null,0,10,1299.951151856,null,909.95115185600002,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-26",24,"250.00, V58.66, V58.67",99214,"Primary","Office visits & procedures","Office/Outpatient Visit Est","","","","","","","","",1,102.47359376999999,0,2976.5402174209989,null,59,null,0,90.0488,1099.9999518559998,12.424793769999994,302.42479377000001,null,0,102.47359376999999,1402.424745626,90.0488,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-30",25,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Medical equipment and supplies","Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","",1,"","","","","","","",3,null,2976.5402174209989,3,62,null,0,null,1099.9999518559998,null,302.42479377000001,null,0,0,1402.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-30",14,"250.00, V58.66, V58.67",8290328279,"Pharmacy Retail","Medical equipment and supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","",1,"","","","","","","",8.4,8.4,2984.940217420999,null,62,null,0,null,1099.9999518559998,null,302.42479377000001,null,0,0,1402.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-30",18,"250.00, V58.66, V58.67",93104801,"Pharmacy Retail","Pharmacy","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]","","",1,"","","","","","",34.369999999999997,24.369999999999997,3009.3102174209989,null,62,null,0,0,1099.9999518559998,10,312.42479377000001,null,0,10,1412.424745626,null,999.99995185600005,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-30",19,"250.00, V58.66, V58.67",93743801,"Pharmacy Retail","Pharmacy","Ramipril 10mg (Rx) [1 QD; #30 pills/month]","","",1,"","","","","","",53.81,43.81,3053.1202174209989,null,62,null,0,0,1099.9999518559998,10,322.42479377000001,null,0,10,1422.424745626,null,999.99995185600005,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-03",28,{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,2,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,2,FALSE))","v":"V03.82"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,3,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,3,FALSE))","v":90472},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,4,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,4,FALSE))","v":"Primary"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,5,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,5,FALSE))","v":"Vaccines, other preventive"},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,6,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,6,FALSE))","v":"Immunization admin each add "},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,8,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,8,FALSE))","v":""},{"$f":"IF(Dia_Col_Category=\"Medical equipment and supplies\",1,\"\")","v":""},{"$f":"IF(AND(Dia_Col_Category=\"Pharmacy\",Dia_Col_BillCode<>\"OTC\"),1,\"\")","v":""},{"$f":"IF(AND(Dia_Col_Category=\"Anesthesia\",Dia_Col_Provider<>\"Inpatient facility\"),1,\"\")","v":""},{"$f":"IF(Dia_Col_Category=\"Laboratory tests\",1,\"\")","v":""},{"$f":"IF(Dia_Col_Category=\"Radiology\",1,\"\")","v":""},{"$f":"IF(Dia_Col_BillCode=\"Bundled in global OB package - 59400\",1,\"\")","v":""},{"$f":"IF(Dia_Col_Category=\"Vaccines, other preventive\",1,\"\")","v":1},{"$f":"IF(Dia_Col_Category=\"Office visits & procedures\",1,\"\")","v":""},{"$f":"IF(ISBLANK(VLOOKUP(Dia_Claim,Dia_UniqueLine,7,FALSE)),\"\",VLOOKUP(Dia_Claim,Dia_UniqueLine,7,FALSE))","v":13.436576236000001},13.436576236000001,3066.5567936569987,null,62,null,0,null,1099.9999518559998,null,322.42479377000001,null,0,0,1422.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-03",27,"V03.82",90471,"Primary","Vaccines, other preventive","Immunization Admin ADMIN","","","","","","","",1,"",13.436576236000001,13.436576236000001,3079.9933698929985,null,62,null,0,null,1099.9999518559998,null,322.42479377000001,null,0,0,1422.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-03",29,"V03.82",90669,"Primary","Vaccines, other preventive","Pneumococcal vacc 7 val im","","","","","","","",1,"",98.218151268,98.218151268,3178.2115211609985,null,62,null,0,null,1099.9999518559998,null,322.42479377000001,null,0,0,1422.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-03",30,"V04.81",90656,"Primary","Vaccines, other preventive","Flu Vaccine No Preserv 3 & >","","","","","","","",1,"",15.03511905,15.03511905,3193.2466402109985,null,62,null,0,null,1099.9999518559998,null,322.42479377000001,null,0,0,1422.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-10",17,"250.00, V58.66, V58.67",88222033,"Pharmacy Retail","Pharmacy","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","","",1,"","","","","","",119.2,109.2,3302.4466402109983,null,62,null,0,0,1099.9999518559998,10,332.42479377000001,null,0,10,1432.424745626,null,999.99995185600005,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-30",25,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Medical equipment and supplies","Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","",1,"","","","","","","",3,null,3302.4466402109983,3,65,null,0,null,1099.9999518559998,null,332.42479377000001,null,0,0,1432.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-30",14,"250.00, V58.66, V58.67",8290328279,"Pharmacy Retail","Medical equipment and supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","",1,"","","","","","","",8.4,8.4,3310.8466402109984,null,65,null,0,null,1099.9999518559998,null,332.42479377000001,null,0,0,1432.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-30",5,"250.00, V58.66, V58.67",53885039310,"Pharmacy Retail","Medical equipment and supplies","OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","",1,"","","","","","","",9,9,3319.8466402109984,null,65,null,0,null,1099.9999518559998,null,332.42479377000001,null,0,0,1432.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-30",18,"250.00, V58.66, V58.67",93104801,"Pharmacy Retail","Pharmacy","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]","","",1,"","","","","","",34.369999999999997,24.369999999999997,3344.2166402109983,null,65,null,0,0,1099.9999518559998,10,342.42479377000001,null,0,10,1442.424745626,null,999.99995185600005,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-30",19,"250.00, V58.66, V58.67",93743801,"Pharmacy Retail","Pharmacy","Ramipril 10mg (Rx) [1 QD; #30 pills/month]","","",1,"","","","","","",53.81,43.81,3388.0266402109983,null,65,null,0,0,1099.9999518559998,10,352.42479377000001,null,0,10,1452.424745626,null,999.99995185600005,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-11-07",17,"250.00, V58.66, V58.67",88222033,"Pharmacy Retail","Pharmacy","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","","",1,"","","","","","",119.2,109.2,3497.2266402109981,null,65,null,0,0,1099.9999518559998,10,362.42479377000001,null,0,10,1462.424745626,null,999.99995185600005,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-11-29",25,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Medical equipment and supplies","Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","",1,"","","","","","","",3,null,3497.2266402109981,3,68,null,0,null,1099.9999518559998,null,362.42479377000001,null,0,0,1462.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-11-29",14,"250.00, V58.66, V58.67",8290328279,"Pharmacy Retail","Medical equipment and supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","",1,"","","","","","","",8.4,8.4,3505.6266402109982,null,68,null,0,null,1099.9999518559998,null,362.42479377000001,null,0,0,1462.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-11-29",18,"250.00, V58.66, V58.67",93104801,"Pharmacy Retail","Pharmacy","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]","","",1,"","","","","","",34.369999999999997,24.369999999999997,3529.9966402109981,null,68,null,0,0,1099.9999518559998,10,372.42479377000001,null,0,10,1472.424745626,null,999.99995185600005,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-11-29",19,"250.00, V58.66, V58.67",93743801,"Pharmacy Retail","Pharmacy","Ramipril 10mg (Rx) [1 QD; #30 pills/month]","","",1,"","","","","","",53.81,43.81,3573.806640210998,null,68,null,0,0,1099.9999518559998,10,382.42479377000001,null,0,10,1482.424745626,null,999.99995185600005,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-05",26,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Pharmacy","Aspirin 81mg (OTC - bottle 100) [usage = 1 QD; #30 pills per month]","","","","","","","","","",8,null,3573.806640210998,8,76,null,0,null,1099.9999518559998,null,382.42479377000001,null,0,0,1482.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-05",17,"250.00, V58.66, V58.67",88222033,"Pharmacy Retail","Pharmacy","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","","",1,"","","","","","",119.2,109.2,3683.0066402109978,null,76,null,0,0,1099.9999518559998,10,392.42479377000001,null,0,10,1492.424745626,null,999.99995185600005,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-19",5,"250.00, V58.66, V58.67",53885039310,"Pharmacy Retail","Medical equipment and supplies","OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","",1,"","","","","","","",9,9,3692.0066402109978,null,76,null,0,null,1099.9999518559998,null,392.42479377000001,null,0,0,1492.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-19",4,"250.00, V58.66, V58.67",53885024510,"Pharmacy Retail","Medical equipment and supplies","OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","",1,"","","","","","","",123.6,123.6,3815.6066402109977,null,76,null,0,null,1099.9999518559998,null,392.42479377000001,null,0,0,1492.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-29",25,"250.00, V58.66, V58.67","OTC","Pharmacy Retail","Medical equipment and supplies","Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","",1,"","","","","","","",3,null,3815.6066402109977,3,79,null,0,null,1099.9999518559998,null,392.42479377000001,null,0,0,1492.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-29",14,"250.00, V58.66, V58.67",8290328279,"Pharmacy Retail","Medical equipment and supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","",1,"","","","","","","",8.4,8.4,3824.0066402109978,null,79,null,0,null,1099.9999518559998,null,392.42479377000001,null,0,0,1492.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-29",6,"250.00, V58.66, V58.67","53885041601","Pharmacy Retail","Medical equipment and supplies","OneTouch Ultra Control Solution (2 vials/box)","",1,"","","","","","","",6.02,6.02,3830.0266402109978,null,79,null,0,null,1099.9999518559998,null,392.42479377000001,null,0,0,1492.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-29",18,"250.00, V58.66, V58.67",93104801,"Pharmacy Retail","Pharmacy","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]","","",1,"","","","","","",34.369999999999997,24.369999999999997,3854.3966402109977,null,79,null,0,0,1099.9999518559998,10,402.42479377000001,null,0,10,1502.424745626,null,999.99995185600005,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-29",19,"250.00, V58.66, V58.67",93743801,"Pharmacy Retail","Pharmacy","Ramipril 10mg (Rx) [1 QD; #30 pills/month]","","",1,"","","","","","",53.81,43.81,3898.2066402109976,null,79,null,0,0,1099.9999518559998,10,412.42479377000001,null,0,10,1512.424745626,null,999.99995185600005,null,0,0,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3898.2066402109976,null,79,null,0,null,1099.9999518559998,null,412.42479377000001,null,0,0,1512.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3898.2066402109976,null,79,null,0,null,1099.9999518559998,null,412.42479377000001,null,0,0,1512.424745626,null,999.99995185600005,null,0,null,100,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(Dia_Col_Insurer)","v":3898.2066402109976},"N/A",{"$f":"SUM(Dia_Col_Excl)","v":79},"N/A",{"$f":"SUM(Dia_Col_Limit)","v":0},"N/A",{"$f":"SUM(Dia_Col_Deduct)","v":1099.9999518559998},"N/A",{"$f":"SUM(Dia_Col_Copay)","v":412.42479377000001},"N/A",{"$f":"SUM(Dia_Col_Coinsur)","v":0},"N/A",{"$f":"Dia_Prior_Deduct+Dia_Prior_Copay+Dia_Prior_Coinsur","v":1512.4247456259998},"N/A",{"$f":"SUM(Dia_Col_Deduct_Overall)","v":999.99995185600005},"N/A",{"$f":"SUM(Dia_Col_Deduct_DME)","v":0},"N/A",{"$f":"SUM(Dia_Col_Deduct_RX)","v":100},"N/A",{"$f":"SUM(Dia_Col_Deduct_Hospital)","v":0},"N/A",{"$f":"SUM(Dia_Col_Deduct_Obst)","v":0},"N/A",{"$f":"SUM(Dia_Col_Deduct_Vaccine)","v":0},"N/A","N/A","N/A",{"$f":"SUM(Dia_Col_Limit_RX_Yr)","v":0},"N/A","N/A","N/A",{"$f":"SUM(Dia_Col_Limit_DME_Yr)","v":0},"N/A",{"$f":"SUM(Dia_Col_Limit_Visit_Yr)","v":0},"N/A"]

{"sheet":"Maternity Timeline","index":7,"n_rows":400,"n_cols":47,"rows_kept":400,"cut":false,"hidden":false,"merged":[[0,17,0,30],[0,31,0,42],[0,43,0,46],[0,8,0,15]]}
[null,null,null,null,null,null,null,null,"CATEGORIES",null,null,null,null,null,null,null,null,"COSTS",null,null,null,null,null,null,null,null,null,null,null,null,null,"DEDUCTIBLES",null,null,null,null,null,null,null,null,null,null,null,"LIMITS"]
["Date of\nService","Maternity Claim\nUnique Key","Diagnosis Code \n(ICD-9)","CPT©, HCPCS, or\nOther Billing Code","Provider\nType","Category"," Descriptor","Notes","DME","Generic RX","Hospital Care","Lab","Radiology","Obstetric","Vaccines","Visits","Amount Allowed","Insurer Expense","Running Insurer","Exclusions","Running Excl","Limitations","Running Limit","Deductible","Running Deduct","Copayment","Running Copay","Coinsurance","Running Coinsur","OOP","Running OOP","Overall","Running Overall","DME","Running DME","Generic RX","Running RX","Hospital Care","Running Hospital","Obstetric","Running Obst","Vaccines","Running Vaccine","Mat RX per month","Running Mat RX Month","Mat RX per year","Running Mat RX Yr"]
["2011-01-07",8,{"$f":"IF(ISBLANK(VLOOKUP(Mat_Claim,Mat_UniqueLine,2,FALSE)),\"\",VLOOKUP(Mat_Claim,Mat_UniqueLine,2,FALSE))","v":""},{"$f":"IF(ISBLANK(VLOOKUP(Mat_Claim,Mat_UniqueLine,3,FALSE)),\"\",VLOOKUP(Mat_Claim,Mat_UniqueLine,3,FALSE))","v":"OTC"},{"$f":"IF(ISBLANK(VLOOKUP(Mat_Claim,Mat_UniqueLine,4,FALSE)),\"\",VLOOKUP(Mat_Claim,Mat_UniqueLine,4,FALSE))","v":"Pharmacy Retail"},{"$f":"IF(ISBLANK(VLOOKUP(Mat_Claim,Mat_UniqueLine,5,FALSE)),\"\",VLOOKUP(Mat_Claim,Mat_UniqueLine,5,FALSE))","v":"Pharmacy"},{"$f":"IF(ISBLANK(VLOOKUP(Mat_Claim,Mat_UniqueLine,6,FALSE)),\"\",VLOOKUP(Mat_Claim,Mat_UniqueLine,6,FALSE))","v":"Prenatal Vitamins (OTC - Bottle of 100) [1 pill daily; 30 pills/month]"},{"$f":"IF(ISBLANK(VLOOKUP(Mat_Claim,Mat_UniqueLine,8,FALSE)),\"\",VLOOKUP(Mat_Claim,Mat_UniqueLine,8,FALSE))","v":""},{"$f":"IF(Mat_Col_Category=\"Medical equipment and supplies\",1,\"\")","v":""},{"$f":"IF(AND(Mat_Col_Category=\"Pharmacy\",Mat_Col_BillCode<>\"OTC\"),1,\"\")","v":""},{"$f":"IF(OR(Mat_Col_Category=\"Anesthesia\",Mat_Col_Provider=\"Inpatient Facility\"),1,\"\")","v":""},{"$f":"IF(Mat_Col_Category=\"Laboratory tests\",1,\"\")","v":""},{"$f":"IF(Mat_Col_Category=\"Radiology\",1,\"\")","v":""},{"$f":"IF(Mat_Col_BillCode=\"Bundled in global OB package - 59400\",1,\"\")","v":""},{"$f":"IF(Mat_Col_Category=\"Vaccines, other preventive\",1,\"\")","v":""},{"$f":"IF(Mat_Col_Category=\"Office visits & procedures\",1,\"\")","v":""},{"$f":"IF(ISBLANK(VLOOKUP(Mat_Claim,Mat_UniqueLine,7,FALSE)),\"\",VLOOKUP(Mat_Claim,Mat_UniqueLine,7,FALSE))","v":30},null,{"$f":"R3","v":0},30,{"$f":"T3","v":30},null,{"$f":"V3","v":0},null,{"$f":"X3","v":0},null,{"$f":"Z3","v":0},null,{"$f":"AB3","v":0},{"$f":"Mat_Col_Deduct+Mat_Col_Copay+Mat_Col_Coinsur","v":0},{"$f":"AD3","v":0},null,{"$f":"AF3","v":0},null,{"$f":"AH3","v":0},null,{"$f":"AJ3","v":0},null,{"$f":"AL3","v":0},null,{"$f":"AN3","v":0},null,{"$f":"AP3","v":0},null,{"$f":"AR3","v":0},null,{"$f":"AT3","v":0}]
["2011-04-01",14,"V22.0",80055,"OBGYN","Laboratory tests","Obstetric Panel","80055 - Global OB panel code","","","",1,"","","","",54.239906423000001,54.239906423000001,{"$f":"S3+R4","v":54.239906423000001},null,{"$f":"U3+T4","v":30},null,{"$f":"W3+V4","v":0},null,{"$f":"Y3+X4","v":0},null,{"$f":"AA3+Z4","v":0},null,{"$f":"AC3+AB4","v":0},0,{"$f":"AE3+AD4","v":0},null,{"$f":"AG3+AF4","v":0},null,{"$f":"AI3+AH4","v":0},null,{"$f":"AK3+AJ4","v":0},null,{"$f":"AM3+AL4","v":0},null,{"$f":"AO3+AN4","v":0},null,{"$f":"AQ3+AP4","v":0},null,{"$f":"AS3+AR4","v":0},null,{"$f":"AU3+AT4","v":0}]
["2011-04-01",30,"V22.0","87801 x2","OBGYN","Laboratory tests","Detect agnt mult dna ampli ","Gonorrhea / Chlamydia screen","","","",1,"","","","",9.4479524864000002,9.4479524864000002,{"$f":"S4+R5","v":63.687858909399999},null,{"$f":"U4+T5","v":30},null,{"$f":"W4+V5","v":0},null,{"$f":"Y4+X5","v":0},null,{"$f":"AA4+Z5","v":0},null,{"$f":"AC4+AB5","v":0},0,{"$f":"AE4+AD5","v":0},null,{"$f":"AG4+AF5","v":0},null,{"$f":"AI4+AH5","v":0},null,{"$f":"AK4+AJ5","v":0},null,{"$f":"AM4+AL5","v":0},null,{"$f":"AO4+AN5","v":0},null,{"$f":"AQ4+AP5","v":0},null,{"$f":"AS4+AR5","v":0},null,{"$f":"AU4+AT5","v":0}]
["2011-04-01",31,"V22.0",88164,"OBGYN","Laboratory tests","Cytopath TBS C/V Manual","Pap smear","","","",1,"","","","",14.735122969000001,14.735122969000001,78.422981878399995,null,30,null,0,null,0,null,0,null,0,0,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-04-01",28,"V22.0",86701,"OBGYN","Laboratory tests","HIV-1","","","","",1,"","","","",12.935806004,12.935806004,91.358787882399994,null,30,null,0,null,0,null,0,null,0,0,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-04-01",12,"V22.0",36415,"OBGYN","Laboratory tests","Routine Venipuncture","Cystic fibrosis screen","","","",1,"","","","",4.1312550556999996,4.1312550556999996,95.49004293809999,null,30,null,0,null,0,null,0,null,0,0,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-04-01",35,"V72.42",81025,"OBGYN","Laboratory tests","Urine Pregnancy Test","","","","",1,"","","","",8.8680026237000007,8.8680026237000007,104.3580455618,null,30,null,0,null,0,null,0,null,0,0,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-04-01",32,"V22.0","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est","","","","","","",1,"","",2084.2800000000002,1044.2800000000002,1148.6380455618003,null,30,null,0,1000,1000,40,40,null,0,1040,1040,1000,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-04-07",32,"V22.0","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est","","","","","","",1,"","",2084.2800000000002,null,1148.6380455618003,null,30,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-04-07",8,"","OTC","Pharmacy Retail","Pharmacy","Prenatal Vitamins (OTC - Bottle of 100) [1 pill daily; 30 pills/month]","","","","","","","","","",30,null,1148.6380455618003,30,60,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-05-27",32,"V22.0","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est","","","","","","",1,"","",2084.2800000000002,null,1148.6380455618003,null,60,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-24",15,"V22.0",82105,"OBGYN","Laboratory tests","Alpha-fetoprotein serum","Maternal serum quad screen","","","",1,"","","","",27.859090028000001,27.859090028000001,1176.4971355898003,null,60,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-24",16,"V22.0","82677","OBGYN","Laboratory tests","Alssay of estriol","Maternal serum quad screen","","","",1,"","","","",26.628776623,26.628776623,1203.1259122128004,null,60,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-24",25,"V22.0","84702","OBGYN","Laboratory tests","Chorionic gonadotropin test","Maternal serum quad screen","","","",1,"","","","",21.473647412999998,21.473647412999998,1224.5995596258003,null,60,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-24",27,"V22.0","86336","OBGYN","Laboratory tests","Inhibin A","Maternal serum quad screen","","","",1,"","","","",22.502594885000001,22.502594885000001,1247.1021545108003,null,60,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-24",23,"V22.0",83912,"OBGYN","Laboratory tests","Genetic examination","Cystic fibrosis screen","","","",1,"","","","",11.780489834999999,11.780489834999999,1258.8826443458004,null,60,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-24",19,"V22.0",83891,"OBGYN","Laboratory tests","Molecule isolate nucleic","Cystic fibrosis screen","","","",1,"","","","",7.1985144897,7.1985144897,1266.0811588355004,null,60,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-24",20,"V22.0",83900,"OBGYN","Laboratory tests","Molecule nucleic ampli 2 seq","Cystic fibrosis screen","","","",1,"","","","",31.840380951,31.840380951,1297.9215397865005,null,60,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-24",21,"V22.0","83901 x13","OBGYN","Laboratory tests","Molecule nucleic ampli addon","Cystic fibrosis screen","","","",1,"","","","",129.52352633000001,129.52352633000001,1427.4450661165006,null,60,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-24",24,"V22.0","83914 x32","OBGYN","Laboratory tests","Mutation ident ola/sbce/aspe","Cystic fibrosis screen","","","",1,"","","","",50.061243402999999,50.061243402999999,1477.5063095195005,null,60,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-24",22,"V22.0",83909,"OBGYN","Laboratory tests","Nucleic acid high resolute","Cystic fibrosis screen","","","",1,"","","","",18.976676401999999,18.976676401999999,1496.4829859215006,null,60,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-24",12,"V22.0",36415,"OBGYN","Laboratory tests","Routine Venipuncture","Cystic fibrosis screen","","","",1,"","","","",4.1312550556999996,4.1312550556999996,1500.6142409772006,null,60,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-06-24",32,"V22.0","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est","","","","","","",1,"","",2084.2800000000002,null,1500.6142409772006,null,60,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-07-06",8,"","OTC","Pharmacy Retail","Pharmacy","Prenatal Vitamins (OTC - Bottle of 100) [1 pill daily; 30 pills/month]","","","","","","","","","",30,null,1500.6142409772006,30,90,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-07-22",32,"V22.0","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est","","","","","","",1,"","",2084.2800000000002,null,1500.6142409772006,null,90,null,0,null,1000,null,40,null,0,0,1040,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-07-22",13,"V22.0",76805,"Radiology","Radiology","OB US >/= 14 WKS SNGL FETUS","","","","","",1,"","","",176.11339355000001,123.279375485,1623.8936164622005,null,90,null,0,0,1000,null,40,52.834018065000002,52.834018065000002,52.834018065000002,1092.834018065,0,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-08-19",32,"V22.0","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est","","","","","","",1,"","",2084.2800000000002,null,1623.8936164622005,null,90,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-16",17,"V22.0",82947,"OBGYN","Laboratory tests","Assay Glucose Blood Quant","","","","",1,"","","","",6.4317604084999997,6.4317604084999997,1630.3253768707004,null,90,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-16",26,"V22.0",85025,"OBGYN","Laboratory tests","Complete cbc w/auto diff wbc","","","","",1,"","","","",12.282662974999999,12.282662974999999,1642.6080398457004,null,90,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-16",18,"V22.0",82950,"OBGYN","Laboratory tests","Glucose Test","","","","",1,"","","","",6.9532965180000001,6.9532965180000001,1649.5613363637003,null,90,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-16",12,"V22.0",36415,"OBGYN","Laboratory tests","Routine Venipuncture","Cystic fibrosis screen","","","",1,"","","","",4.1312550556999996,4.1312550556999996,1653.6925914194003,null,90,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-16",32,"V22.0","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est","","","","","","",1,"","",2084.2800000000002,null,1653.6925914194003,null,90,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-09-30",32,{"$f":"IF(ISBLANK(VLOOKUP(Mat_Claim,Mat_UniqueLine,2,FALSE)),\"\",VLOOKUP(Mat_Claim,Mat_UniqueLine,2,FALSE))","v":"V22.0"},{"$f":"IF(ISBLANK(VLOOKUP(Mat_Claim,Mat_UniqueLine,3,FALSE)),\"\",VLOOKUP(Mat_Claim,Mat_UniqueLine,3,FALSE))","v":"Bundled in global OB package - 59400"},{"$f":"IF(ISBLANK(VLOOKUP(Mat_Claim,Mat_UniqueLine,4,FALSE)),\"\",VLOOKUP(Mat_Claim,Mat_UniqueLine,4,FALSE))","v":"OBGYN"},{"$f":"IF(ISBLANK(VLOOKUP(Mat_Claim,Mat_UniqueLine,5,FALSE)),\"\",VLOOKUP(Mat_Claim,Mat_UniqueLine,5,FALSE))","v":"Routine Obstetric Care"},{"$f":"IF(ISBLANK(VLOOKUP(Mat_Claim,Mat_UniqueLine,6,FALSE)),\"\",VLOOKUP(Mat_Claim,Mat_UniqueLine,6,FALSE))","v":"Office/Outpatient Visit Est"},{"$f":"IF(ISBLANK(VLOOKUP(Mat_Claim,Mat_UniqueLine,8,FALSE)),\"\",VLOOKUP(Mat_Claim,Mat_UniqueLine,8,FALSE))","v":""},{"$f":"IF(Mat_Col_Category=\"Medical equipment and supplies\",1,\"\")","v":""},{"$f":"IF(AND(Mat_Col_Category=\"Pharmacy\",Mat_Col_BillCode<>\"OTC\"),1,\"\")","v":""},{"$f":"IF(OR(Mat_Col_Category=\"Anesthesia\",Mat_Col_Provider=\"Inpatient Facility\"),1,\"\")","v":""},{"$f":"IF(Mat_Col_Category=\"Laboratory tests\",1,\"\")","v":""},{"$f":"IF(Mat_Col_Category=\"Radiology\",1,\"\")","v":""},{"$f":"IF(Mat_Col_BillCode=\"Bundled in global OB package - 59400\",1,\"\")","v":1},{"$f":"IF(Mat_Col_Category=\"Vaccines, other preventive\",1,\"\")","v":""},{"$f":"IF(Mat_Col_Category=\"Office visits & procedures\",1,\"\")","v":""},{"$f":"IF(ISBLANK(VLOOKUP(Mat_Claim,Mat_UniqueLine,7,FALSE)),\"\",VLOOKUP(Mat_Claim,Mat_UniqueLine,7,FALSE))","v":2084.2800000000002},null,1653.6925914194003,null,90,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-04",8,"","OTC","Pharmacy Retail","Pharmacy","Prenatal Vitamins (OTC - Bottle of 100) [1 pill daily; 30 pills/month]","","","","","","","","","",30,null,1653.6925914194003,30,120,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-14",32,"V22.0","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est","","","","","","",1,"","",2084.2800000000002,null,1653.6925914194003,null,120,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-20",9,"","S9442","Alternative Provider","Education","Birthing class","","","","","","","","","",0,null,1653.6925914194003,null,120,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-27",9,"","S9442","Alternative Provider","Education","Birthing class","","","","","","","","","",0,null,1653.6925914194003,null,120,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-28",29,"V22.0",87653,"OBGYN","Laboratory tests","Strep B DNA Amp Probe","","","","",1,"","","","",40.612070811000002,40.612070811000002,1694.3046622304003,null,120,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-28",32,"V22.0","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est","","","","","","",1,"","",2084.2800000000002,null,1694.3046622304003,null,120,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-28",10,"V04.81",90471,"OBGYN","Vaccines, other preventive"," Immunization Admin","","","","","","","",1,"",20.038710250000001,20.038710250000001,1714.3433724804001,null,120,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-10-28",11,"V04.81",90656,"OBGYN","Vaccines, other preventive","Flu Vaccine N0 Preserv 3 & >","","","","","","","",1,"",15.03511905,15.03511905,1729.3784915304002,null,120,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-11-01",9,"","S9442","Alternative Provider","Education","Birthing class","","","","","","","","","",0,null,1729.3784915304002,null,120,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-11-08",9,"","S9442","Alternative Provider","Education","Birthing class","","","","","","","","","",0,null,1729.3784915304002,null,120,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-11-11",32,"V22.0","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est","","","","","","",1,"","",2084.2800000000002,null,1729.3784915304002,null,120,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-11-18",32,"V22.0","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est","","","","","","",1,"","",2084.2800000000002,null,1729.3784915304002,null,120,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-11-25",32,"V22.0","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est","","","","","","",1,"","",2084.2800000000002,null,1729.3784915304002,null,120,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-02",32,"V22.0","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est","","","","","","",1,"","",2084.2800000000002,null,1729.3784915304002,null,120,null,0,null,1000,null,40,null,52.834018065000002,0,1092.834018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-09",36,"","","Inpatient Facility","Hospital charges (bundle)","Inpatient Maternity Bundle (Bundled line items 4, 5, 34)","see individual line items on Line Item Maternity tab","","",1,"","","","","",4471.4400000000005,3130.0080000000007,4859.3864915304011,null,120,null,0,0,1000,null,40,1341.432,1394.266018065,1341.432,2434.266018065,0,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-09",6,"650, V27.0, Proc: 73.59","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Obstetrical Care","59400 - Global OB package description/code","","","","","",1,"","",2084.2829046000002,null,4859.3864915304011,null,120,null,0,null,1000,null,40,null,1394.266018065,0,2434.266018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-09",3,"650, V27.0","S9443","Inpatient Facility","Education","Lactation class","Included in hospital rate**","","",1,"","","","","",0,null,4859.3864915304011,null,120,null,0,null,1000,null,40,null,1394.266018065,0,2434.266018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-11",7,"","OTC","Pharmacy Retail","Pharmacy","Docusate sodium (OTC) [1 pill QD]","","","","","","","","","",30,null,4859.3864915304011,30,150,null,0,null,1000,null,40,null,1394.266018065,0,2434.266018065,null,1000,null,0,null,0,null,0,null,0,null,0,null,0,null,0]
["2011-12-11",2,"",591346601,"Pharmacy Retail","Pharmacy","Ibuprofen 800mg (Rx) [1 pill Q8H PRN; 60 pills]","","",1,"","","","","","",17.52,0,4859.3864915304011,null,150,null,0,17.52,1017.52,0,40,null,1394.266018065,17.52,2451.786018065,null,1000,null,0,17.52,17.52,null,0,null,0,null,0,null,0,null,0]
["2011-12-11",1,"",378710401,"Pharmacy Retail","Pharmacy","Oxycodone/APAP 5mg/325mg (Rx) [1 pill Q6H PRN; 15 pills]","","",1,"","","","","","",5.21,0,4859.3864915304011,null,150,null,0,5.21,1022.73,0,40,null,1394.266018065,5.21,2456.996018065,null,1000,null,0,5.21,22.73,null,0,null,0,null,0,null,0,null,0]
["2011-12-23",33,"V24.2","Bundled in global OB package - 59400","OBGYN","Routine Obstetric Care","Office/Outpatient Visit Est","Post partum visit","","","","","",1,"","",2084.2800000000002,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,{"$f":"Mat_Col_Deduct+Mat_Col_Copay+Mat_Col_Coinsur","v":0},2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"S66+R67","v":4859.3864915304011},null,150,null,{"$f":"W66+V67","v":0},null,{"$f":"Y66+X67","v":1022.73},null,{"$f":"AA66+Z67","v":40},null,{"$f":"AC66+AB67","v":1394.266018065},0,{"$f":"AE66+AD67","v":2456.996018065},null,{"$f":"AG66+AF67","v":1000},null,{"$f":"AI66+AH67","v":0},null,{"$f":"AK66+AJ67","v":22.73},null,{"$f":"AM66+AL67","v":0},null,{"$f":"AO66+AN67","v":0},null,0,null,{"$f":"AS66+AR67","v":0},null,{"$f":"AU66+AT67","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,{"$f":"U68+T69","v":150},null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,{"$f":"AQ68+AP69","v":0},null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4859.3864915304011,null,150,null,0,null,1022.73,null,40,null,1394.266018065,0,2456.996018065,null,1000,null,0,null,22.73,null,0,null,0,null,0,null,0,null,0]
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[null,null,null,null,"The results for the two scenarios are currently open in a separate file.\nThe resulting CSV file was saved in the same location as the input file. "]

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