pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	pbp_vbid_group_id	pbp_b13a_bendesc_yn	pbp_b13a_bendesc_ehc	pbp_b13a_bendesc_amo	pbp_b13a_bendesc_lim	pbp_b13a_bendesc_numv	pbp_b13a_bendesc_per	pbp_b13a_bendesc_per_d	pbp_b13a_maxplan_yn	pbp_b13a_maxplan_amt	pbp_b13a_maxplan_per	pbp_b13a_maxplan_per_d	pbp_b13a_maxenr_yn	pbp_b13a_maxenr_amt	pbp_b13a_maxenr_per	pbp_b13a_maxenr_per_d	pbp_b13a_coins_yn	pbp_b13a_coins_pct_min	pbp_b13a_coins_pct_max	pbp_b13a_ded_yn	pbp_b13a_ded_amt	pbp_b13a_copay_yn	pbp_b13a_copay_amt_min	pbp_b13a_copay_amt_max	pbp_b13a_auth_yn	pbp_b13a_refer_yn	pbp_b13b_bendesc_otc	pbp_b13b_bendesc_amo	pbp_b13b_maxplan_yn	pbp_b13b_maxplan_amt	pbp_b13b_otc_maxplan_per	pbp_b13b_maxplan_prd_yn	pbp_b13b_maxenr_yn	pbp_b13b_maxenr_amt	pbp_b13b_maxenr_per	pbp_b13b_maxenr_per_d	pbp_b13b_nrt_yn	pbp_b13b_nrt_attestation	pbp_b13b_naloxone_yn	pbp_b13b_coins_yn	pbp_b13b_coins_pct_min	pbp_b13b_coins_pct_max	pbp_b13b_ded_yn	pbp_b13b_ded_amt	pbp_b13b_copay_yn	pbp_b13b_copay_amt_min	pbp_b13b_copay_amt_max	pbp_b13b_cms_otc_list_yn	pbp_b13b_mode	pbp_b13b_mode_desc	pbp_b13b_auth_yn	pbp_b13c_bendesc_service	pbp_b13c_bendesc_amo	pbp_b13c_meal_type_chk	pbp_b13c_maxplan_yn	pbp_b13c_maxplan_amt	pbp_b13c_maxplan_per	pbp_b13c_maxplan_per_d	pbp_b13c_maxenr_yn	pbp_b13c_maxenr_amt	pbp_b13c_maxenr_per	pbp_b13c_maxenr_per_d	pbp_b13c_coins_yn	pbp_b13c_coins_pct_min	pbp_b13c_coins_pct_max	pbp_b13c_ded_yn	pbp_b13c_ded_amt	pbp_b13c_copay_yn	pbp_b13c_copay_amt_min	pbp_b13c_copay_amt_max	pbp_b13c_auth_yn	pbp_b13c_refer_yn	pbp_b13d_bendesc_service	pbp_b13d_bendesc_amo	pbp_b13d_maxplan_yn	pbp_b13d_maxplan_amt	pbp_b13d_maxplan_per	pbp_b13d_maxplan_per_d	pbp_b13d_maxenr_yn	pbp_b13d_maxenr_amt	pbp_b13d_maxenr_per	pbp_b13d_maxenr_per_d	pbp_b13d_coins_yn	pbp_b13d_coins_pct_min	pbp_b13d_coins_pct_max	pbp_b13d_ded_yn	pbp_b13d_ded_amt	pbp_b13d_copay_yn	pbp_b13d_copay_amt_min	pbp_b13d_copay_amt_max	pbp_b13d_auth_yn	pbp_b13d_refer_yn	pbp_b13e_bendesc_service	pbp_b13e_bendesc_amo	pbp_b13e_maxplan_yn	pbp_b13e_maxplan_amt	pbp_b13e_maxplan_per	pbp_b13e_maxplan_per_d	pbp_b13e_maxenr_yn	pbp_b13e_maxenr_amt	pbp_b13e_maxenr_per	pbp_b13e_maxenr_per_d	pbp_b13e_coins_yn	pbp_b13e_coins_pct_min	pbp_b13e_coins_pct_max	pbp_b13e_ded_yn	pbp_b13e_ded_amt	pbp_b13e_copay_yn	pbp_b13e_copay_amt_min	pbp_b13e_copay_amt_max	pbp_b13e_auth_yn	pbp_b13e_refer_yn	pbp_b13f_bendesc_service	pbp_b13f_bendesc_amo	pbp_b13f_maxplan_yn	pbp_b13f_maxplan_amt	pbp_b13f_maxplan_per	pbp_b13f_maxplan_per_d	pbp_b13f_maxenr_yn	pbp_b13f_maxenr_amt	pbp_b13f_maxenr_per	pbp_b13f_maxenr_per_d	pbp_b13f_coins_yn	pbp_b13f_coins_pct_min	pbp_b13f_coins_pct_max	pbp_b13f_ded_yn	pbp_b13f_ded_amt	pbp_b13f_copay_yn	pbp_b13f_copay_amt_min	pbp_b13f_copay_amt_max	pbp_b13f_auth_yn	pbp_b13f_refer_yn
H0028	039	0	1	01	01	H0028_039_0	5	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H0028	046	0	1	01	01	H0028_046_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H0104	012	0	1	04	01	H0104_012_0	6	1																																																			1	2	010	2				2				2			2		2			2	2																																																												
H0104	014	0	1	04	01	H0104_014_0	7	1																																																			1	2	010	2				2				2			2		2			2	2																																																												
H0104	015	0	1	04	01	H0104_015_0	6	1																																																			1	2	010	2				2				2			2		2			2	2																																																												
H0473	003	0	1	04	01	H0473_003_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H0523	074	0	1	02	01	H0523_074_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0523	801	0	1	01	01	H0523_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H0523	801	0	1	01	01	H0523_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H0523	805	0	1	01	01	H0523_805_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H0523	805	0	1	01	01	H0523_805_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H0524	008	0	1	01	01	H0524_008_0	5	1																																																																																																																Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	2	1
H0524	032	0	1	01	01	H0524_032_0	5	1																																																																																																																Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	2	1
H0524	033	0	1	01	01	H0524_033_0	5	1																																																																																																																Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	2	1
H0524	039	0	1	01	01	H0524_039_0	5	1																																																																																																																Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	2	1
H0524	059	0	1	01	01	H0524_059_0	5	1																																																																																																																Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	2	1
H0524	060	0	1	01	01	H0524_060_0	5	1																																																																																																																Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	2	1
H0524	061	0	1	01	01	H0524_061_0	5	1																																																																																																																Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	2	1
H0524	062	0	1	01	01	H0524_062_0	5	1																																																																																																																Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	2	1
H0524	063	0	1	01	01	H0524_063_0	5	1																																																																																																																Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	2	1
H0571	001	0	1	01	01	H0571_001_0	9	1																										1	2	2				2				2		2	2			2		2			1	00010		2																																																																																	
H0571	005	0	1	01	01	H0571_005_0	9	1																										1	2	2				2				2		2	2			2		2			1	00010		2																																																																																	
H0571	007	0	1	01	01	H0571_007_0	10	1																										1	2	2				2				2		2	2			2		2			2	00010		2																																																																																	
H0571	010	0	1	01	01	H0571_010_0	9	1																										1	2	2				2				2		2	2			2		2			1	00010		2																																																																																	
H0571	011	0	1	01	01	H0571_011_0	10	1																										1	2	2				2				2		2	2			2		2			2	00010		2																																																																																	
H0628	001	0	1	02	01	H0628_001_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	005	0	1	02	01	H0628_005_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	012	0	1	01	01	H0628_012_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	013	0	1	01	01	H0628_013_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	017	0	1	02	01	H0628_017_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	031	0	1	01	01	H0628_031_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	032	0	1	01	01	H0628_032_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	033	0	1	01	01	H0628_033_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	034	0	1	01	01	H0628_034_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	035	0	1	01	01	H0628_035_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	036	0	1	01	01	H0628_036_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	037	0	1	01	01	H0628_037_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	038	0	1	01	01	H0628_038_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	039	0	1	01	01	H0628_039_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	040	0	1	01	01	H0628_040_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	041	0	1	01	01	H0628_041_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	801	0	1	01	01	H0628_801_0	2	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H0628	801	0	1	01	01	H0628_801_0	2	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H0630	013	0	1	01	01	H0630_013_0	5	1																																																																																												Advanced Care at Home	2	2				2				2			2		1	0.00	0.00	1	1																				
H0630	014	0	1	01	01	H0630_014_0	5	1																																																																																												Advanced Care at Home	2	2				2				2			2		1	0.00	0.00	1	1																				
H0630	015	0	1	02	01	H0630_015_0	5	1																																																																																												Advanced Care at Home	2	2				2				2			2		1	0.00	0.00	1	1																				
H0630	016	0	1	02	01	H0630_016_0	6	1																																																																																												Advanced Care at Home	2	2				2				2			2		1	0.00	0.00	1	1																				
H0630	025	0	1	02	01	H0630_025_0	5	1																																																																																												Advanced Care at Home	2	2				2				2			2		1	0.00	0.00	1	1																				
H0630	027	0	1	01	01	H0630_027_0	5	1																																																																																												Advanced Care at Home	2	2				2				2			2		1	0.00	0.00	1	1																				
H0783	004	0	1	01	01	H0783_004_0	2	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H0885	001	0	1	04	01	H0885_001_0	5	1																										1	2	2				2				2		2	2			2		2			2	00010		2																																																																																	
H0885	002	0	1	04	01	H0885_002_0	5	1																										1	2	2				2				2		2	2			2		2			2	00010		2																																																																																	
H0885	003	0	1	04	01	H0885_003_0	5	1																										1	2	2				2				2		2	2			2		2			2	00010		2																																																																																	
H0885	005	0	1	04	01	H0885_005_0	5	1																										1	2	2				2				2		2	2			2		2			2	00010		2																																																																																	
H0885	006	0	1	04	01	H0885_006_0	5	1																										1	2	2				2				2		2	2			2		2			2	00010		2																																																																																	
H0885	007	0	1	04	01	H0885_007_0	5	1																										1	2	2				2				2		2	2			2		2			2	00010		2																																																																																	
H0885	008	0	1	04	01	H0885_008_0	5	1																										1	2	2				2				2		2	2			2		2			2	00010		2																																																																																	
H0885	009	0	1	04	01	H0885_009_0	5	1																										1	2	2				2				2		2	2			2		2			2	00010		2																																																																																	
H1019	001	0	1	02	01	H1019_001_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1019	006	0	1	01	01	H1019_006_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1019	103	1	1	01	01	H1019_103_1	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1019	103	2	1	01	01	H1019_103_2	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1019	109	0	1	01	01	H1019_109_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	00010		2																																																																																	
H1019	113	0	1	01	01	H1019_113_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1019	118	0	1	01	01	H1019_118_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	00010		2																																																																																	
H1019	121	0	1	01	01	H1019_121_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	00010		2																																																																																	
H1019	123	0	1	01	01	H1019_123_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	00010		2																																																																																	
H1019	124	0	1	02	01	H1019_124_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10010	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1019	130	0	1	02	01	H1019_130_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10010	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1019	147	2	1	01	01	H1019_147_2	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1019	151	2	1	01	01	H1019_151_2	4	1																										1	2	2				2				1	1	1	2			2		2			2	10010	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	054	0	1	01	01	H1036_054_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	062	0	1	01	01	H1036_062_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	065	0	1	01	01	H1036_065_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	077	0	1	01	01	H1036_077_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	102	0	1	01	01	H1036_102_0	5	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	209	0	1	01	01	H1036_209_0	5	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	210	0	1	01	01	H1036_210_0	5	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	213	0	1	01	01	H1036_213_0	5	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	214	0	1	01	01	H1036_214_0	5	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	230	0	1	01	01	H1036_230_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	285	0	1	01	01	H1036_285_0	5	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	301	0	1	01	01	H1036_301_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	302	0	1	01	01	H1036_302_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	304	0	1	01	01	H1036_304_0	5	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	314	0	1	01	01	H1036_314_0	5	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	315	0	1	01	01	H1036_315_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	316	0	1	01	01	H1036_316_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	336	0	1	01	01	H1036_336_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	337	0	1	01	01	H1036_337_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	338	0	1	01	01	H1036_338_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	339	0	1	01	01	H1036_339_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	340	0	1	01	01	H1036_340_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1036	341	0	1	01	01	H1036_341_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H1109	801	0	1	01	01	H1109_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H1109	801	0	1	01	01	H1109_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H1109	802	0	1	01	01	H1109_802_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H1109	802	0	1	01	01	H1109_802_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H1170	002	0	1	01	01	H1170_002_0	6	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	008	0	1	01	01	H1170_008_0	6	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	009	0	1	01	01	H1170_009_0	6	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	011	0	1	01	01	H1170_011_0	6	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	012	0	1	01	01	H1170_012_0	6	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	013	0	1	02	01	H1170_013_0	6	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	014	0	1	01	01	H1170_014_0	5	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	015	0	1	01	01	H1170_015_0	6	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	016	0	1	01	01	H1170_016_0	6	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	017	0	1	01	01	H1170_017_0	5	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1206	004	0	1	01	01	H1206_004_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1206	009	0	1	01	01	H1206_009_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1206	801	0	1	01	01	H1206_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H1206	801	0	1	01	01	H1206_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H1280	001	0	1	01	01	H1280_001_0	4	1																										1	2	2				2				1	1	1	2			2		2			1	00010		2																																																																																	
H1347	001	0	1	04	01	H1347_001_0	4	1																																																			1	2	010	2				2				2			2		2			2	2																																																												
H1347	002	0	1	04	01	H1347_002_0	4	1																																																			1	2	010	2				2				2			2		2			2	2																																																												
H1347	003	0	1	04	01	H1347_003_0	4	1																																																			1	2	010	2				2				2			2		2			2	2																																																												
H1526	001	0	1	02	01	H1526_001_0	5	1																										1	2	1	100.00	5	2	2				2		2	2			2		2			1	01010		1																																																																																	
H1526	002	0	1	02	01	H1526_002_0	5	1																										1	2	1	100.00	5	2	2				2		2	2			2		2			1	01010		1																																																																																	
H1526	003	0	1	02	01	H1526_003_0	5	1																										1	2	1	100.00	5	2	2				2		2	2			2		2			1	01010		1																						Non-Medicare Covered In-Home Staff-Assisted Dialysis	2	2				2				2			2		2			2	1																																								
H1526	004	0	1	02	01	H1526_004_0	4	1																										1	2	1	100.00	5	2	2				2		2	2			2		2			1	01010		1																						Non-Medicare Covered In-Home Staff-Assisted Dialysis	2	2				2				2			2		2			2	1																																								
H1526	008	0	1	02	01	H1526_008_0	4	1																										1	2	1	100.00	5	2	2				2		2	2			2		2			1	01010		1																																																																																	
H1526	009	0	1	02	01	H1526_009_0	4	1																										1	2	1	100.00	5	2	2				2		2	2			2		2			1	01010		1																						Non-Medicare Covered In-Home Staff-Assisted Dialysis	2	2				2				2			2		2			2	1																																								
H1608	021	0	1	04	01	H1608_021_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1608	027	0	1	04	01	H1608_027_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1608	027	0	1	04	01	H1608_027_0	2	2																										1	2	2				2				2		2	2			2		1	0.00	0.00	2	10000	Restricted Items	2	1	2	001	2				2				2			2		1	0.00	0.00	2	2																																																												
H1608	062	0	1	04	01	H1608_062_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1608	076	0	1	04	01	H1608_076_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1608	077	0	1	04	01	H1608_077_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1608	121	0	1	04	01	H1608_121_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1608	801	0	1	04	01	H1608_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H1608	801	0	1	04	01	H1608_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H1609	017	0	1	01	01	H1609_017_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	019	0	1	01	01	H1609_019_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	043	0	1	01	01	H1609_043_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	044	0	1	01	01	H1609_044_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	045	0	1	01	01	H1609_045_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	046	0	1	01	01	H1609_046_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	047	0	1	01	01	H1609_047_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	048	0	1	01	01	H1609_048_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	049	0	1	01	01	H1609_049_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	055	0	1	01	01	H1609_055_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	056	0	1	01	01	H1609_056_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	061	0	1	01	01	H1609_061_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	062	0	1	01	01	H1609_062_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	064	0	1	01	01	H1609_064_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	068	0	1	02	01	H1609_068_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	073	0	1	01	01	H1609_073_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	074	0	1	01	01	H1609_074_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	075	0	1	01	01	H1609_075_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	076	0	1	01	01	H1609_076_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	077	0	1	01	01	H1609_077_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	078	0	1	01	01	H1609_078_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	079	0	1	01	01	H1609_079_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	080	0	1	01	01	H1609_080_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	081	0	1	01	01	H1609_081_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	082	0	1	01	01	H1609_082_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	083	0	1	01	01	H1609_083_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	084	0	1	01	01	H1609_084_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	085	0	1	01	01	H1609_085_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	088	0	1	01	01	H1609_088_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	089	0	1	01	01	H1609_089_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	090	0	1	01	01	H1609_090_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	092	0	1	01	01	H1609_092_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	094	0	1	01	01	H1609_094_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	801	0	1	01	01	H1609_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H1609	801	0	1	01	01	H1609_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H1609	807	0	1	01	01	H1609_807_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H1609	807	0	1	01	01	H1609_807_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H1610	001	0	1	01	01	H1610_001_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1692	005	0	1	01	01	H1692_005_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1692	006	0	1	01	01	H1692_006_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1692	801	0	1	01	01	H1692_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H1692	801	0	1	01	01	H1692_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H1994	015	0	1	01	01	H1994_015_0	4	1																										1	2	2				2				2		1	2			2		2			1	01011		2																																																																																	
H1994	021	0	1	01	01	H1994_021_0	5	1																										1	2	2				2				2		2	2			2		2			1	01011		2																																																																																	
H1994	022	0	1	01	01	H1994_022_0	5	1																										1	2	2				2				2		1	2			2		2			1	01011		2																																																																																	
H1994	030	0	1	01	01	H1994_030_0	6	1																										1	2	2				2				2		2	2			2		2			1	01011		2																																																																																	
H1994	034	0	1	01	01	H1994_034_0	6	1																										1	2	2				2				2		1	2			2		2			1	01011		2																																																																																	
H1994	040	0	1	01	01	H1994_040_0	4	1																										1	2	2				2				2		1	2			2		2			1	01011		2																																																																																	
H2056	801	0	1	01	01	H2056_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H2056	801	0	1	01	01	H2056_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H2056	802	0	1	01	01	H2056_802_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H2056	802	0	1	01	01	H2056_802_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H2172	001	0	1	02	01	H2172_001_0	5	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	002	0	1	02	01	H2172_002_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	005	0	1	01	01	H2172_005_0	3	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	008	0	1	02	01	H2172_008_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	009	0	1	02	01	H2172_009_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	010	0	1	02	01	H2172_010_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	013	0	1	02	01	H2172_013_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	014	0	1	02	01	H2172_014_0	5	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	016	0	1	01	01	H2172_016_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	017	0	1	01	01	H2172_017_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	018	0	1	01	01	H2172_018_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	019	0	1	01	01	H2172_019_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	020	0	1	02	01	H2172_020_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	021	0	1	02	01	H2172_021_0	5	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	022	0	1	02	01	H2172_022_0	5	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	023	0	1	02	01	H2172_023_0	5	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	024	0	1	02	01	H2172_024_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	025	0	1	01	01	H2172_025_0	5	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	026	0	1	01	01	H2172_026_0	5	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2172	027	0	1	02	01	H2172_027_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2293	001	0	1	04	01	H2293_001_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2293	002	0	1	04	01	H2293_002_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2293	004	0	1	04	01	H2293_004_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2293	009	0	1	04	01	H2293_009_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2293	021	0	1	04	01	H2293_021_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2293	023	0	1	04	01	H2293_023_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2293	029	0	1	04	01	H2293_029_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2293	031	0	1	04	01	H2293_031_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2293	033	0	1	04	01	H2293_033_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2293	035	0	1	04	01	H2293_035_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	039	0	1	01	01	H2663_039_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	052	0	1	01	01	H2663_052_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	053	0	1	01	01	H2663_053_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	056	0	1	01	01	H2663_056_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	057	0	1	02	01	H2663_057_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	064	0	1	01	01	H2663_064_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	067	0	1	01	01	H2663_067_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	097	0	1	01	01	H2663_097_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	098	0	1	01	01	H2663_098_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	099	0	1	01	01	H2663_099_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	100	0	1	01	01	H2663_100_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	102	0	1	01	01	H2663_102_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	805	0	1	01	01	H2663_805_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H2663	805	0	1	01	01	H2663_805_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H2694	002	0	1	04	01	H2694_002_0	4	1																										1	2	2				2				2		1	2			2		2			1	00010		2																																																																																	
H2875	001	0	1	02	01	H2875_001_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H2875	002	0	1	02	01	H2875_002_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H2875	006	0	1	02	01	H2875_006_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H3146	002	0	1	01	01	H3146_002_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3146	006	0	1	01	01	H3146_006_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3146	011	0	1	01	01	H3146_011_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3146	012	0	1	01	01	H3146_012_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3146	016	0	1	01	01	H3146_016_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3146	021	0	1	01	01	H3146_021_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3146	022	0	1	01	01	H3146_022_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3146	023	0	1	01	01	H3146_023_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3146	036	0	1	01	01	H3146_036_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3146	037	0	1	01	01	H3146_037_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3146	038	0	1	01	01	H3146_038_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3146	044	0	1	01	01	H3146_044_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3146	801	0	1	01	01	H3146_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3146	801	0	1	01	01	H3146_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3152	801	0	1	01	01	H3152_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3152	801	0	1	01	01	H3152_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3152	804	0	1	01	01	H3152_804_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3152	804	0	1	01	01	H3152_804_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3192	007	0	1	01	01	H3192_007_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3192	021	0	1	02	01	H3192_021_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3192	028	0	1	01	01	H3192_028_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3192	029	0	1	01	01	H3192_029_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3192	033	0	1	01	01	H3192_033_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3192	801	0	1	01	01	H3192_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3192	801	0	1	01	01	H3192_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3219	015	0	1	04	01	H3219_015_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3219	016	0	1	04	01	H3219_016_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3219	801	0	1	04	01	H3219_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3219	801	0	1	04	01	H3219_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3239	001	0	1	01	01	H3239_001_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	002	0	1	01	01	H3239_002_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	005	0	1	01	01	H3239_005_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	007	0	1	01	01	H3239_007_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	010	0	1	01	01	H3239_010_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	012	0	1	01	01	H3239_012_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	015	0	1	01	01	H3239_015_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	017	0	1	01	01	H3239_017_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	020	0	1	01	01	H3239_020_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	022	0	1	01	01	H3239_022_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	023	0	1	01	01	H3239_023_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	026	0	1	01	01	H3239_026_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	027	0	1	01	01	H3239_027_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	028	0	1	01	01	H3239_028_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	030	0	1	01	01	H3239_030_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3288	001	0	1	04	01	H3288_001_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3288	002	0	1	04	01	H3288_002_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3288	003	0	1	04	01	H3288_003_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3288	004	0	1	04	01	H3288_004_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3288	017	0	1	04	01	H3288_017_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3288	018	0	1	04	01	H3288_018_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3288	019	0	1	04	01	H3288_019_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3288	034	0	1	04	01	H3288_034_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3288	048	0	1	04	01	H3288_048_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3288	053	0	1	04	01	H3288_053_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3288	801	0	1	04	01	H3288_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3288	801	0	1	04	01	H3288_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3291	002	0	1	01	01	H3291_002_0	4	1																																																			1	2	101	1	0.00	7		2				2			2		2			2	2																																																												
H3305	007	0	1	02	01	H3305_007_0	8	1																										1	2	2				2				2		2	2			2		2			2	01000		1																																																																																	
H3305	015	0	1	02	01	H3305_015_0	17	1																										1	2	2				2				2		2	2			2		2			2	01000		1																																																																																	
H3305	020	0	1	02	01	H3305_020_0	8	1																										1	2	2				2				2		2	2			2		2			2	01000		1																																																																																	
H3305	022	0	1	02	01	H3305_022_0	16	1																										1	2	2				2				2		2	2			2		2			2	01000		1																																																																																	
H3312	069	0	1	01	01	H3312_069_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3312	070	0	1	01	01	H3312_070_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3312	073	0	1	01	01	H3312_073_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3312	074	0	1	01	01	H3312_074_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3312	087	0	1	01	01	H3312_087_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3312	089	0	1	01	01	H3312_089_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3312	090	0	1	01	01	H3312_090_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3312	091	0	1	01	01	H3312_091_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3312	801	0	1	01	01	H3312_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3312	801	0	1	01	01	H3312_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3312	804	0	1	01	01	H3312_804_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3312	804	0	1	01	01	H3312_804_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3551	001	0	1	01	01	H3551_001_0	4	1																										1	2	2				2				2		1	2			2		2			1	00010		2																																																																																	
H3551	004	0	1	01	01	H3551_004_0	4	1																										1	2	2				2				1	1	1	2			2		2			1	00010		2																																																																																	
H3597	011	0	1	02	01	H3597_011_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3597	012	0	1	02	01	H3597_012_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3597	801	0	1	01	01	H3597_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3597	801	0	1	01	01	H3597_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3597	802	0	1	01	01	H3597_802_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3597	802	0	1	01	01	H3597_802_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3660	028	0	1	02	01	H3660_028_0	6	1																																																			1	2	001	2				2				2			2		2			2	2																																																												
H3660	029	0	1	02	01	H3660_029_0	7	2																																																			1	2	001	2				2				2			2		2			2	2																																																												
H3660	044	0	1	01	01	H3660_044_0	7	2																																																			1	2	001	2				2				2			2		2			2	2																																																												
H3660	052	1	1	01	01	H3660_052_1	6	2																																																			1	2	001	2				2				2			2		2			2	2																																																												
H3660	052	2	1	01	01	H3660_052_2	6	2																																																			1	2	001	2				2				2			2		2			2	2																																																												
H3660	801	0	1	01	01	H3660_801_0	2	2																																																			1	2	001	2				2				2			2		2			2	2																																																												
H3660	805	0	1	02	01	H3660_805_0	2	2																																																			1	2	001	2				2				2			2		2			2	2																																																												
H3706	024	0	1	01	01	H3706_024_0	6	1																										1	2	2				2				1	1	2	2			2		2			1	00010		2																																																																																	
H3706	025	0	1	01	01	H3706_025_0	5	1																										1	2	2				2				1	1	2	2			2		2			1	00010		2																																																																																	
H3748	801	0	1	01	01	H3748_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3748	801	0	1	01	01	H3748_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3755	006	0	1	01	01	H3755_006_0	7	1																																																			1	2	011	2				2				2			2		2			1	1																																																												
H3907	002	0	1	01	01	H3907_002_0	13	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	006	0	1	01	01	H3907_006_0	18	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	037	0	1	01	01	H3907_037_0	16	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	057	1	1	01	01	H3907_057_1	18	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	057	2	1	01	01	H3907_057_2	17	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	057	3	1	01	01	H3907_057_3	17	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	057	4	1	01	01	H3907_057_4	15	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	057	5	1	01	01	H3907_057_5	16	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	057	6	1	01	01	H3907_057_6	16	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	057	7	1	01	01	H3907_057_7	16	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	058	1	1	01	01	H3907_058_1	16	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	058	2	1	01	01	H3907_058_2	17	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	058	3	1	01	01	H3907_058_3	17	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	059	1	1	01	01	H3907_059_1	18	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	059	2	1	01	01	H3907_059_2	18	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	059	3	1	01	01	H3907_059_3	18	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	059	4	1	01	01	H3907_059_4	18	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	059	5	1	01	01	H3907_059_5	18	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3928	001	0	1	01	01	H3928_001_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3928	801	0	1	01	01	H3928_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3928	801	0	1	01	01	H3928_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3928	803	0	1	01	01	H3928_803_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3928	803	0	1	01	01	H3928_803_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3931	095	0	1	02	01	H3931_095_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3931	099	0	1	02	01	H3931_099_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3931	100	0	1	02	01	H3931_100_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3931	157	0	1	01	01	H3931_157_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3931	160	0	1	01	01	H3931_160_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3931	175	0	1	01	01	H3931_175_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3931	188	0	1	01	01	H3931_188_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3931	191	0	1	01	01	H3931_191_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3931	196	0	1	01	01	H3931_196_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3931	801	0	1	01	01	H3931_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3931	801	0	1	01	01	H3931_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3931	804	0	1	01	01	H3931_804_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3931	804	0	1	01	01	H3931_804_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3952	053	0	1	02	01	H3952_053_0	6	3																										1	2	1	10.00	5	2	2				2		1	2			2		2			2	00010		2																																																																																	
H3952	054	0	1	02	01	H3952_054_0	6	3																										1	2	1	10.00	5	2	2				2		1	2			2		2			2	00010		2																																																																																	
H3959	010	0	1	02	01	H3959_010_0	2	1																										1	2	2				2				2		2	2			2		1	0.00	0.00	2	10000	Restricted Items	2																																																																																	
H3959	011	0	1	02	01	H3959_011_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	032	0	1	02	01	H3959_032_0	2	1																										1	2	2				2				2		2	2			2		1	0.00	0.00	2	10000	Restricted Items	2																																																																																	
H3959	032	0	1	02	01	H3959_032_0	2	2																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	033	0	1	02	01	H3959_033_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	035	0	1	01	01	H3959_035_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	036	0	1	01	01	H3959_036_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	041	0	1	02	01	H3959_041_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	053	0	1	02	01	H3959_053_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	056	0	1	01	01	H3959_056_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	069	0	1	01	01	H3959_069_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	070	0	1	01	01	H3959_070_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	071	0	1	01	01	H3959_071_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	072	0	1	01	01	H3959_072_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	073	0	1	01	01	H3959_073_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	074	0	1	01	01	H3959_074_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	075	0	1	01	01	H3959_075_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	076	0	1	01	01	H3959_076_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	083	0	1	01	01	H3959_083_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	084	0	1	01	01	H3959_084_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	085	0	1	01	01	H3959_085_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	804	0	1	01	01	H3959_804_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3959	804	0	1	01	01	H3959_804_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H4003	009	0	1	01	01	H4003_009_0	5	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4003	017	0	1	01	01	H4003_017_0	6	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4003	019	0	1	02	01	H4003_019_0	6	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4003	034	0	1	02	01	H4003_034_0	5	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4003	055	0	1	02	01	H4003_055_0	6	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4003	058	0	1	01	01	H4003_058_0	5	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	048	0	1	01	01	H4004_048_0	5	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	056	0	1	02	01	H4004_056_0	7	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	065	0	1	02	01	H4004_065_0	5	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	066	0	1	02	01	H4004_066_0	6	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	068	0	1	01	01	H4004_068_0	5	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	069	0	1	01	01	H4004_069_0	5	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	070	0	1	02	01	H4004_070_0	5	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	071	0	1	02	01	H4004_071_0	5	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	072	1	1	01	01	H4004_072_1	5	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	072	2	1	01	01	H4004_072_2	5	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	072	3	1	01	01	H4004_072_3	5	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	073	1	1	02	01	H4004_073_1	6	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	073	2	1	02	01	H4004_073_2	6	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	073	3	1	02	01	H4004_073_3	6	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4140	004	0	1	01	01	H4140_004_0	8	1																										1	2	2				2				1	1	2	2			2		2			1	01010		2																																																																																	
H4140	012	0	1	01	01	H4140_012_0	8	1																										1	2	2				2				1	1	2	2			2		2			1	01010		2																																																																																	
H4140	013	0	1	01	01	H4140_013_0	8	1																										1	2	2				2				1	1	2	2			2		2			1	01010		2																																																																																	
H4140	017	0	1	01	01	H4140_017_0	8	1																										1	2	2				2				1	1	2	2			2		2			1	01010		2																																																																																	
H4140	018	0	1	01	01	H4140_018_0	8	1																										1	2	2				2				1	1	2	2			2		2			1	01010		2																																																																																	
H4152	022	0	1	02	01	H4152_022_0	6	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4286	002	0	1	01	01	H4286_002_0	6	1																										1	2	2				2				1	1	2	2			2		2			2	00010		2																																																																																	
H4329	001	0	1	01	01	H4329_001_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H4461	022	0	1	01	01	H4461_022_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H4461	038	0	1	01	01	H4461_038_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H4461	052	0	1	01	01	H4461_052_0	2	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H4461	066	0	1	01	01	H4461_066_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H4523	020	0	1	01	01	H4523_020_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	021	0	1	01	01	H4523_021_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	024	0	1	01	01	H4523_024_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	027	0	1	01	01	H4523_027_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	028	0	1	01	01	H4523_028_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	029	0	1	01	01	H4523_029_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	030	0	1	01	01	H4523_030_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	034	0	1	01	01	H4523_034_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	037	0	1	01	01	H4523_037_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	038	0	1	01	01	H4523_038_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	039	0	1	01	01	H4523_039_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	041	0	1	01	01	H4523_041_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	043	0	1	01	01	H4523_043_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	044	0	1	01	01	H4523_044_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	801	0	1	01	01	H4523_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H4523	801	0	1	01	01	H4523_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H4523	802	0	1	01	01	H4523_802_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H4523	802	0	1	01	01	H4523_802_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H4624	023	0	1	01	01	H4624_023_0	8	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H4624	025	0	1	01	01	H4624_025_0	9	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H4624	027	0	1	01	01	H4624_027_0	10	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H4624	028	0	1	01	01	H4624_028_0	8	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H4624	029	0	1	01	01	H4624_029_0	8	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H4624	031	0	1	01	01	H4624_031_0	7	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H4624	032	0	1	01	01	H4624_032_0	7	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H4624	033	0	1	01	01	H4624_033_0	7	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H4624	036	0	1	01	01	H4624_036_0	8	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H4624	039	0	1	01	01	H4624_039_0	7	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H4624	042	0	1	01	01	H4624_042_0	8	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H4624	045	0	1	01	01	H4624_045_0	7	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H4711	011	0	1	01	01	H4711_011_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4711	012	0	1	01	01	H4711_012_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4711	013	0	1	01	01	H4711_013_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4711	801	0	1	01	01	H4711_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H4711	801	0	1	01	01	H4711_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H4835	801	0	1	01	01	H4835_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H4835	801	0	1	01	01	H4835_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H4869	001	0	1	02	01	H4869_001_0	4	1																										1	2	1	100.00	5	2	2				2		2	2			2		2			1	01010		1																																																																																	
H4869	003	0	1	02	01	H4869_003_0	5	1																										1	2	1	100.00	5	2	2				2		2	2			2		2			1	01010		1																						Non-Medicare Covered In-Home Staff-Assisted Dialysis	2	2				2				2			2		2			2	1																																								
H4869	011	0	1	02	01	H4869_011_0	4	1																										1	2	1	100.00	5	2	2				2		2	2			2		2			1	01010		1																																																																																	
H4869	013	0	1	02	01	H4869_013_0	5	1																										1	2	1	100.00	5	2	2				2		2	2			2		2			1	01010		1																						Non-Medicare Covered In-Home Staff-Assisted Dialysis	2	2				2				2			2		2			2	1																																								
H4869	014	0	1	02	01	H4869_014_0	6	1																										1	2	1	100.00	5	2	2				2		2	2			2		2			1	01010		1																						Non-Medicare Covered In-Home Staff-Assisted Dialysis	2	2				2				2			2		2			2	1																																								
H4939	001	0	1	02	01	H4939_001_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H4982	022	0	1	02	01	H4982_022_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4982	801	0	1	01	01	H4982_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H4982	801	0	1	01	01	H4982_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5050	004	0	1	01	01	H5050_004_0	4	1																																																																								Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	009	0	1	01	01	H5050_009_0	4	1																																																																								Advanced Care at Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	022	0	1	01	01	H5050_022_0	4	1																																																																								Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	024	0	1	01	01	H5050_024_0	4	1																																																																								Advanced Care at Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	025	0	1	01	01	H5050_025_0	4	1																																																																								Advanced Care at Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	026	0	1	01	01	H5050_026_0	4	1																																																																								Advanced Care at Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	027	0	1	01	01	H5050_027_0	4	1																																																																								Advanced Care at Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	028	0	1	01	01	H5050_028_0	4	1																																																																								Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	029	0	1	01	01	H5050_029_0	4	1																																																																								Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	030	0	1	01	01	H5050_030_0	4	1																																																																								Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	031	0	1	01	01	H5050_031_0	4	1																																																																								Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	032	0	1	01	01	H5050_032_0	4	1																																																																								Advanced Care at Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5178	002	0	1	01	01	H5178_002_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5211	001	0	1	02	01	H5211_001_0	9	1																																																			1	2	010	2				2				2			2		2			2	2																																																												
H5211	001	0	1	02	01	H5211_001_0	9	2																																																																																												Hospital at Home	2	2				2				1	0	20	2		1	0.00	150.00	1	2																				
H5211	002	0	1	02	01	H5211_002_0	10	2																																																																																												Hospital at Home	2	2				2				1	0	20	2		1	0.00	200.00	1	2																				
H5211	002	0	1	02	01	H5211_002_0	10	1																																																			1	2	010	2				2				2			2		2			2	2																																																												
H5211	003	0	1	02	01	H5211_003_0	9	1																																																			1	2	010	2				2				2			2		2			2	2																																																												
H5211	003	0	1	02	01	H5211_003_0	9	2																																																																																												Hospital at Home	2	2				2				1	0	20	2		1	0.00	200.00	1	2																				
H5211	004	0	1	02	01	H5211_004_0	11	2																																																																																												Hospital at Home	2	2				2				1	0	20	2		1	0.00	150.00	1	2																				
H5211	004	0	1	02	01	H5211_004_0	11	1																																																			1	2	010	2				2				2			2		2			2	2																																																												
H5211	010	0	1	01	01	H5211_010_0	11	1																																																			1	2	010	2				2				2			2		2			2	2																																																												
H5211	012	0	1	02	01	H5211_012_0	11	2																																																																																												Hospital at Home	2	2				2				1	0	20	2		1	0.00	250.00	1	2																				
H5211	012	0	1	02	01	H5211_012_0	11	1																																																			1	2	010	2				2				2			2		2			2	2																																																												
H5215	002	0	1	04	01	H5215_002_0	5	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																										
H5215	005	0	1	04	01	H5215_005_0	5	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																										
H5215	007	0	1	04	01	H5215_007_0	5	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																										
H5215	008	0	1	04	01	H5215_008_0	5	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																										
H5215	009	0	1	04	01	H5215_009_0	5	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																										
H5215	010	0	1	04	01	H5215_010_0	5	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																										
H5215	011	0	1	04	01	H5215_011_0	5	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																										
H5215	012	0	1	04	01	H5215_012_0	5	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																										
H5215	013	0	1	04	01	H5215_013_0	4	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																										
H5215	014	0	1	04	01	H5215_014_0	4	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																										
H5216	242	0	1	04	01	H5216_242_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	243	0	1	04	01	H5216_243_0	2	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	257	0	1	04	01	H5216_257_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	277	0	1	04	01	H5216_277_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	352	0	1	04	01	H5216_352_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	353	0	1	04	01	H5216_353_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	362	0	1	04	01	H5216_362_0	2	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	369	0	1	04	01	H5216_369_0	2	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	400	0	1	04	01	H5216_400_0	5	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	401	0	1	04	01	H5216_401_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	402	0	1	04	01	H5216_402_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	413	0	1	04	01	H5216_413_0	2	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	416	0	1	04	01	H5216_416_0	2	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	432	0	1	04	01	H5216_432_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	444	0	1	04	01	H5216_444_0	2	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	446	0	1	04	01	H5216_446_0	2	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	447	0	1	04	01	H5216_447_0	2	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5216	453	0	1	04	01	H5216_453_0	2	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5262	001	0	1	01	01	H5262_001_0	4	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	45.00	2	2																																								
H5262	001	0	1	01	01	H5262_001_0	4	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H5262	003	0	1	01	01	H5262_003_0	4	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H5262	003	0	1	01	01	H5262_003_0	4	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	50.00	2	2																																								
H5262	004	0	1	01	01	H5262_004_0	3	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H5262	004	0	1	01	01	H5262_004_0	3	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	50.00	2	2																																								
H5262	005	0	1	01	01	H5262_005_0	3	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	45.00	2	2																																								
H5262	005	0	1	01	01	H5262_005_0	3	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H5262	007	0	1	01	01	H5262_007_0	4	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H5262	008	0	1	01	01	H5262_008_0	4	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H5262	009	0	1	01	01	H5262_009_0	3	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H5262	010	0	1	01	01	H5262_010_0	3	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H5262	021	0	1	01	01	H5262_021_0	4	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	60.00	2	2																																								
H5262	021	0	1	01	01	H5262_021_0	4	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H5262	023	0	1	01	01	H5262_023_0	4	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H5262	029	0	1	01	01	H5262_029_0	5	1																										1	2	2				2				2		2	2			2		2			2	00101		2																																																																																	
H5262	030	0	1	01	01	H5262_030_0	5	1																										1	2	2				2				2		2	2			2		2			2	00101		2																																																																																	
H5262	032	0	1	01	01	H5262_032_0	4	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	75.00	2	2																																								
H5262	032	0	1	01	01	H5262_032_0	4	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H5262	033	0	1	01	01	H5262_033_0	4	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H5302	012	0	1	01	01	H5302_012_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5302	020	0	1	01	01	H5302_020_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5302	022	0	1	01	01	H5302_022_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5302	024	0	1	01	01	H5302_024_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5302	026	0	1	01	01	H5302_026_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5302	809	0	1	01	01	H5302_809_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5302	809	0	1	01	01	H5302_809_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5325	003	0	1	01	01	H5325_003_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5325	004	0	1	01	01	H5325_004_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5325	005	0	1	01	01	H5325_005_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5325	006	0	1	01	01	H5325_006_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5325	007	0	1	01	01	H5325_007_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5325	011	0	1	01	01	H5325_011_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5325	012	0	1	01	01	H5325_012_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5325	013	0	1	01	01	H5325_013_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5325	014	0	1	01	01	H5325_014_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5325	015	0	1	01	01	H5325_015_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	084	0	1	04	01	H5521_084_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	116	0	1	04	01	H5521_116_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	171	0	1	04	01	H5521_171_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	218	0	1	04	01	H5521_218_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	224	0	1	04	01	H5521_224_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	227	0	1	04	01	H5521_227_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	229	0	1	04	01	H5521_229_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	233	0	1	04	01	H5521_233_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	235	0	1	04	01	H5521_235_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	302	0	1	04	01	H5521_302_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	324	0	1	04	01	H5521_324_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	326	0	1	04	01	H5521_326_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	364	0	1	04	01	H5521_364_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	365	0	1	04	01	H5521_365_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	398	0	1	04	01	H5521_398_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	399	0	1	04	01	H5521_399_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	400	0	1	04	01	H5521_400_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	414	0	1	04	01	H5521_414_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	443	0	1	04	01	H5521_443_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	449	0	1	04	01	H5521_449_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	464	0	1	04	01	H5521_464_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	465	0	1	04	01	H5521_465_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	467	0	1	04	01	H5521_467_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	470	0	1	04	01	H5521_470_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	472	0	1	04	01	H5521_472_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	490	0	1	04	01	H5521_490_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	496	0	1	04	01	H5521_496_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	500	0	1	04	01	H5521_500_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	502	0	1	04	01	H5521_502_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	553	0	1	04	01	H5521_553_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	598	0	1	04	01	H5521_598_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	644	0	1	04	01	H5521_644_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	645	0	1	04	01	H5521_645_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	646	0	1	04	01	H5521_646_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	649	0	1	04	01	H5521_649_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	801	0	1	04	01	H5521_801_0	2	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5521	801	0	1	04	01	H5521_801_0	2	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5521	805	0	2	04	01	H5521_805_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5521	805	0	2	04	01	H5521_805_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	001	0	1	04	01	H5522_001_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5522	002	0	1	04	01	H5522_002_0	2	1																										1	2	2				2				2		2	2			2		1	0.00	0.00	2	10000	Restricted Items	2																																																																																	
H5522	005	0	1	04	01	H5522_005_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5522	013	0	1	04	01	H5522_013_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5522	802	0	1	04	01	H5522_802_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	802	0	1	04	01	H5522_802_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	803	0	1	04	01	H5522_803_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	803	0	1	04	01	H5522_803_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	808	0	2	04	01	H5522_808_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	808	0	2	04	01	H5522_808_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	809	0	2	04	01	H5522_809_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	809	0	2	04	01	H5522_809_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	810	0	1	04	01	H5522_810_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	810	0	1	04	01	H5522_810_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	811	0	1	04	01	H5522_811_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	811	0	1	04	01	H5522_811_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	813	0	2	04	01	H5522_813_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	813	0	2	04	01	H5522_813_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	814	0	2	04	01	H5522_814_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	814	0	2	04	01	H5522_814_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	815	0	1	04	01	H5522_815_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	815	0	1	04	01	H5522_815_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	816	0	1	04	01	H5522_816_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	816	0	1	04	01	H5522_816_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	817	0	2	04	01	H5522_817_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	817	0	2	04	01	H5522_817_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	818	0	2	04	01	H5522_818_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	818	0	2	04	01	H5522_818_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	819	0	1	04	01	H5522_819_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	819	0	1	04	01	H5522_819_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	820	0	1	04	01	H5522_820_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	820	0	1	04	01	H5522_820_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	821	0	1	04	01	H5522_821_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	821	0	1	04	01	H5522_821_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	822	0	2	04	01	H5522_822_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	822	0	2	04	01	H5522_822_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	823	0	1	04	01	H5522_823_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	823	0	1	04	01	H5522_823_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	824	0	2	04	01	H5522_824_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	824	0	2	04	01	H5522_824_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	825	0	2	04	01	H5522_825_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	825	0	2	04	01	H5522_825_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	827	0	2	04	01	H5522_827_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	827	0	2	04	01	H5522_827_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	828	0	1	04	01	H5522_828_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	828	0	1	04	01	H5522_828_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	832	0	1	04	01	H5522_832_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	832	0	1	04	01	H5522_832_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	836	0	1	04	01	H5522_836_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	836	0	1	04	01	H5522_836_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	837	0	1	04	01	H5522_837_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	837	0	1	04	01	H5522_837_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	838	0	2	04	01	H5522_838_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5522	838	0	2	04	01	H5522_838_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5525	036	0	1	04	01	H5525_036_0	4	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5533	003	0	1	04	01	H5533_003_0	15	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5533	005	0	1	04	01	H5533_005_0	15	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5533	008	0	1	04	01	H5533_008_0	16	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5533	011	0	1	04	01	H5533_011_0	17	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5533	013	0	1	04	01	H5533_013_0	18	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5533	015	1	1	04	01	H5533_015_1	17	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5533	015	2	1	04	01	H5533_015_2	17	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5533	015	3	1	04	01	H5533_015_3	17	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5533	015	4	1	04	01	H5533_015_4	15	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5533	015	6	1	04	01	H5533_015_6	16	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5533	016	1	1	04	01	H5533_016_1	14	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5533	016	2	1	04	01	H5533_016_2	13	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5533	017	1	1	04	01	H5533_017_1	15	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5533	017	2	1	04	01	H5533_017_2	15	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5580	004	0	1	01	01	H5580_004_0	5	1																										1	2	2				2				2		2	2			2		2			1	00010		2																																																																																	
H5593	001	0	1	01	01	H5593_001_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5593	801	0	1	01	01	H5593_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5593	801	0	1	01	01	H5593_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5619	173	0	1	01	01	H5619_173_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H5628	013	1	1	01	01	H5628_013_1	9	2																																																			1	2	001	2				2				2			2		2			1	2																																																												
H5628	013	2	1	01	01	H5628_013_2	9	2																																																			1	2	001	2				2				2			2		2			1	2																																																												
H5793	017	0	1	02	01	H5793_017_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5793	019	0	1	02	01	H5793_019_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5793	020	0	1	02	01	H5793_020_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5793	801	0	1	01	01	H5793_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5793	801	0	1	01	01	H5793_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5793	802	0	1	01	01	H5793_802_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5793	802	0	1	01	01	H5793_802_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5826	014	0	1	01	01	H5826_014_0	5	3																										1	2	2				2				2		2	2			2		2			2	10000	Mail order	2																																																																																	
H5826	017	0	1	01	01	H5826_017_0	6	3																										1	2	2				2				2		2	2			2		2			2	10000	Mail order	2																																																																																	
H5852	001	0	1	01	01	H5852_001_0	6	1																																																			1	2	101	2				2				2			2		2			1	1																																																												
H5859	001	0	1	01	01	H5859_001_0	9	1																										1	2	2				2				1	1	1	2			2		2			1	00010		2																																																																																	
H5943	003	0	1	02	01	H5943_003_0	7	1																										1	2	2				2				1	1	1	2			2		2			1	00010		2																																																																																	
H5943	004	0	1	02	01	H5943_004_0	7	1																										1	2	2				2				1	1	1	2			2		2			1	00010		2																																																																																	
H6154	001	0	1	02	01	H6154_001_0	4	1																																																			1	2	111	2				2				2			2		2			2	2	Osteoporosis Services	2	2				2				2			2		2			2	2																																								
H6170	001	0	1	02	01	H6170_001_0	9	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6170	002	0	1	02	01	H6170_002_0	12	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6170	003	0	1	02	01	H6170_003_0	10	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6170	007	0	1	01	01	H6170_007_0	8	1																										1	2	2				2				2		2	2			2		2			1	00010		2																																																																																	
H6170	008	0	1	01	01	H6170_008_0	7	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6170	009	0	1	01	01	H6170_009_0	11	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6170	010	0	1	01	01	H6170_010_0	10	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6399	001	0	1	01	01	H6399_001_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H6474	001	0	1	02	01	H6474_001_0	8	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6474	002	0	1	02	01	H6474_002_0	9	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6474	003	0	1	02	01	H6474_003_0	8	1																										1	2	2				2				2		2	2			2		2			1	00010		2																																																																																	
H6474	007	0	1	01	01	H6474_007_0	8	1																										1	2	2				2				2		2	2			2		2			1	00010		2																																																																																	
H6474	008	0	1	01	01	H6474_008_0	7	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6474	009	0	1	01	01	H6474_009_0	11	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6474	010	0	1	01	01	H6474_010_0	11	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6622	033	0	1	01	01	H6622_033_0	2	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H6622	057	0	1	02	01	H6622_057_0	5	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H6874	001	0	1	04	01	H6874_001_0	9	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H6874	003	0	1	04	01	H6874_003_0	8	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7149	006	0	1	01	01	H7149_006_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H7149	801	0	1	01	01	H7149_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H7149	801	0	1	01	01	H7149_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H7301	002	0	1	04	01	H7301_002_0	2	1																										1	2	2				2				2		2	2			2		1	0.00	0.00	2	10000	Restricted Items	2																																																																																	
H7301	006	0	1	04	01	H7301_006_0	2	1																										1	2	2				2				2		2	2			2		1	0.00	0.00	2	10000	Restricted Items	2																																																																																	
H7301	803	0	1	04	01	H7301_803_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H7301	803	0	1	04	01	H7301_803_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H7607	014	0	1	01	01	H7607_014_0	12	1																																																			1	2	001	2				2				2			2		2			1	1																																																												
H7607	016	0	1	01	01	H7607_016_0	11	1																																																			1	2	001	2				2				2			2		2			1	1																																																												
H7607	017	0	1	01	01	H7607_017_0	11	1																																																			1	2	001	2				2				2			2		2			1	1																																																												
H7617	053	0	1	04	01	H7617_053_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H7617	063	0	1	04	01	H7617_063_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H7617	095	0	1	04	01	H7617_095_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H8298	001	0	1	01	01	H8298_001_0	7	1																										1	2	2				2				2		2	2			2		2			2	00010		2																																																																																	
H8332	801	0	1	01	01	H8332_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H8332	801	0	1	01	01	H8332_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H8597	001	0	1	01	01	H8597_001_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H8597	002	0	1	01	01	H8597_002_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H8597	003	0	1	01	01	H8597_003_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H8649	010	0	1	01	01	H8649_010_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H8649	801	0	1	01	01	H8649_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H8649	801	0	1	01	01	H8649_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H8649	803	0	1	01	01	H8649_803_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H8649	803	0	1	01	01	H8649_803_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H8889	001	0	1	04	01	H8889_001_0	5	1																																																			1	2	111	2				2				2			2		2			2	2	Osteoporosis Services	2	2				2				2			2		2			2	2																																								
H8889	002	0	1	04	01	H8889_002_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	003	0	1	04	01	H8889_003_0	5	1																																																			1	2	111	2				2				2			2		2			2	2	Osteoporosis Services	2	2				2				2			2		2			2	2																																								
H8889	004	0	1	04	01	H8889_004_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	005	0	1	04	01	H8889_005_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	008	0	1	04	01	H8889_008_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	009	0	1	04	01	H8889_009_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	010	0	1	04	01	H8889_010_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	011	0	1	04	01	H8889_011_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	012	0	1	04	01	H8889_012_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	013	0	1	04	01	H8889_013_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	014	0	1	04	01	H8889_014_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	015	0	1	04	01	H8889_015_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	017	0	1	04	01	H8889_017_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	018	0	1	04	01	H8889_018_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8908	007	0	1	01	01	H8908_007_0	3	1																										1	2	2				2				1	1	1	2			2		2			2	10000	Purchases must be coordinated by a care manager on the member's behalf through the plan's approved vendor.	1																																																																																	
H9003	001	0	1	02	01	H9003_001_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H9003	006	0	1	02	01	H9003_006_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H9003	009	0	1	02	01	H9003_009_0	4	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H9314	001	0	1	01	01	H9314_001_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H9431	801	0	1	04	01	H9431_801_0	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H9431	801	0	1	04	01	H9431_801_0	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11000	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H9615	021	0	1	04	01	H9615_021_0	16	1																										1	2	2				2				2		2	2			2		2			2	01000		2																																																																																	
H9615	022	0	1	04	01	H9615_022_0	16	1																										1	2	2				2				2		2	2			2		2			2	01000		2																																																																																	
H9615	023	0	1	04	01	H9615_023_0	16	1																										1	2	2				2				2		2	2			2		2			2	01000		2																																																																																	
H9615	024	0	1	04	01	H9615_024_0	16	1																										1	2	2				2				2		2	2			2		2			2	01000		2																																																																																	
H9771	001	0	1	01	01	H9771_001_0	2	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H9834	001	0	1	01	01	H9834_001_0	5	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	45.00	2	2																																								
H9834	001	0	1	01	01	H9834_001_0	5	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H9834	003	0	1	01	01	H9834_003_0	4	1																										1	2	2				2				2		2	2			2		2			2	00100		1																																																																																	
H9834	003	0	1	01	01	H9834_003_0	4	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	50.00	2	2																																								
H9834	004	0	1	01	01	H9834_004_0	3	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	45.00	2	2																																								
H9834	004	0	1	01	01	H9834_004_0	3	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H9834	006	0	1	01	01	H9834_006_0	4	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	55.00	2	2																																								
H9834	006	0	1	01	01	H9834_006_0	4	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H9834	007	0	1	01	01	H9834_007_0	4	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	55.00	2	2																																								
H9834	007	0	1	01	01	H9834_007_0	4	1																										1	2	2				2				2		2	2			2		2			2	00101		1																																																																																	
H9986	002	0	1	02	01	H9986_002_0	8	1																																																																								Advanced Care At Home	2	2				2				1	20	20	2		2			1	2																																								
H9986	002	0	1	02	01	H9986_002_0	8	2																																																			1	2	001	2				2				2			2		2			1	2																																																												
H9986	004	1	1	02	01	H9986_004_1	10	2																																																			1	2	001	2				2				2			2		2			1	2																																																												
H9986	004	1	1	02	01	H9986_004_1	10	1																																																																								Advanced Care At Home	2	2				2				1	20	20	2		2			1	2																																								
H9986	004	2	1	02	01	H9986_004_2	10	2																																																			1	2	001	2				2				2			2		2			1	2																																																												
H9986	004	2	1	02	01	H9986_004_2	10	1																																																																								Advanced Care At Home	2	2				2				1	20	20	2		2			1	2																																								
H9986	004	3	1	02	01	H9986_004_3	10	2																																																			1	2	001	2				2				2			2		2			1	2																																																												
H9986	004	3	1	02	01	H9986_004_3	10	1																																																																								Advanced Care At Home	2	2				2				1	20	20	2		2			1	2																																								
