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	007	0	1	01	01	H0028_007_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	014	0	1	01	01	H0028_014_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	015	0	1	02	01	H0028_015_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	016	0	1	02	01	H0028_016_0	7	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	017	0	1	01	01	H0028_017_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	019	0	1	01	01	H0028_019_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	021	0	1	01	01	H0028_021_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	024	0	1	01	01	H0028_024_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	028	0	1	01	01	H0028_028_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	029	0	1	01	01	H0028_029_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	030	0	1	01	01	H0028_030_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	032	0	1	01	01	H0028_032_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	035	0	1	01	01	H0028_035_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	036	0	1	01	01	H0028_036_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	037	0	1	01	01	H0028_037_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	039	0	1	01	01	H0028_039_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	041	0	1	01	01	H0028_041_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	042	0	1	01	01	H0028_042_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	043	1	1	01	01	H0028_043_1	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	043	2	1	01	01	H0028_043_2	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	046	0	1	01	01	H0028_046_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	046	0	1	01	01	H0028_046_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	051	0	1	01	01	H0028_051_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	053	1	1	01	01	H0028_053_1	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	053	3	1	01	01	H0028_053_3	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	054	1	1	02	01	H0028_054_1	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	054	2	1	02	01	H0028_054_2	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	055	0	1	02	01	H0028_055_0	7	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	056	0	1	02	01	H0028_056_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	059	0	1	01	01	H0028_059_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	060	0	1	01	01	H0028_060_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	062	0	1	01	01	H0028_062_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	063	0	1	01	01	H0028_063_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	065	0	1	01	01	H0028_065_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	066	0	1	02	01	H0028_066_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	067	0	1	02	01	H0028_067_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	070	0	1	01	01	H0028_070_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	072	0	1	01	01	H0028_072_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	074	1	1	01	01	H0028_074_1	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	074	2	1	01	01	H0028_074_2	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	076	0	1	01	01	H0028_076_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	077	0	1	01	01	H0028_077_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	078	0	1	01	01	H0028_078_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	079	0	1	01	01	H0028_079_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	080	0	1	01	01	H0028_080_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	081	1	1	01	01	H0028_081_1	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	081	2	1	01	01	H0028_081_2	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0028	082	0	1	01	01	H0028_082_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0292	001	0	1	01	01	H0292_001_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0292	002	0	1	01	01	H0292_002_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0292	003	0	1	01	01	H0292_003_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0292	004	0	1	02	01	H0292_004_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0473	003	0	1	04	01	H0473_003_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0473	003	0	1	04	01	H0473_003_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																																																																																	
H0473	004	0	1	04	01	H0473_004_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0473	005	0	1	04	01	H0473_005_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H0523	074	0	1	01	01	H0523_074_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0523	094	0	1	01	01	H0523_094_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0523	095	0	1	01	01	H0523_095_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0523	096	0	1	01	01	H0523_096_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0523	097	0	1	01	01	H0523_097_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0523	098	0	1	01	01	H0523_098_0	3	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	11010	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	11010	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	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H0523	808	0	1	01	01	H0523_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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H0523	808	0	1	01	01	H0523_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	11010	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	6	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	6	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	6	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	6	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	6	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	6	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	7	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	6	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	6	1																																																																																																																Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	2	1
H0571	005	0	1	01	01	H0571_005_0	7	1																										1	2	2				2				2		2	2			2		2			1	00010		2																																																																																	
H0628	001	0	1	02	01	H0628_001_0	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	042	0	1	01	01	H0628_042_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	043	0	1	01	01	H0628_043_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	044	0	1	01	01	H0628_044_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H0628	045	0	1	02	01	H0628_045_0	3	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	1	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	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	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H0630	013	0	1	02	01	H0630_013_0	9	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	9	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	8	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	8	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	8	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	8	1																																																																																												Advanced Care at Home	2	2				2				2			2		1	0.00	0.00	1	1																				
H0963	001	0	1	01	01	H0963_001_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	001	0	1	02	01	H1019_001_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	001	0	1	02	01	H1019_001_0	6	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	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	006	0	1	01	01	H1019_006_0	6	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	023	0	1	01	01	H1019_023_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	043	0	1	02	01	H1019_043_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	057	0	1	02	01	H1019_057_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	065	0	1	01	01	H1019_065_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	073	0	1	01	01	H1019_073_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	094	0	1	01	01	H1019_094_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	103	1	1	02	01	H1019_103_1	6	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	02	01	H1019_103_1	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	103	2	1	02	01	H1019_103_2	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	103	2	1	02	01	H1019_103_2	6	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	104	1	1	01	01	H1019_104_1	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	104	2	1	01	01	H1019_104_2	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	109	0	1	01	01	H1019_109_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	113	0	1	01	01	H1019_113_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																																																																																	
H1019	113	0	1	01	01	H1019_113_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	118	0	1	01	01	H1019_118_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	121	0	1	01	01	H1019_121_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	123	0	1	01	01	H1019_123_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	124	0	1	02	01	H1019_124_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	124	0	1	02	01	H1019_124_0	6	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	130	0	1	02	01	H1019_130_0	7	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	130	0	1	02	01	H1019_130_0	7	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	132	0	1	01	01	H1019_132_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	134	0	1	01	01	H1019_134_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	135	0	1	02	01	H1019_135_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	136	0	1	01	01	H1019_136_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	138	0	1	01	01	H1019_138_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	139	0	1	01	01	H1019_139_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	144	0	1	01	01	H1019_144_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	146	0	1	01	01	H1019_146_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	147	1	1	01	01	H1019_147_1	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	147	2	1	01	01	H1019_147_2	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	147	2	1	01	01	H1019_147_2	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																																																																																	
H1019	148	0	1	01	01	H1019_148_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	149	0	1	01	01	H1019_149_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	150	0	1	01	01	H1019_150_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	151	1	1	01	01	H1019_151_1	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	151	2	1	01	01	H1019_151_2	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	151	2	1	01	01	H1019_151_2	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																																																																																	
H1019	153	0	1	01	01	H1019_153_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	154	0	1	01	01	H1019_154_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	155	0	1	02	01	H1019_155_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1019	156	0	1	01	01	H1019_156_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	025	0	1	01	01	H1036_025_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	044	0	1	01	01	H1036_044_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	054	0	1	01	01	H1036_054_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	054	0	1	01	01	H1036_054_0	6	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	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	062	0	1	01	01	H1036_062_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	065	0	1	01	01	H1036_065_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	065	0	1	01	01	H1036_065_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	068	0	1	01	01	H1036_068_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	074	0	1	01	01	H1036_074_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	077	0	1	01	01	H1036_077_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	102	0	1	01	01	H1036_102_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	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	119	0	1	01	01	H1036_119_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	121	0	1	01	01	H1036_121_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	137	0	1	02	01	H1036_137_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	143	0	1	01	01	H1036_143_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	146	0	1	01	01	H1036_146_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	151	0	1	01	01	H1036_151_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	153	0	1	01	01	H1036_153_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	157	0	1	01	01	H1036_157_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	167	0	1	01	01	H1036_167_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	209	0	1	01	01	H1036_209_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	209	0	1	01	01	H1036_209_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	210	0	1	01	01	H1036_210_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	210	0	1	01	01	H1036_210_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	213	0	1	01	01	H1036_213_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	213	0	1	01	01	H1036_213_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	214	0	1	01	01	H1036_214_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	214	0	1	01	01	H1036_214_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	217	0	1	01	01	H1036_217_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	222	0	1	01	01	H1036_222_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	226	0	1	01	01	H1036_226_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	229	0	1	01	01	H1036_229_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	230	0	1	01	01	H1036_230_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	230	0	1	01	01	H1036_230_0	6	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	233	0	1	02	01	H1036_233_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	234	0	1	01	01	H1036_234_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	236	0	1	01	01	H1036_236_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	265	1	1	01	01	H1036_265_1	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	265	2	1	01	01	H1036_265_2	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	266	0	1	01	01	H1036_266_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	269	0	1	01	01	H1036_269_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	270	0	1	01	01	H1036_270_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	271	0	1	01	01	H1036_271_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	278	0	1	01	01	H1036_278_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	279	0	1	01	01	H1036_279_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	280	0	1	01	01	H1036_280_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	285	0	1	01	01	H1036_285_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	285	0	1	01	01	H1036_285_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	286	0	1	01	01	H1036_286_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	290	0	1	01	01	H1036_290_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	292	0	1	01	01	H1036_292_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	297	0	1	01	01	H1036_297_0	7	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	298	0	1	01	01	H1036_298_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	299	0	1	01	01	H1036_299_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	300	0	1	01	01	H1036_300_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	301	0	1	01	01	H1036_301_0	6	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	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	302	0	1	01	01	H1036_302_0	6	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	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	304	0	1	01	01	H1036_304_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	304	0	1	01	01	H1036_304_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	305	0	1	01	01	H1036_305_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	306	0	1	01	01	H1036_306_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	307	0	1	01	01	H1036_307_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	308	0	1	01	01	H1036_308_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	310	0	1	01	01	H1036_310_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	311	0	1	01	01	H1036_311_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	312	0	1	01	01	H1036_312_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	313	0	1	01	01	H1036_313_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	314	0	1	01	01	H1036_314_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	314	0	1	01	01	H1036_314_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	315	0	1	01	01	H1036_315_0	6	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	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	316	0	1	01	01	H1036_316_0	6	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	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	317	0	1	01	01	H1036_317_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	318	0	1	02	01	H1036_318_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	319	0	1	01	01	H1036_319_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	321	0	1	01	01	H1036_321_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	322	0	1	01	01	H1036_322_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	323	0	1	01	01	H1036_323_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	325	0	1	01	01	H1036_325_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	327	0	1	01	01	H1036_327_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	328	0	1	01	01	H1036_328_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	329	0	1	01	01	H1036_329_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	331	0	1	01	01	H1036_331_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	332	0	1	01	01	H1036_332_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	333	0	1	01	01	H1036_333_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	334	0	1	01	01	H1036_334_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	335	1	1	02	01	H1036_335_1	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	335	2	1	02	01	H1036_335_2	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	336	0	1	01	01	H1036_336_0	6	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	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
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	337	0	1	01	01	H1036_337_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	338	0	1	01	01	H1036_338_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	338	0	1	01	01	H1036_338_0	6	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	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	340	0	1	01	01	H1036_340_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	340	0	1	01	01	H1036_340_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	341	0	1	01	01	H1036_341_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	341	0	1	01	01	H1036_341_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	342	0	1	01	01	H1036_342_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	343	0	1	02	01	H1036_343_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1036	344	0	1	01	01	H1036_344_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
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	11010	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	11010	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	11010	Retail Store	2	1	2	111	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	11010	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	805	0	1	01	01	H1109_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	11010	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	805	0	1	01	01	H1109_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	11010	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	6	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	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1206	010	0	1	01	01	H1206_010_0	3	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	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H1280	001	0	1	01	01	H1280_001_0	8	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H1396	001	0	1	01	01	H1396_001_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1468	007	0	1	01	01	H1468_007_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1468	013	0	1	01	01	H1468_013_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1468	017	0	1	01	01	H1468_017_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1468	021	0	1	01	01	H1468_021_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1526	001	0	1	02	01	H1526_001_0	7	1																										1	2	2				2				2		2	2			2		2			1	01010		1																																																																																	
H1526	002	0	1	02	01	H1526_002_0	8	1																										1	2	2				2				2		2	2			2		2			1	01010		1																																																																																	
H1526	003	0	1	02	01	H1526_003_0	6	1																										1	2	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	6	1																										1	2	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	009	0	1	02	01	H1526_009_0	6	1																										1	2	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	010	0	1	02	01	H1526_010_0	5	1																										1	2	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	011	0	1	02	01	H1526_011_0	5	1																										1	2	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	012	0	1	02	01	H1526_012_0	5	1																										1	2	2				2				2		2	2			2		2			1	01010		1																																																																																	
H1526	013	0	1	02	01	H1526_013_0	5	1																										1	2	2				2				2		2	2			2		2			1	01010		1																																																																																	
H1608	021	0	1	04	01	H1608_021_0	4	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	5	2																										1	2	2				2				2		2	2			2		1	0.00	0.00	2	01000		2	1	2	001	2				2				2			2		1	0.00	0.00	2	2																																																												
H1608	027	0	1	04	01	H1608_027_0	5	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1608	062	0	1	04	01	H1608_062_0	5	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	4	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	2	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H1608	801	0	1	04	01	H1608_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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H1609	043	0	1	01	01	H1609_043_0	4	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	4	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	4	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	4	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	4	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	4	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	4	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	062	0	1	01	01	H1609_062_0	4	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	4	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	5	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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	5	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	093	0	1	01	01	H1609_093_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	098	0	1	01	01	H1609_098_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	099	0	1	01	01	H1609_099_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	101	0	1	01	01	H1609_101_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	102	0	1	01	01	H1609_102_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	103	0	1	01	01	H1609_103_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	104	0	1	01	01	H1609_104_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1609	105	0	1	01	01	H1609_105_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	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	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	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	11010	Retail Store	2	1	2	111	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	11010	Retail Store	2	1	2	111	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	11010	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	810	0	1	01	01	H1609_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	11010	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	810	0	1	01	01	H1609_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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H1610	001	0	1	01	01	H1610_001_0	3	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	3	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	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1692	010	0	1	01	01	H1692_010_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H1692	011	0	1	01	01	H1692_011_0	3	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	11010	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	11010	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H1822	011	0	1	02	01	H1822_011_0	10	1																										1	2	2				2				1	1	1	2			2		2			1	01010		2	1	2	011	2				2				2			2		2			1	2																																																												
H1951	013	0	1	01	01	H1951_013_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	024	0	1	01	01	H1951_024_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	028	0	1	01	01	H1951_028_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	032	0	1	01	01	H1951_032_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	038	0	1	01	01	H1951_038_0	7	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	039	0	1	01	01	H1951_039_0	7	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	041	0	1	01	01	H1951_041_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	044	0	1	01	01	H1951_044_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	047	1	1	01	01	H1951_047_1	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	047	2	1	01	01	H1951_047_2	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	048	1	1	01	01	H1951_048_1	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	048	2	1	01	01	H1951_048_2	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	049	1	1	01	01	H1951_049_1	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	049	2	1	01	01	H1951_049_2	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	049	3	1	01	01	H1951_049_3	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	051	0	1	01	01	H1951_051_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	052	0	1	01	01	H1951_052_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	053	0	1	01	01	H1951_053_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	056	0	1	01	01	H1951_056_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	057	0	1	01	01	H1951_057_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	059	0	1	01	01	H1951_059_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	060	0	1	01	01	H1951_060_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	061	0	1	01	01	H1951_061_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H1951	062	0	1	01	01	H1951_062_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	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	11010	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	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	11010	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	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H2056	804	0	1	01	01	H2056_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	11010	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	804	0	1	01	01	H2056_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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H2172	001	0	1	02	01	H2172_001_0	6	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	7	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	5	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	6	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	6	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	6	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	6	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	7	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H2237	007	0	1	01	01	H2237_007_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H2293	001	0	1	04	01	H2293_001_0	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2463	001	0	1	01	01	H2463_001_0	7	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H2486	003	0	1	01	01	H2486_003_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H2486	005	0	1	01	01	H2486_005_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H2663	034	0	1	01	01	H2663_034_0	3	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	3	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	3	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	4	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	3	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	3	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	3	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	3	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	3	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	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	104	0	1	01	01	H2663_104_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	107	0	1	01	01	H2663_107_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	108	0	1	01	01	H2663_108_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	109	0	1	01	01	H2663_109_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	110	0	1	01	01	H2663_110_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	112	0	1	01	01	H2663_112_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	114	0	1	01	01	H2663_114_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	116	0	1	01	01	H2663_116_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H2663	117	0	1	01	01	H2663_117_0	3	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	11010	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H2694	002	0	1	04	01	H2694_002_0	10	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H2875	001	0	1	02	01	H2875_001_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H2875	001	0	1	02	01	H2875_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																																																																																	
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	002	0	1	02	01	H2875_002_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H2875	003	0	1	01	01	H2875_003_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H2875	004	0	1	01	01	H2875_004_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H2875	005	0	1	01	01	H2875_005_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
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																																																																																	
H2875	006	0	1	02	01	H2875_006_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H3146	002	0	1	01	01	H3146_002_0	4	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3146	053	0	1	01	01	H3146_053_0	4	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	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	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	11010	Retail Store	2	1	2	111	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	11010	Retail Store	2	1	2	111	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	11010	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	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	11010	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	11010	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	807	0	1	01	01	H3152_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	11010	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	807	0	1	01	01	H3152_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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3192	007	0	1	01	01	H3192_007_0	3	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	3	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	3	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	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3192	036	0	1	01	01	H3192_036_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3192	037	0	1	01	01	H3192_037_0	3	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	11010	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3219	015	0	1	04	01	H3219_015_0	3	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	3	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	11010	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3239	001	0	1	01	01	H3239_001_0	5	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	3	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	3	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	3	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	4	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	3	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	3	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	3	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	3	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	3	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	3	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	4	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	3	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	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3239	031	0	1	01	01	H3239_031_0	3	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	5	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	3	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	5	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	3	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	11010	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3291	002	0	1	01	01	H3291_002_0	6	1																																																			1	2	101	2				2				2			2		2			2	2																																																												
H3305	007	0	1	02	01	H3305_007_0	6	1																										1	2	2				2				2		2	2			2		2			2	01000		1																																																																																	
H3305	015	0	1	02	01	H3305_015_0	7	1																										1	2	2				2				2		2	2			2		2			2	01000		1																																																																																	
H3305	020	0	1	02	01	H3305_020_0	6	1																										1	2	2				2				2		2	2			2		2			2	01000		1																																																																																	
H3305	022	0	1	02	01	H3305_022_0	8	1																										1	2	2				2				2		2	2			2		2			2	01000		1																																																																																	
H3305	038	0	1	02	01	H3305_038_0	8	1																										1	2	2				2				2		2	2			2		2			2	01000		1																																																																																	
H3305	039	0	1	02	01	H3305_039_0	8	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	4	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	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	105	0	1	01	01	H3312_105_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3312	111	0	1	01	01	H3312_111_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3312	112	0	1	01	01	H3312_112_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	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	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	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	11010	Retail Store	2	1	2	111	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	11010	Retail Store	2	1	2	111	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	11010	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	807	0	1	01	01	H3312_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	11010	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	807	0	1	01	01	H3312_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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3407	001	0	1	01	01	H3407_001_0	8	1																										1	2	2				2				1	1	1	2			2		2			1	00010		2																																																																																	
H3407	004	0	1	01	01	H3407_004_0	8	1																										1	2	2				2				1	1	1	2			2		2			1	00010		2																																																																																	
H3533	033	0	1	01	01	H3533_033_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H3533	035	0	1	01	01	H3533_035_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H3533	036	1	1	01	01	H3533_036_1	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H3533	036	2	1	01	01	H3533_036_2	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H3533	037	0	1	01	01	H3533_037_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H3551	004	0	1	01	01	H3551_004_0	8	1																										1	2	2				2				1	1	1	2			2		2			1	01011		2																																																																																	
H3551	005	0	1	01	01	H3551_005_0	11	1																										1	2	2				2				1	1	1	2			2		2			1	01010		2																																																																																	
H3597	011	0	1	02	01	H3597_011_0	3	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	3	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	11010	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	11010	Retail Store	2	1	2	111	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	11010	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	11010	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	804	0	1	01	01	H3597_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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3597	804	0	1	01	01	H3597_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	11010	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H3642	001	0	1	04	01	H3642_001_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H3660	028	0	1	02	01	H3660_028_0	10	1																																																			1	2	001	2				2				2			2		2			2	2																																																												
H3660	029	0	1	02	01	H3660_029_0	10	2																																																			1	2	001	2				2				2			2		2			2	2																																																												
H3660	044	0	1	01	01	H3660_044_0	10	2																																																			1	2	001	2				2				2			2		2			2	2																																																												
H3660	058	0	1	01	01	H3660_058_0	8	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	5	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	020	0	1	01	01	H3748_020_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		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	11010	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3755	006	0	1	01	01	H3755_006_0	6	1																																																			1	2	011	2				2				2			2		2			1	1																																																												
H3767	001	0	1	01	01	H3767_001_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H3767	002	0	1	01	01	H3767_002_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H3907	002	0	1	01	01	H3907_002_0	9	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	006	0	1	01	01	H3907_006_0	8	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	037	0	1	01	01	H3907_037_0	8	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	057	1	1	01	01	H3907_057_1	8	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	057	2	1	01	01	H3907_057_2	7	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	057	3	1	01	01	H3907_057_3	8	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	057	4	1	01	01	H3907_057_4	8	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	057	8	1	01	01	H3907_057_8	7	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	058	1	1	01	01	H3907_058_1	7	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	058	2	1	01	01	H3907_058_2	7	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	058	3	1	01	01	H3907_058_3	7	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	059	1	1	01	01	H3907_059_1	9	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	059	2	1	01	01	H3907_059_2	8	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	059	3	1	01	01	H3907_059_3	9	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	061	0	1	01	01	H3907_061_0	7	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	062	0	1	01	01	H3907_062_0	7	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	063	0	1	01	01	H3907_063_0	7	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3907	064	0	1	01	01	H3907_064_0	7	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H3928	001	0	1	01	01	H3928_001_0	5	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	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	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	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	11010	Retail Store	2	1	2	111	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	11010	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	11010	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	805	0	1	01	01	H3928_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	11010	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	805	0	1	01	01	H3928_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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3931	095	0	1	02	01	H3931_095_0	3	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	3	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	3	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	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	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	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	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	11010	Retail Store	2	1	2	111	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	11010	Retail Store	2	1	2	111	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	11010	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	808	0	1	01	01	H3931_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	11010	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	808	0	1	01	01	H3931_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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H3959	010	0	1	02	01	H3959_010_0	3	1																										1	2	2				2				2		2	2			2		1	0.00	0.00	2	01000		2																																																																																	
H3959	010	0	1	02	01	H3959_010_0	3	3																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	011	0	1	02	01	H3959_011_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	011	0	1	02	01	H3959_011_0	3	3																										1	2	2				2				2		2	2			2		1	0.00	0.00	2	01000		2																																																																																	
H3959	032	0	1	02	01	H3959_032_0	3	1																										1	2	2				2				2		2	2			2		1	0.00	0.00	2	01000		2																																																																																	
H3959	032	0	1	02	01	H3959_032_0	3	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	3	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	3	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	3	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	3	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	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	3	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	3	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	3	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	3	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	3	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	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	088	0	1	01	01	H3959_088_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	089	0	1	01	01	H3959_089_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	090	0	1	01	01	H3959_090_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	091	0	1	01	01	H3959_091_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	092	0	1	01	01	H3959_092_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	097	0	1	01	01	H3959_097_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H3959	098	0	1	01	01	H3959_098_0	3	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	11010	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H4003	009	0	1	01	01	H4003_009_0	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4003	017	0	1	01	01	H4003_017_0	5	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4003	034	0	1	02	01	H4003_034_0	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4003	058	0	1	01	01	H4003_058_0	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4003	059	1	1	02	01	H4003_059_1	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4003	059	2	1	02	01	H4003_059_2	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4003	059	3	1	02	01	H4003_059_3	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	048	0	1	01	01	H4004_048_0	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	056	0	1	02	01	H4004_056_0	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	065	0	1	02	01	H4004_065_0	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	066	0	1	02	01	H4004_066_0	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	068	0	1	01	01	H4004_068_0	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	070	0	1	02	01	H4004_070_0	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	071	0	1	02	01	H4004_071_0	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	072	1	1	01	01	H4004_072_1	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	072	2	1	01	01	H4004_072_2	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	072	3	1	01	01	H4004_072_3	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	073	1	1	02	01	H4004_073_1	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	073	2	1	02	01	H4004_073_2	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	073	3	1	02	01	H4004_073_3	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	075	0	1	02	01	H4004_075_0	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	076	1	1	01	01	H4004_076_1	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	076	2	1	01	01	H4004_076_2	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4004	076	3	1	01	01	H4004_076_3	4	1																										1	2	2				2				1	1	2	2			2		2			2	01010		2																																																																																	
H4140	013	0	1	01	01	H4140_013_0	8	1																										1	2	2				2				1	1	1	2			2		2			1	01010		2																																																																																	
H4140	017	0	1	01	01	H4140_017_0	8	1																										1	2	2				2				1	1	1	2			2		2			1	01010		2																																																																																	
H4140	020	0	1	01	01	H4140_020_0	8	1																										1	2	2				2				1	1	1	2			2		2			1	01010		2																																																																																	
H4140	021	0	1	01	01	H4140_021_0	8	1																										1	2	2				2				1	1	1	2			2		2			1	01010		2																																																																																	
H4140	023	0	1	01	01	H4140_023_0	9	1																										1	2	2				2				1	1	1	2			2		2			1	01010		2																																																																																	
H4140	024	0	1	01	01	H4140_024_0	8	1																										1	2	2				2				1	1	1	2			2		2			1	01010		2																																																																																	
H4141	003	0	1	01	01	H4141_003_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4141	015	0	1	01	01	H4141_015_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4141	017	3	1	01	01	H4141_017_3	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4141	017	5	1	01	01	H4141_017_5	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4141	022	0	1	01	01	H4141_022_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4141	023	0	1	01	01	H4141_023_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4141	024	0	1	01	01	H4141_024_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	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																																																																																	
H4329	001	0	1	01	01	H4329_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																																																																																	
H4329	001	0	1	01	01	H4329_001_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	004	0	1	01	01	H4461_004_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	022	0	1	01	01	H4461_022_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
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	025	0	1	01	01	H4461_025_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	038	0	1	01	01	H4461_038_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
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	039	0	1	01	01	H4461_039_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	042	0	1	01	01	H4461_042_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	043	1	1	01	01	H4461_043_1	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	043	2	1	01	01	H4461_043_2	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	044	0	1	02	01	H4461_044_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	045	0	1	01	01	H4461_045_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	046	0	1	01	01	H4461_046_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	047	0	1	02	01	H4461_047_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	048	0	1	02	01	H4461_048_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	049	0	1	01	01	H4461_049_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	050	0	1	01	01	H4461_050_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	051	0	1	01	01	H4461_051_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	052	0	1	01	01	H4461_052_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	052	0	1	01	01	H4461_052_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	053	0	1	01	01	H4461_053_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	054	0	1	01	01	H4461_054_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	055	0	1	01	01	H4461_055_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	056	0	1	01	01	H4461_056_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	057	0	1	01	01	H4461_057_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	058	0	1	01	01	H4461_058_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	059	0	1	01	01	H4461_059_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	060	0	1	01	01	H4461_060_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	061	0	1	01	01	H4461_061_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	062	0	1	01	01	H4461_062_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	063	0	1	01	01	H4461_063_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	064	0	1	01	01	H4461_064_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	065	0	1	01	01	H4461_065_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	066	0	1	01	01	H4461_066_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	067	0	1	01	01	H4461_067_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	068	0	1	01	01	H4461_068_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	069	0	1	01	01	H4461_069_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	070	0	1	01	01	H4461_070_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	071	0	1	01	01	H4461_071_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	072	0	1	01	01	H4461_072_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	073	0	1	01	01	H4461_073_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	074	0	1	01	01	H4461_074_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	075	0	1	01	01	H4461_075_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	076	0	1	01	01	H4461_076_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	077	0	1	01	01	H4461_077_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	078	0	1	01	01	H4461_078_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	079	0	1	01	01	H4461_079_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	080	1	1	01	01	H4461_080_1	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	080	2	1	01	01	H4461_080_2	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	081	1	1	01	01	H4461_081_1	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	081	2	1	01	01	H4461_081_2	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	082	0	1	01	01	H4461_082_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	083	1	1	01	01	H4461_083_1	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	083	2	1	01	01	H4461_083_2	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	084	0	1	01	01	H4461_084_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	084	0	1	01	01	H4461_084_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4461	085	0	1	01	01	H4461_085_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
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	4	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	047	0	1	01	01	H4523_047_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	048	0	1	01	01	H4523_048_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	049	0	1	01	01	H4523_049_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	050	0	1	01	01	H4523_050_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4523	051	0	1	01	01	H4523_051_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	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	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	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	11010	Retail Store	2	1	2	111	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	11010	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	11010	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	805	0	1	01	01	H4523_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	11010	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	805	0	1	01	01	H4523_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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H4623	001	0	1	02	01	H4623_001_0	7	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4623	002	0	1	02	01	H4623_002_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4711	011	0	1	01	01	H4711_011_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H4711	014	0	1	01	01	H4711_014_0	4	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	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	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	11010	Retail Store	2	1	2	111	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	11010	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H4869	001	0	1	02	01	H4869_001_0	7	1																										1	2	2				2				2		2	2			2		2			1	01010		1																																																																																	
H4869	003	0	1	02	01	H4869_003_0	6	1																										1	2	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	7	1																										1	2	2				2				2		2	2			2		2			1	01010		1																																																																																	
H4869	013	0	1	02	01	H4869_013_0	6	1																										1	2	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	5	1																										1	2	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	015	0	1	02	01	H4869_015_0	5	1																										1	2	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	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																																																																																	
H4939	001	0	1	02	01	H4939_001_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4939	002	0	1	02	01	H4939_002_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4939	003	0	1	02	01	H4939_003_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4939	004	0	1	02	01	H4939_004_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																																																																																	
H4939	004	0	1	02	01	H4939_004_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H4982	022	0	1	01	01	H4982_022_0	3	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	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	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	11010	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5050	004	0	1	01	01	H5050_004_0	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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																																																																																	
H5178	002	0	1	01	01	H5178_002_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5178	003	0	1	01	01	H5178_003_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5178	004	0	1	01	01	H5178_004_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	001	0	1	04	01	H5216_001_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	001	0	1	04	01	H5216_001_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	006	0	1	04	01	H5216_006_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	006	0	1	04	01	H5216_006_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	011	0	1	04	01	H5216_011_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	011	0	1	04	01	H5216_011_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	013	0	1	04	01	H5216_013_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	013	0	1	04	01	H5216_013_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	014	0	1	04	01	H5216_014_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	014	0	1	04	01	H5216_014_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	017	0	1	04	01	H5216_017_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	017	0	1	04	01	H5216_017_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	019	0	1	04	01	H5216_019_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	019	0	1	04	01	H5216_019_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	023	0	1	04	01	H5216_023_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	023	0	1	04	01	H5216_023_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	027	0	1	04	01	H5216_027_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	027	0	1	04	01	H5216_027_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	032	0	1	04	01	H5216_032_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	032	0	1	04	01	H5216_032_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	034	0	1	04	01	H5216_034_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	034	0	1	04	01	H5216_034_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	037	0	1	04	01	H5216_037_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	037	0	1	04	01	H5216_037_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	039	0	1	04	01	H5216_039_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	039	0	1	04	01	H5216_039_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	042	0	1	04	01	H5216_042_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	042	0	1	04	01	H5216_042_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	043	1	1	04	01	H5216_043_1	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	043	1	1	04	01	H5216_043_1	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	043	5	1	04	01	H5216_043_5	7	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	043	5	1	04	01	H5216_043_5	7	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	043	6	1	04	01	H5216_043_6	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	043	6	1	04	01	H5216_043_6	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	048	0	1	04	01	H5216_048_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	048	0	1	04	01	H5216_048_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	053	0	1	04	01	H5216_053_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	053	0	1	04	01	H5216_053_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	059	0	1	04	01	H5216_059_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	059	0	1	04	01	H5216_059_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	062	0	1	04	01	H5216_062_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	062	0	1	04	01	H5216_062_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	064	0	1	04	01	H5216_064_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	064	0	1	04	01	H5216_064_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	068	0	1	04	01	H5216_068_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	068	0	1	04	01	H5216_068_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	070	0	1	04	01	H5216_070_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	070	0	1	04	01	H5216_070_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	072	0	1	04	01	H5216_072_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	072	0	1	04	01	H5216_072_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	074	0	1	04	01	H5216_074_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	074	0	1	04	01	H5216_074_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	078	1	1	04	01	H5216_078_1	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	078	1	1	04	01	H5216_078_1	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	078	2	1	04	01	H5216_078_2	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	078	2	1	04	01	H5216_078_2	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	078	6	1	04	01	H5216_078_6	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	078	6	1	04	01	H5216_078_6	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	081	0	1	04	01	H5216_081_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	081	0	1	04	01	H5216_081_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	083	0	1	04	01	H5216_083_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	083	0	1	04	01	H5216_083_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	089	0	1	04	01	H5216_089_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	089	0	1	04	01	H5216_089_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	097	0	1	04	01	H5216_097_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	097	0	1	04	01	H5216_097_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	100	0	1	04	01	H5216_100_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	100	0	1	04	01	H5216_100_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	106	0	1	04	01	H5216_106_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	106	0	1	04	01	H5216_106_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	116	0	1	04	01	H5216_116_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	116	0	1	04	01	H5216_116_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	120	0	1	04	01	H5216_120_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	120	0	1	04	01	H5216_120_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	124	0	1	04	01	H5216_124_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	124	0	1	04	01	H5216_124_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	132	0	1	04	01	H5216_132_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	132	0	1	04	01	H5216_132_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	136	0	1	04	01	H5216_136_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	136	0	1	04	01	H5216_136_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	138	0	1	04	01	H5216_138_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	138	0	1	04	01	H5216_138_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	141	0	1	04	01	H5216_141_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	141	0	1	04	01	H5216_141_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	144	0	1	04	01	H5216_144_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	144	0	1	04	01	H5216_144_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	152	0	1	04	01	H5216_152_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	152	0	1	04	01	H5216_152_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	154	0	1	04	01	H5216_154_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	154	0	1	04	01	H5216_154_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	157	0	1	04	01	H5216_157_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	157	0	1	04	01	H5216_157_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	160	0	1	04	01	H5216_160_0	4	3																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	160	0	1	04	01	H5216_160_0	4	4																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	161	0	1	04	01	H5216_161_0	4	4																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	161	0	1	04	01	H5216_161_0	4	3																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	164	0	1	04	01	H5216_164_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	168	0	1	04	01	H5216_168_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	168	0	1	04	01	H5216_168_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	173	0	1	04	01	H5216_173_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	173	0	1	04	01	H5216_173_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	174	0	1	04	01	H5216_174_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	174	0	1	04	01	H5216_174_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	175	0	1	04	01	H5216_175_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	175	0	1	04	01	H5216_175_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	179	0	1	04	01	H5216_179_0	4	3																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	179	0	1	04	01	H5216_179_0	4	4																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	180	0	1	04	01	H5216_180_0	4	3																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	180	0	1	04	01	H5216_180_0	4	4																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	188	0	1	04	01	H5216_188_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	188	0	1	04	01	H5216_188_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	190	0	1	04	01	H5216_190_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	190	0	1	04	01	H5216_190_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	192	0	1	04	01	H5216_192_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	192	0	1	04	01	H5216_192_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	194	0	1	04	01	H5216_194_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	194	0	1	04	01	H5216_194_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	200	0	1	04	01	H5216_200_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	200	0	1	04	01	H5216_200_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	201	0	1	04	01	H5216_201_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	201	0	1	04	01	H5216_201_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	203	1	1	04	01	H5216_203_1	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	203	1	1	04	01	H5216_203_1	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	203	2	1	04	01	H5216_203_2	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	203	2	1	04	01	H5216_203_2	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	205	0	1	04	01	H5216_205_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	206	0	1	04	01	H5216_206_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	207	0	1	04	01	H5216_207_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	207	0	1	04	01	H5216_207_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	211	0	1	04	01	H5216_211_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	211	0	1	04	01	H5216_211_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	216	0	1	04	01	H5216_216_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	216	0	1	04	01	H5216_216_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	217	0	1	04	01	H5216_217_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	217	0	1	04	01	H5216_217_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	218	0	1	04	01	H5216_218_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	218	0	1	04	01	H5216_218_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	219	0	1	04	01	H5216_219_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	220	0	1	04	01	H5216_220_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	221	0	1	04	01	H5216_221_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	221	0	1	04	01	H5216_221_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	223	0	1	04	01	H5216_223_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	223	0	1	04	01	H5216_223_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	224	0	1	04	01	H5216_224_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	224	0	1	04	01	H5216_224_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	225	0	1	04	01	H5216_225_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	225	0	1	04	01	H5216_225_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	226	0	1	04	01	H5216_226_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	226	0	1	04	01	H5216_226_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	227	0	1	04	01	H5216_227_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	228	0	1	04	01	H5216_228_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	229	0	1	04	01	H5216_229_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	229	0	1	04	01	H5216_229_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	231	0	1	04	01	H5216_231_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	231	0	1	04	01	H5216_231_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	234	0	1	04	01	H5216_234_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	234	0	1	04	01	H5216_234_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	235	0	1	04	01	H5216_235_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	235	0	1	04	01	H5216_235_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	236	0	1	04	01	H5216_236_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	236	0	1	04	01	H5216_236_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	242	0	1	04	01	H5216_242_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	243	0	1	04	01	H5216_243_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	244	0	1	04	01	H5216_244_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	246	0	1	04	01	H5216_246_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	249	0	1	04	01	H5216_249_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	249	0	1	04	01	H5216_249_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	251	0	1	04	01	H5216_251_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	251	0	1	04	01	H5216_251_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	252	0	1	04	01	H5216_252_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	252	0	1	04	01	H5216_252_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	253	0	1	04	01	H5216_253_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	253	0	1	04	01	H5216_253_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	256	0	1	04	01	H5216_256_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	256	0	1	04	01	H5216_256_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
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	257	0	1	04	01	H5216_257_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	257	0	1	04	01	H5216_257_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	261	0	1	04	01	H5216_261_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	261	0	1	04	01	H5216_261_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	263	0	1	04	01	H5216_263_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	263	0	1	04	01	H5216_263_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	264	0	1	04	01	H5216_264_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	264	0	1	04	01	H5216_264_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	265	0	1	04	01	H5216_265_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	265	0	1	04	01	H5216_265_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	266	0	1	04	01	H5216_266_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	266	0	1	04	01	H5216_266_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	267	0	1	04	01	H5216_267_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	268	0	1	04	01	H5216_268_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	269	0	1	04	01	H5216_269_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	269	0	1	04	01	H5216_269_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	271	0	1	04	01	H5216_271_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	271	0	1	04	01	H5216_271_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
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	277	0	1	04	01	H5216_277_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	278	1	1	04	01	H5216_278_1	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	278	1	1	04	01	H5216_278_1	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	278	3	1	04	01	H5216_278_3	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	278	3	1	04	01	H5216_278_3	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	280	1	1	04	01	H5216_280_1	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	280	1	1	04	01	H5216_280_1	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	280	2	1	04	01	H5216_280_2	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	280	2	1	04	01	H5216_280_2	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	281	0	1	04	01	H5216_281_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	281	0	1	04	01	H5216_281_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	283	0	1	04	01	H5216_283_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	283	0	1	04	01	H5216_283_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	284	0	1	04	01	H5216_284_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	284	0	1	04	01	H5216_284_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	285	0	1	04	01	H5216_285_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	285	0	1	04	01	H5216_285_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	286	0	1	04	01	H5216_286_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	286	0	1	04	01	H5216_286_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	288	0	1	04	01	H5216_288_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	288	0	1	04	01	H5216_288_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	289	0	1	04	01	H5216_289_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	289	0	1	04	01	H5216_289_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	291	0	1	04	01	H5216_291_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	292	0	1	04	01	H5216_292_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	296	0	1	04	01	H5216_296_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	298	0	1	04	01	H5216_298_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	300	0	1	04	01	H5216_300_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	300	0	1	04	01	H5216_300_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	302	0	1	04	01	H5216_302_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	306	0	1	04	01	H5216_306_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	306	0	1	04	01	H5216_306_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	308	0	1	04	01	H5216_308_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	308	0	1	04	01	H5216_308_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	310	0	1	04	01	H5216_310_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	310	0	1	04	01	H5216_310_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	311	0	1	04	01	H5216_311_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	311	0	1	04	01	H5216_311_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	313	0	1	04	01	H5216_313_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	313	0	1	04	01	H5216_313_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	314	0	1	04	01	H5216_314_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	314	0	1	04	01	H5216_314_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	316	1	1	04	01	H5216_316_1	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	316	1	1	04	01	H5216_316_1	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	316	3	1	04	01	H5216_316_3	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	316	3	1	04	01	H5216_316_3	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	317	0	1	04	01	H5216_317_0	6	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	317	0	1	04	01	H5216_317_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	318	1	1	04	01	H5216_318_1	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	318	1	1	04	01	H5216_318_1	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	318	2	1	04	01	H5216_318_2	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	318	2	1	04	01	H5216_318_2	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	318	3	1	04	01	H5216_318_3	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	318	3	1	04	01	H5216_318_3	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	319	0	1	04	01	H5216_319_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	319	0	1	04	01	H5216_319_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	322	0	1	04	01	H5216_322_0	7	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	322	0	1	04	01	H5216_322_0	7	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	325	0	1	04	01	H5216_325_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	325	0	1	04	01	H5216_325_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	326	0	1	04	01	H5216_326_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	326	0	1	04	01	H5216_326_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	327	0	1	04	01	H5216_327_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	327	0	1	04	01	H5216_327_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	328	0	1	04	01	H5216_328_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	328	0	1	04	01	H5216_328_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	330	0	1	04	01	H5216_330_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	331	0	1	04	01	H5216_331_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	332	0	1	04	01	H5216_332_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	334	0	1	04	01	H5216_334_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	337	1	1	04	01	H5216_337_1	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	337	1	1	04	01	H5216_337_1	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	337	2	1	04	01	H5216_337_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																																																																																	
H5216	337	2	1	04	01	H5216_337_2	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	337	2	1	04	01	H5216_337_2	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	337	3	1	04	01	H5216_337_3	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	337	3	1	04	01	H5216_337_3	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	339	0	1	04	01	H5216_339_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	339	0	1	04	01	H5216_339_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	340	0	1	04	01	H5216_340_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	340	0	1	04	01	H5216_340_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	343	0	1	04	01	H5216_343_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	343	0	1	04	01	H5216_343_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	345	0	1	04	01	H5216_345_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	345	0	1	04	01	H5216_345_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	347	0	1	04	01	H5216_347_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	347	0	1	04	01	H5216_347_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	348	0	1	04	01	H5216_348_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	348	0	1	04	01	H5216_348_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	350	0	1	04	01	H5216_350_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	350	0	1	04	01	H5216_350_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	351	0	1	04	01	H5216_351_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	351	0	1	04	01	H5216_351_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	352	0	1	04	01	H5216_352_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	352	0	1	04	01	H5216_352_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	355	0	1	04	01	H5216_355_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	355	0	1	04	01	H5216_355_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	358	0	1	04	01	H5216_358_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	358	0	1	04	01	H5216_358_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	361	0	1	04	01	H5216_361_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	362	0	1	04	01	H5216_362_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	363	0	1	04	01	H5216_363_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	363	0	1	04	01	H5216_363_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	366	0	1	04	01	H5216_366_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	367	0	1	04	01	H5216_367_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	368	0	1	04	01	H5216_368_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	368	0	1	04	01	H5216_368_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	369	0	1	04	01	H5216_369_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	370	0	1	04	01	H5216_370_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	371	0	1	04	01	H5216_371_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	371	0	1	04	01	H5216_371_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	372	0	1	04	01	H5216_372_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	375	0	1	04	01	H5216_375_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	376	0	1	04	01	H5216_376_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	376	0	1	04	01	H5216_376_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	379	0	1	04	01	H5216_379_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	379	0	1	04	01	H5216_379_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	381	0	1	04	01	H5216_381_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	381	0	1	04	01	H5216_381_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	382	0	1	04	01	H5216_382_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	382	0	1	04	01	H5216_382_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	383	0	1	04	01	H5216_383_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	383	0	1	04	01	H5216_383_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	384	0	1	04	01	H5216_384_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	384	0	1	04	01	H5216_384_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	385	0	1	04	01	H5216_385_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	387	1	1	04	01	H5216_387_1	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	387	1	1	04	01	H5216_387_1	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	387	2	1	04	01	H5216_387_2	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	387	2	1	04	01	H5216_387_2	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	388	0	1	04	01	H5216_388_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	390	0	1	04	01	H5216_390_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	390	0	1	04	01	H5216_390_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	394	0	1	04	01	H5216_394_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	399	0	1	04	01	H5216_399_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	399	0	1	04	01	H5216_399_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	401	0	1	04	01	H5216_401_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	403	0	1	04	01	H5216_403_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	403	0	1	04	01	H5216_403_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	404	0	1	04	01	H5216_404_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	404	0	1	04	01	H5216_404_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	405	0	1	04	01	H5216_405_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	405	0	1	04	01	H5216_405_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	406	0	1	04	01	H5216_406_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	406	0	1	04	01	H5216_406_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	407	0	1	04	01	H5216_407_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	407	0	1	04	01	H5216_407_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	408	0	1	04	01	H5216_408_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	408	0	1	04	01	H5216_408_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	409	0	1	04	01	H5216_409_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	409	0	1	04	01	H5216_409_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	410	0	1	04	01	H5216_410_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	410	0	1	04	01	H5216_410_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	416	0	1	04	01	H5216_416_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	417	0	1	04	01	H5216_417_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	417	0	1	04	01	H5216_417_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	420	0	1	04	01	H5216_420_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	421	0	1	04	01	H5216_421_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	421	0	1	04	01	H5216_421_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	423	0	1	04	01	H5216_423_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	423	0	1	04	01	H5216_423_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	425	0	1	04	01	H5216_425_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	425	0	1	04	01	H5216_425_0	5	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	427	1	1	04	01	H5216_427_1	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	427	1	1	04	01	H5216_427_1	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	427	2	1	04	01	H5216_427_2	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	427	2	1	04	01	H5216_427_2	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	427	3	1	04	01	H5216_427_3	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	427	3	1	04	01	H5216_427_3	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	427	4	1	04	01	H5216_427_4	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	427	4	1	04	01	H5216_427_4	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	427	5	1	04	01	H5216_427_5	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	427	5	1	04	01	H5216_427_5	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	428	1	1	04	01	H5216_428_1	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	428	1	1	04	01	H5216_428_1	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	428	2	1	04	01	H5216_428_2	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	428	2	1	04	01	H5216_428_2	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	428	3	1	04	01	H5216_428_3	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	428	3	1	04	01	H5216_428_3	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	428	5	1	04	01	H5216_428_5	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	428	5	1	04	01	H5216_428_5	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	430	0	1	04	01	H5216_430_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	430	0	1	04	01	H5216_430_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	431	0	1	04	01	H5216_431_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	431	0	1	04	01	H5216_431_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	432	0	1	04	01	H5216_432_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	432	0	1	04	01	H5216_432_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	433	0	1	04	01	H5216_433_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	433	0	1	04	01	H5216_433_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	435	1	1	04	01	H5216_435_1	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	435	1	1	04	01	H5216_435_1	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	435	2	1	04	01	H5216_435_2	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	435	2	1	04	01	H5216_435_2	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	435	3	1	04	01	H5216_435_3	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	435	3	1	04	01	H5216_435_3	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	436	1	1	04	01	H5216_436_1	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	436	1	1	04	01	H5216_436_1	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	436	2	1	04	01	H5216_436_2	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	436	2	1	04	01	H5216_436_2	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	436	3	1	04	01	H5216_436_3	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	436	3	1	04	01	H5216_436_3	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	441	0	1	04	01	H5216_441_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	441	0	1	04	01	H5216_441_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	442	0	1	04	01	H5216_442_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	442	0	1	04	01	H5216_442_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	443	0	1	04	01	H5216_443_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	446	0	1	04	01	H5216_446_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	455	0	1	04	01	H5216_455_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	455	0	1	04	01	H5216_455_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	457	1	1	04	01	H5216_457_1	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	457	1	1	04	01	H5216_457_1	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	457	2	1	04	01	H5216_457_2	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	457	2	1	04	01	H5216_457_2	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	461	0	1	04	01	H5216_461_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	461	0	1	04	01	H5216_461_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	463	0	1	04	01	H5216_463_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	463	0	1	04	01	H5216_463_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	464	0	1	04	01	H5216_464_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	464	0	1	04	01	H5216_464_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	465	0	1	04	01	H5216_465_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	465	0	1	04	01	H5216_465_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	466	0	1	04	01	H5216_466_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	466	0	1	04	01	H5216_466_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	471	0	1	04	01	H5216_471_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	471	0	1	04	01	H5216_471_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	472	0	1	04	01	H5216_472_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	472	0	1	04	01	H5216_472_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	473	0	1	04	01	H5216_473_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	473	0	1	04	01	H5216_473_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	474	0	1	04	01	H5216_474_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	474	0	1	04	01	H5216_474_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	475	0	1	04	01	H5216_475_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	475	0	1	04	01	H5216_475_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	476	0	1	04	01	H5216_476_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	476	0	1	04	01	H5216_476_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	477	0	1	04	01	H5216_477_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	477	0	1	04	01	H5216_477_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	478	0	1	04	01	H5216_478_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	478	0	1	04	01	H5216_478_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	479	0	1	04	01	H5216_479_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	480	0	1	04	01	H5216_480_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	481	1	1	04	01	H5216_481_1	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	481	1	1	04	01	H5216_481_1	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5216	481	2	1	04	01	H5216_481_2	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H5216	481	2	1	04	01	H5216_481_2	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5262	001	0	1	01	01	H5262_001_0	6	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H5262	003	0	1	01	01	H5262_003_0	6	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H5262	004	0	1	01	01	H5262_004_0	4	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H5262	005	0	1	01	01	H5262_005_0	4	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H5262	007	0	1	01	01	H5262_007_0	6	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	50.00	2	2																																								
H5262	007	0	1	01	01	H5262_007_0	6	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H5262	008	0	1	01	01	H5262_008_0	6	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H5262	008	0	1	01	01	H5262_008_0	6	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	60.00	2	2																																								
H5262	009	0	1	01	01	H5262_009_0	4	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	50.00	2	2																																								
H5262	009	0	1	01	01	H5262_009_0	4	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H5262	010	0	1	01	01	H5262_010_0	4	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H5262	010	0	1	01	01	H5262_010_0	4	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	40.00	2	2																																								
H5262	021	0	1	01	01	H5262_021_0	6	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H5262	023	0	1	01	01	H5262_023_0	6	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H5262	023	0	1	01	01	H5262_023_0	6	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	70.00	2	2																																								
H5262	029	0	1	01	01	H5262_029_0	6	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		2																																																																																	
H5262	030	0	1	01	01	H5262_030_0	6	2																																																																								Hospital at Home	2	2				2				1	0	20	2		2			2	2																																								
H5262	030	0	1	01	01	H5262_030_0	6	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		2																																																																																	
H5262	032	0	1	01	01	H5262_032_0	6	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H5262	033	0	1	01	01	H5262_033_0	6	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H5262	033	0	1	01	01	H5262_033_0	6	2																																																																								Hospital at Home	2	2				2				2			2		1	0.00	75.00	2	2																																								
H5302	012	0	1	01	01	H5302_012_0	3	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	3	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	3	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	3	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	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5302	028	0	1	01	01	H5302_028_0	3	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	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5325	003	0	1	01	01	H5325_003_0	3	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	3	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	3	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	3	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	012	0	1	01	01	H5325_012_0	3	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	3	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	3	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	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5377	002	0	1	02	01	H5377_002_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5377	003	0	1	01	01	H5377_003_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	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	3	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	227	0	1	04	01	H5521_227_0	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	490	0	1	04	01	H5521_490_0	3	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	3	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	3	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	3	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	4	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	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	722	0	1	04	01	H5521_722_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	726	0	1	04	01	H5521_726_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	727	0	1	04	01	H5521_727_0	3	2																										1	2	2				2				2		2	2			2		1	0.00	0.00	2	01000		2	1	2	001	2				2				2			2		1	0.00	0.00	2	2																																																												
H5521	727	0	1	04	01	H5521_727_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5521	758	0	1	04	01	H5521_758_0	3	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	1	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5521	801	0	1	04	01	H5521_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	11010	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	11010	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	11010	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	001	0	1	04	01	H5522_001_0	4	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	3	1																										1	2	2				2				2		2	2			2		1	0.00	0.00	2	01000		2																																																																																	
H5522	005	0	1	04	01	H5522_005_0	3	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	3	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	11010	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	11010	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	11010	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	11010	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	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	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	11010	Retail Store	2	1	2	111	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	11010	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	11010	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	11010	Retail Store	2	1	2	111	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	11010	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	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	11010	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	11010	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	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	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	11010	Retail Store	2	1	2	111	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	11010	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	11010	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	11010	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	11010	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	11010	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	11010	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	11010	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	11010	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	11010	Retail Store	2	1	2	111	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	11010	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	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	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	11010	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	11010	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	11010	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	11010	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	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	11010	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	11010	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	11010	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	11010	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	839	0	1	04	01	H5522_839_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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5522	839	0	1	04	01	H5522_839_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	11010	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	840	0	1	04	01	H5522_840_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	11010	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	840	0	1	04	01	H5522_840_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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5525	004	0	1	04	01	H5525_004_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	005	0	1	04	01	H5525_005_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	006	0	1	04	01	H5525_006_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	008	0	1	04	01	H5525_008_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	030	0	1	04	01	H5525_030_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	031	0	1	04	01	H5525_031_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	034	0	1	04	01	H5525_034_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	035	0	1	04	01	H5525_035_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	036	0	1	04	01	H5525_036_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	042	0	1	04	01	H5525_042_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	045	0	1	04	01	H5525_045_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	049	0	1	04	01	H5525_049_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	051	1	1	04	01	H5525_051_1	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	051	2	1	04	01	H5525_051_2	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	054	0	1	04	01	H5525_054_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	056	0	1	04	01	H5525_056_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	057	0	1	04	01	H5525_057_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	059	0	1	04	01	H5525_059_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	065	0	1	04	01	H5525_065_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	070	0	1	04	01	H5525_070_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	072	0	1	04	01	H5525_072_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	074	0	1	04	01	H5525_074_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	075	0	1	04	01	H5525_075_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	078	0	1	04	01	H5525_078_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	079	0	1	04	01	H5525_079_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	080	0	1	04	01	H5525_080_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	084	0	1	04	01	H5525_084_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	085	1	1	04	01	H5525_085_1	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	085	2	1	04	01	H5525_085_2	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	086	1	1	04	01	H5525_086_1	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	086	2	1	04	01	H5525_086_2	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5525	087	0	1	04	01	H5525_087_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	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	003	0	1	01	01	H5593_003_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5593	004	0	1	01	01	H5593_004_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5593	005	0	1	01	01	H5593_005_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H5593	009	0	1	01	01	H5593_009_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	11010	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	11010	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5608	001	0	1	01	01	H5608_001_0	7	1																										1	2	2				2				1	1	2	2			2		2			2	00010		2																																																																																	
H5608	002	0	1	01	01	H5608_002_0	7	1																										1	2	2				2				1	1	2	2			2		2			2	00010		2																																																																																	
H5619	001	0	1	01	01	H5619_001_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	003	0	1	01	01	H5619_003_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	012	0	1	01	01	H5619_012_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	015	0	1	01	01	H5619_015_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	016	0	1	01	01	H5619_016_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	021	0	1	01	01	H5619_021_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	026	0	1	01	01	H5619_026_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	038	0	1	01	01	H5619_038_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	046	0	1	01	01	H5619_046_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	047	0	1	01	01	H5619_047_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	051	0	1	02	01	H5619_051_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	055	0	1	01	01	H5619_055_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	057	0	1	01	01	H5619_057_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	061	0	1	01	01	H5619_061_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	066	0	1	01	01	H5619_066_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	069	0	1	02	01	H5619_069_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	075	0	1	01	01	H5619_075_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	089	0	1	01	01	H5619_089_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	090	0	1	01	01	H5619_090_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	091	0	1	01	01	H5619_091_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	093	0	1	01	01	H5619_093_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	095	0	1	01	01	H5619_095_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	111	0	1	02	01	H5619_111_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	113	0	1	02	01	H5619_113_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	116	0	1	01	01	H5619_116_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	119	0	1	01	01	H5619_119_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	121	0	1	01	01	H5619_121_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	122	0	1	01	01	H5619_122_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	123	0	1	02	01	H5619_123_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	126	0	1	02	01	H5619_126_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	133	0	1	01	01	H5619_133_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	135	0	1	01	01	H5619_135_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	137	0	1	01	01	H5619_137_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	143	0	1	01	01	H5619_143_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	145	0	1	01	01	H5619_145_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	146	0	1	01	01	H5619_146_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	147	0	1	01	01	H5619_147_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	150	0	1	01	01	H5619_150_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	151	0	1	01	01	H5619_151_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	152	0	1	01	01	H5619_152_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	157	0	1	01	01	H5619_157_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	159	0	1	01	01	H5619_159_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	161	0	1	01	01	H5619_161_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	162	0	1	02	01	H5619_162_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	163	0	1	01	01	H5619_163_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	165	0	1	01	01	H5619_165_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	166	0	1	01	01	H5619_166_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	167	0	1	01	01	H5619_167_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	169	0	1	01	01	H5619_169_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	171	0	1	01	01	H5619_171_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	174	0	1	01	01	H5619_174_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	177	0	1	01	01	H5619_177_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	178	0	1	01	01	H5619_178_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	179	0	1	02	01	H5619_179_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	180	0	1	01	01	H5619_180_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	181	0	1	01	01	H5619_181_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	182	0	1	01	01	H5619_182_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	183	0	1	01	01	H5619_183_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	184	0	1	01	01	H5619_184_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	185	0	1	01	01	H5619_185_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	186	0	1	01	01	H5619_186_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	188	1	1	01	01	H5619_188_1	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	188	2	1	01	01	H5619_188_2	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	189	1	1	02	01	H5619_189_1	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	189	2	1	02	01	H5619_189_2	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	190	0	1	01	01	H5619_190_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	191	1	1	01	01	H5619_191_1	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	191	2	1	01	01	H5619_191_2	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5619	191	3	1	01	01	H5619_191_3	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5628	013	1	1	01	01	H5628_013_1	6	2																																																			1	2	001	2				2				2			2		2			1	2																																																												
H5628	013	2	1	01	01	H5628_013_2	6	2																																																			1	2	001	2				2				2			2		2			1	2																																																												
H5774	022	0	1	01	01	H5774_022_0	10	1																										1	2	2				2				1	1	1	2			2		2			2	01010		2																																																																																	
H5774	035	0	1	01	01	H5774_035_0	12	1																										1	2	2				2				1	1	1	2			2		2			2	01010		2																																																																																	
H5774	041	1	1	01	01	H5774_041_1	12	2																										1	2	2				2				1	1	1	2			2		2			2	01010		2																																																																																	
H5774	041	2	1	01	01	H5774_041_2	11	2																										1	2	2				2				1	1	1	2			2		2			2	01010		2																																																																																	
H5774	041	3	1	01	01	H5774_041_3	11	2																										1	2	2				2				1	1	1	2			2		2			2	01010		2																																																																																	
H5774	043	1	1	01	01	H5774_043_1	11	2																										1	2	2				2				1	1	1	2			2		2			2	01010		2																																																																																	
H5774	043	2	1	01	01	H5774_043_2	11	2																										1	2	2				2				1	1	1	2			2		2			2	01010		2																																																																																	
H5774	043	3	1	01	01	H5774_043_3	11	2																										1	2	2				2				1	1	1	2			2		2			2	01010		2																																																																																	
H5774	046	0	1	01	01	H5774_046_0	9	1																										1	2	2				2				1	1	1	2			2		2			2	01010		2																																																																																	
H5774	047	1	1	01	01	H5774_047_1	12	1																										1	2	2				2				1	1	1	2			2		2			2	01010		2																																																																																	
H5774	047	2	1	01	01	H5774_047_2	11	1																										1	2	2				2				1	1	1	2			2		2			2	01010		2																																																																																	
H5774	047	3	1	01	01	H5774_047_3	11	1																										1	2	2				2				1	1	1	2			2		2			2	01010		2																																																																																	
H5774	049	0	1	01	01	H5774_049_0	12	2																										1	2	2				2				1	1	1	2			2		2			2	01010		2																																																																																	
H5793	017	0	1	02	01	H5793_017_0	3	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	3	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	3	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	11010	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	11010	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	11010	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5793	805	0	1	01	01	H5793_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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H5793	805	0	1	01	01	H5793_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	11010	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H5826	014	0	1	01	01	H5826_014_0	6	3																										1	2	2				2				2		2	2			2		2			2	01000		2																																																																																	
H5826	014	0	1	01	01	H5826_014_0	6	5																										1	2	2				2				2		2	2			2		2			2	01000		2																																																																																	
H5826	017	0	1	01	01	H5826_017_0	6	4																										1	2	2				2				2		2	2			2		2			2	01000		2																																																																																	
H5826	017	0	1	01	01	H5826_017_0	6	3																										1	2	2				2				2		2	2			2		2			2	01000		2																																																																																	
H5852	001	0	1	01	01	H5852_001_0	8	1																																																			1	2	101	2				2				2			2		2			1	1																																																												
H5859	001	0	1	01	01	H5859_001_0	6	1																										1	2	2				2				1	1	1	2			2		2			1	00010		2																																																																																	
H5943	003	0	1	02	01	H5943_003_0	11	1																										1	2	2				2				1	1	1	2			2		2			1	01010		2	1	2	011	2				2				2			2		2			1	2																																																												
H5943	005	0	1	02	01	H5943_005_0	10	1																										1	2	2				2				1	1	1	2			2		2			1	01010		2	1	2	011	2				2				2			2		2			1	2																																																												
H5970	016	0	1	04	01	H5970_016_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5970	028	0	1	04	01	H5970_028_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H5970	029	0	1	04	01	H5970_029_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6170	001	0	1	02	01	H6170_001_0	8	1																										1	2	2				2				2		2	2			2		1	0.00	0.00	1	00010		2																																										Start Dialysis Treatment	2	2				2				2			2		2			1	2																				
H6170	002	0	1	02	01	H6170_002_0	8	1																										1	2	2				2				2		2	2			2		1	0.00	0.00	1	00010		2																																										Start Dialysis Treatment	2	2				2				2			2		2			1	2																				
H6170	008	0	1	01	01	H6170_008_0	9	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6170	009	0	1	01	01	H6170_009_0	8	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6170	010	0	1	01	01	H6170_010_0	8	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6170	015	0	1	01	01	H6170_015_0	8	1																										1	2	2				2				2		2	2			2		2			1	00010		2																																																																																	
H6170	016	0	1	01	01	H6170_016_0	9	1																										1	2	2				2				2		2	2			2		2			1	00010		2																																																																																	
H6303	001	0	1	02	01	H6303_001_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H6303	004	0	1	02	01	H6303_004_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H6303	005	0	1	02	01	H6303_005_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
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		1	0.00	0.00	1	00010		2																																										Start Dialysis Treatment	2	2				2				2			2		2			1	2																				
H6474	002	0	1	02	01	H6474_002_0	8	1																										1	2	2				2				2		2	2			2		1	0.00	0.00	1	00010		2																																										Start Dialysis Treatment	2	2				2				2			2		2			1	2																				
H6474	008	0	1	01	01	H6474_008_0	8	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6474	009	0	1	01	01	H6474_009_0	8	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6474	010	0	1	01	01	H6474_010_0	8	1																										1	2	2				2				2		2	2			2		2			1	00010		1																																																																																	
H6622	001	0	1	01	01	H6622_001_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	004	0	1	01	01	H6622_004_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	007	0	1	01	01	H6622_007_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	008	0	1	01	01	H6622_008_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	013	0	1	02	01	H6622_013_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	014	0	1	02	01	H6622_014_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	017	0	1	01	01	H6622_017_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	018	0	1	01	01	H6622_018_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	021	1	1	02	01	H6622_021_1	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	021	2	1	02	01	H6622_021_2	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	022	0	1	02	01	H6622_022_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	023	0	1	02	01	H6622_023_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	025	0	1	02	01	H6622_025_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	026	0	1	02	01	H6622_026_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	027	0	1	02	01	H6622_027_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	028	0	1	01	01	H6622_028_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	029	0	1	01	01	H6622_029_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	032	0	1	01	01	H6622_032_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	033	0	1	01	01	H6622_033_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	033	0	1	01	01	H6622_033_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																																																																																	
H6622	035	0	1	01	01	H6622_035_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	036	0	1	01	01	H6622_036_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	037	0	1	01	01	H6622_037_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	047	0	1	01	01	H6622_047_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	048	0	1	01	01	H6622_048_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	054	0	1	01	01	H6622_054_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	055	0	1	01	01	H6622_055_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	056	0	1	01	01	H6622_056_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	057	0	1	02	01	H6622_057_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
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																																																																																	
H6622	060	0	1	02	01	H6622_060_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	061	0	1	02	01	H6622_061_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	071	0	1	01	01	H6622_071_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	075	0	1	01	01	H6622_075_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	078	1	1	01	01	H6622_078_1	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	078	2	1	01	01	H6622_078_2	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	079	0	1	01	01	H6622_079_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	081	0	1	01	01	H6622_081_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	082	0	1	01	01	H6622_082_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	083	0	1	01	01	H6622_083_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	084	0	1	01	01	H6622_084_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	085	0	1	01	01	H6622_085_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	090	0	1	01	01	H6622_090_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	091	0	1	01	01	H6622_091_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	094	0	1	01	01	H6622_094_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	097	0	1	01	01	H6622_097_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	098	0	1	01	01	H6622_098_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	099	1	1	01	01	H6622_099_1	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	099	2	1	01	01	H6622_099_2	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	100	1	1	01	01	H6622_100_1	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	100	2	1	01	01	H6622_100_2	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	101	0	1	01	01	H6622_101_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	103	0	1	01	01	H6622_103_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	104	0	1	01	01	H6622_104_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H6622	105	0	1	01	01	H6622_105_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7149	006	0	1	01	01	H7149_006_0	3	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	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H7284	008	0	1	04	01	H7284_008_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7284	009	0	1	04	01	H7284_009_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7284	010	0	1	04	01	H7284_010_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7284	011	0	1	04	01	H7284_011_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7284	012	0	1	04	01	H7284_012_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7284	013	0	1	04	01	H7284_013_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	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	11010	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	2																																								
H7617	004	0	1	04	01	H7617_004_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	004	0	1	04	01	H7617_004_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	006	0	1	04	01	H7617_006_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	007	0	1	04	01	H7617_007_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	007	0	1	04	01	H7617_007_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	008	0	1	04	01	H7617_008_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	008	0	1	04	01	H7617_008_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	010	0	1	04	01	H7617_010_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	010	0	1	04	01	H7617_010_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	011	0	1	04	01	H7617_011_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	011	0	1	04	01	H7617_011_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	012	0	1	04	01	H7617_012_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	012	0	1	04	01	H7617_012_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	013	0	1	04	01	H7617_013_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	013	0	1	04	01	H7617_013_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	014	0	1	04	01	H7617_014_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	014	0	1	04	01	H7617_014_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	015	0	1	04	01	H7617_015_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	015	0	1	04	01	H7617_015_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	016	0	1	04	01	H7617_016_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	016	0	1	04	01	H7617_016_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	017	0	1	04	01	H7617_017_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	017	0	1	04	01	H7617_017_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	018	0	1	04	01	H7617_018_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	018	0	1	04	01	H7617_018_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
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H7617	020	0	1	04	01	H7617_020_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	021	0	1	04	01	H7617_021_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	021	0	1	04	01	H7617_021_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	022	0	1	04	01	H7617_022_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	022	0	1	04	01	H7617_022_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	023	0	1	04	01	H7617_023_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	023	0	1	04	01	H7617_023_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	024	0	1	04	01	H7617_024_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	024	0	1	04	01	H7617_024_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	025	0	1	04	01	H7617_025_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	025	0	1	04	01	H7617_025_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	026	0	1	04	01	H7617_026_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	026	0	1	04	01	H7617_026_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	027	0	1	04	01	H7617_027_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	027	0	1	04	01	H7617_027_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	028	0	1	04	01	H7617_028_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	028	0	1	04	01	H7617_028_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	029	0	1	04	01	H7617_029_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	029	0	1	04	01	H7617_029_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	030	0	1	04	01	H7617_030_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	030	0	1	04	01	H7617_030_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	031	0	1	04	01	H7617_031_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	031	0	1	04	01	H7617_031_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	032	0	1	04	01	H7617_032_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	032	0	1	04	01	H7617_032_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	033	0	1	04	01	H7617_033_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	035	0	1	04	01	H7617_035_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	035	0	1	04	01	H7617_035_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	036	0	1	04	01	H7617_036_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	037	0	1	04	01	H7617_037_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	038	0	1	04	01	H7617_038_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	039	0	1	04	01	H7617_039_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	041	0	1	04	01	H7617_041_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	041	0	1	04	01	H7617_041_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	042	0	1	04	01	H7617_042_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	042	0	1	04	01	H7617_042_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	043	0	1	04	01	H7617_043_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	043	0	1	04	01	H7617_043_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	044	0	1	04	01	H7617_044_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	044	0	1	04	01	H7617_044_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	045	0	1	04	01	H7617_045_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	045	0	1	04	01	H7617_045_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	046	0	1	04	01	H7617_046_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	046	0	1	04	01	H7617_046_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	048	0	1	04	01	H7617_048_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	049	0	1	04	01	H7617_049_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	049	0	1	04	01	H7617_049_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	050	0	1	04	01	H7617_050_0	6	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	050	0	1	04	01	H7617_050_0	6	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	051	0	1	04	01	H7617_051_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	051	0	1	04	01	H7617_051_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	052	0	1	04	01	H7617_052_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	052	0	1	04	01	H7617_052_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	053	0	1	04	01	H7617_053_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	053	0	1	04	01	H7617_053_0	4	2																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	053	0	1	04	01	H7617_053_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																																																																																	
H7617	054	0	1	04	01	H7617_054_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	054	0	1	04	01	H7617_054_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	056	0	1	04	01	H7617_056_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	056	0	1	04	01	H7617_056_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	057	0	1	04	01	H7617_057_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	057	0	1	04	01	H7617_057_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	058	0	1	04	01	H7617_058_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	058	0	1	04	01	H7617_058_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	059	0	1	04	01	H7617_059_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	059	0	1	04	01	H7617_059_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	061	0	1	04	01	H7617_061_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	061	0	1	04	01	H7617_061_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	062	0	1	04	01	H7617_062_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	062	0	1	04	01	H7617_062_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	063	0	1	04	01	H7617_063_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																																																																																	
H7617	063	0	1	04	01	H7617_063_0	4	3																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	063	0	1	04	01	H7617_063_0	4	4																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
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H7617	064	0	1	04	01	H7617_064_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	065	0	1	04	01	H7617_065_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	065	0	1	04	01	H7617_065_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
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H7617	066	0	1	04	01	H7617_066_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
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H7617	068	0	1	04	01	H7617_068_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
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H7617	069	0	1	04	01	H7617_069_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	070	0	1	04	01	H7617_070_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	070	0	1	04	01	H7617_070_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
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H7617	073	0	1	04	01	H7617_073_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	074	0	1	04	01	H7617_074_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
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H7617	077	0	1	04	01	H7617_077_0	5	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	078	0	1	04	01	H7617_078_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	079	0	1	04	01	H7617_079_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	079	0	1	04	01	H7617_079_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
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H7617	080	0	1	04	01	H7617_080_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	081	0	1	04	01	H7617_081_0	4	4																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	081	0	1	04	01	H7617_081_0	4	3																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	082	0	1	04	01	H7617_082_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	083	0	1	04	01	H7617_083_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	084	0	1	04	01	H7617_084_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	085	0	1	04	01	H7617_085_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	085	0	1	04	01	H7617_085_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
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H7617	086	0	1	04	01	H7617_086_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
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H7617	087	0	1	04	01	H7617_087_0	4	3																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	088	0	1	04	01	H7617_088_0	4	4																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	088	0	1	04	01	H7617_088_0	4	3																																																			1	2	011	2				2				2			2		2			2	2																																																												
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H7617	089	0	1	04	01	H7617_089_0	4	4																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	090	0	1	04	01	H7617_090_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	090	0	1	04	01	H7617_090_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	091	0	1	04	01	H7617_091_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	091	0	1	04	01	H7617_091_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	092	0	1	04	01	H7617_092_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	092	0	1	04	01	H7617_092_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	093	0	1	04	01	H7617_093_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	093	0	1	04	01	H7617_093_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	094	0	1	04	01	H7617_094_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	094	0	1	04	01	H7617_094_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	095	0	1	04	01	H7617_095_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	095	0	1	04	01	H7617_095_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	096	0	1	04	01	H7617_096_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	096	0	1	04	01	H7617_096_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	098	0	1	04	01	H7617_098_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	098	0	1	04	01	H7617_098_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	100	0	1	04	01	H7617_100_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	100	0	1	04	01	H7617_100_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	101	0	1	04	01	H7617_101_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	101	0	1	04	01	H7617_101_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	107	0	1	04	01	H7617_107_0	5	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	107	0	1	04	01	H7617_107_0	5	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	108	0	1	04	01	H7617_108_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	108	0	1	04	01	H7617_108_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	110	0	1	04	01	H7617_110_0	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	110	0	1	04	01	H7617_110_0	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	114	0	1	04	01	H7617_114_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	114	0	1	04	01	H7617_114_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	115	0	1	04	01	H7617_115_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	116	0	1	04	01	H7617_116_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	117	0	1	04	01	H7617_117_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																																																																																	
H7617	118	0	1	04	01	H7617_118_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																																																																																	
H7617	119	0	1	04	01	H7617_119_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	119	0	1	04	01	H7617_119_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	120	0	1	04	01	H7617_120_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	120	0	1	04	01	H7617_120_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	121	0	1	04	01	H7617_121_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	122	0	1	04	01	H7617_122_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	122	0	1	04	01	H7617_122_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	123	0	1	04	01	H7617_123_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	123	0	1	04	01	H7617_123_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	124	0	1	04	01	H7617_124_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	124	0	1	04	01	H7617_124_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	125	0	1	04	01	H7617_125_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	125	0	1	04	01	H7617_125_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	126	0	1	04	01	H7617_126_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	126	0	1	04	01	H7617_126_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	127	0	1	04	01	H7617_127_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	127	0	1	04	01	H7617_127_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	128	0	1	04	01	H7617_128_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																																																																																	
H7617	129	0	1	04	01	H7617_129_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	130	0	1	04	01	H7617_130_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																																																																																	
H7617	131	0	1	04	01	H7617_131_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																																																																																	
H7617	138	0	1	04	01	H7617_138_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																																																																																	
H7617	139	0	1	04	01	H7617_139_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																																																																																	
H7617	140	0	1	04	01	H7617_140_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																																																																																	
H7617	142	0	1	04	01	H7617_142_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																																																																																	
H7617	143	0	1	04	01	H7617_143_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																																																																																	
H7617	144	1	1	04	01	H7617_144_1	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	144	1	1	04	01	H7617_144_1	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	144	2	1	04	01	H7617_144_2	6	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H7617	144	2	1	04	01	H7617_144_2	6	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	145	0	1	04	01	H7617_145_0	4	1																																																			1	2	011	2				2				2			2		2			2	2																																																												
H7617	145	0	1	04	01	H7617_145_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H8145	004	0	1	09	04	H8145_004_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H8145	006	0	1	09	04	H8145_006_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H8145	042	0	1	09	04	H8145_042_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H8145	052	0	1	09	04	H8145_052_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H8145	069	0	1	09	04	H8145_069_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H8145	091	0	1	09	04	H8145_091_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H8145	126	0	1	09	04	H8145_126_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H8332	009	0	1	01	01	H8332_009_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H8332	010	0	1	01	01	H8332_010_0	4	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		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	11010	Retail store	2	1	2	111	2				2				2			2		2			2	2	Non-Medicare (Other)	2	2				2				2			2		2			2	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H8597	001	0	1	01	01	H8597_001_0	4	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	4	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																																																																																	
H8597	004	0	1	01	01	H8597_004_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H8597	005	0	1	01	01	H8597_005_0	3	1																										1	2	2				2				1	1	1	2			2		1	0.00	0.00	1	00010		2																																																																																	
H8597	006	0	1	01	01	H8597_006_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	3	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	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	1	2			2		2			2	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	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	11010	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	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	11010	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	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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H8649	805	0	1	01	01	H8649_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	11010	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	805	0	1	01	01	H8649_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	11010	Retail Store	2	1	2	111	2				2				2			2		2			2	2																																																												
H8794	016	0	1	01	01	H8794_016_0	5	1																																																																																																																Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	2	1
H8794	017	0	1	01	01	H8794_017_0	5	1																																																																																																																Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	2	1
H8794	019	0	1	01	01	H8794_019_0	5	1																																																																																																																Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	2	1
H8794	023	0	1	01	01	H8794_023_0	5	1																																																																																																																Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	2	1
H8889	002	0	1	04	01	H8889_002_0	4	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	009	0	1	04	01	H8889_009_0	2	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	012	0	1	04	01	H8889_012_0	3	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	013	0	1	04	01	H8889_013_0	3	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	014	0	1	04	01	H8889_014_0	3	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	019	1	1	04	01	H8889_019_1	3	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	019	2	1	04	01	H8889_019_2	3	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	020	1	1	04	01	H8889_020_1	3	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	020	2	1	04	01	H8889_020_2	3	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	021	1	1	04	01	H8889_021_1	3	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	021	2	1	04	01	H8889_021_2	3	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	022	0	1	04	01	H8889_022_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	023	0	1	04	01	H8889_023_0	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	024	0	1	04	01	H8889_024_0	3	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	025	0	1	04	01	H8889_025_0	8	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	026	0	1	04	01	H8889_026_0	3	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	027	1	1	04	01	H8889_027_1	6	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	027	2	1	04	01	H8889_027_2	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	028	1	1	04	01	H8889_028_1	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	028	2	1	04	01	H8889_028_2	5	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	029	1	1	04	01	H8889_029_1	3	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8889	029	2	1	04	01	H8889_029_2	3	1																																																			1	2	111	2				2				2			2		2			2	2																																																												
H8908	004	0	1	02	01	H8908_004_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H8908	005	0	1	01	01	H8908_005_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H8908	007	0	1	01	01	H8908_007_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																																																																																	
H8908	007	0	1	01	01	H8908_007_0	4	3																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
H8947	006	0	1	04	01	H8947_006_0	7	1																										1	2	2				2				2		2	2			2		2			2	01010		2																																																																																	
H9003	001	0	1	02	01	H9003_001_0	7	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	7	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	7	1																																																																																																																Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H9066	002	0	1	01	01	H9066_002_0	6	1																																																																								Companion Care	2	2				2				2			2		2			2	2																																								
H9314	001	0	1	01	01	H9314_001_0	4	2																										1	2	2				2				2		2	2			2		1	0.00	0.00	2	10000	Restricted Items	2																																																																																	
H9314	001	0	1	01	01	H9314_001_0	4	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	11010	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	11010	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	023	0	1	04	01	H9615_023_0	10	1																										1	2	2				2				2		2	2			2		2			2	01000		2																																																																																	
H9615	025	0	1	04	01	H9615_025_0	8	1																										1	2	2				2				2		2	2			2		2			2	01000		2																																																																																	
H9771	001	0	1	01	01	H9771_001_0	5	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	6	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H9834	003	0	1	01	01	H9834_003_0	6	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00100		1																																																																																	
H9834	004	0	1	01	01	H9834_004_0	4	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H9834	006	0	1	01	01	H9834_006_0	6	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H9834	007	0	1	01	01	H9834_007_0	6	1																										1	2	1	20.00	1		2				2		2	2			2		2			2	00101		1																																																																																	
H9986	002	0	1	02	01	H9986_002_0	8	1																																																																								FC2 Specialist at-Home Program	2	2				2				1	20	20	2		2			1	2																																								
H9986	004	1	1	02	01	H9986_004_1	9	1																																																																								FC2 Specialist at-Home Program	2	2				2				1	20	20	2		2			1	2																																								
H9986	004	2	1	02	01	H9986_004_2	8	1																																																																								FC2 Specialist at-Home Program	2	2				2				1	20	20	2		2			1	2																																								
H9986	004	3	1	02	01	H9986_004_3	5	1																																																																								FC2 Specialist at-Home Program	2	2				2				1	20	20	2		2			1	2																																								
R0110	001	0	1	31	11	R0110_001_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	003	0	1	31	11	R0110_003_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	004	0	1	31	11	R0110_004_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	005	0	1	31	11	R0110_005_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	006	0	1	31	11	R0110_006_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	007	0	1	31	11	R0110_007_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	008	0	1	31	11	R0110_008_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	011	0	1	31	11	R0110_011_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	012	0	1	31	11	R0110_012_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	013	0	1	31	11	R0110_013_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	014	0	1	31	11	R0110_014_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	015	0	1	31	11	R0110_015_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	016	0	1	31	11	R0110_016_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	017	0	1	31	11	R0110_017_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	018	0	1	31	11	R0110_018_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	019	0	1	31	11	R0110_019_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R0110	020	0	1	31	11	R0110_020_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R1532	001	0	1	31	11	R1532_001_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R1532	002	0	1	31	11	R1532_002_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R4182	001	0	1	31	11	R4182_001_0	4	2																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R4182	003	0	1	31	11	R4182_003_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R4182	004	0	1	31	11	R4182_004_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R5361	001	0	1	31	11	R5361_001_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R5361	002	0	1	31	11	R5361_002_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R5826	005	0	1	31	11	R5826_005_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R5826	018	0	1	31	11	R5826_018_0	5	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R5826	074	0	1	31	11	R5826_074_0	4	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R7220	001	0	1	31	11	R7220_001_0	7	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
R7220	002	0	1	31	11	R7220_002_0	6	1																																																																								Virtual Cardiac Recovery Program	2	2				2				2			2		2			1	2																																								
