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_maxplan_yn	pbp_b13a_maxplan_amt	pbp_b13a_maxplan_per	pbp_b13a_maxenr_yn	pbp_b13a_maxenr_amt	pbp_b13a_maxenr_per	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_nrt_yn	pbp_b13b_nrt_attestation	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_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_maxenr_yn	pbp_b13c_maxenr_amt	pbp_b13c_maxenr_per	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_maxenr_yn	pbp_b13d_maxenr_amt	pbp_b13d_maxenr_per	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_maxenr_yn	pbp_b13e_maxenr_amt	pbp_b13e_maxenr_per	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_maxenr_yn	pbp_b13f_maxenr_amt	pbp_b13f_maxenr_per	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	7	1																																																														Healthy Foods Card	2	1	50	6	2			2			2		2			2	2																																				
H0028	007	0	1	01	01	H0028_007_0	7	2	1	1	2	1			1	1000	3	2			2			2		2			1	2	1	2	1	1000	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000	3	2			2			2		2			1	2																		
H0028	013	0	1	01	01	H0028_013_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H0028	014	0	1	01	01	H0028_014_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H0028	015	0	1	01	01	H0028_015_0	7	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H0028	015	0	1	01	01	H0028_015_0	7	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	010	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H0028	018	0	1	01	01	H0028_018_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H0028	021	0	1	01	01	H0028_021_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H0028	023	0	1	01	01	H0028_023_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H0028	023	0	1	01	01	H0028_023_0	4	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H0028	025	1	1	01	01	H0028_025_1	5	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H0028	025	2	1	01	01	H0028_025_2	5	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H0028	027	0	1	01	01	H0028_027_0	4	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H0028	027	0	1	01	01	H0028_027_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H0028	028	0	1	01	01	H0028_028_0	5	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H0028	028	0	1	01	01	H0028_028_0	5	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H0028	031	0	1	01	01	H0028_031_0	5	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H0028	032	0	1	01	01	H0028_032_0	4	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H0028	032	0	1	01	01	H0028_032_0	4	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H0028	033	0	1	01	01	H0028_033_0	6	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H0028	033	0	1	01	01	H0028_033_0	6	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H0028	034	0	1	01	01	H0028_034_0	4	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H0028	036	0	1	01	01	H0028_036_0	4	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H0028	042	0	1	01	01	H0028_042_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H0028	043	1	1	01	01	H0028_043_1	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H0028	044	0	1	01	01	H0028_044_0	5	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H0028	045	0	1	01	01	H0028_045_0	4	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H0028	047	0	1	01	01	H0028_047_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H0028	050	0	1	01	01	H0028_050_0	5	1	1	1	2	1			1	1000	3	2			2			2		2			1	2	1	2	1	1000	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	1000	3	2			2			2		2			1	2																		
H0028	051	0	1	01	01	H0028_051_0	5	1	1	1	2	1			1	1000	3	2			2			2		2			1	2	1	2	1	1000	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	1000	3	2			2			2		2			1	2																		
H0028	052	0	1	01	01	H0028_052_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H0028	052	0	1	01	01	H0028_052_0	4	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H0028	053	1	1	01	01	H0028_053_1	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H0028	053	2	1	01	01	H0028_053_2	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H0028	053	3	1	01	01	H0028_053_3	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H0104	012	0	1	04	01	H0104_012_0	5	1																																											1	2	010	2			2			2			2		2			2	2																																																						
H0104	014	0	1	04	01	H0104_014_0	5	1																																											1	2	010	2			2			2			2		2			2	2																																																						
H0104	015	0	1	04	01	H0104_015_0	7	1																																											1	2	010	2			2			2			2		2			2	2																																																						
H0169	001	0	1	01	01	H0169_001_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	150.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0169	002	0	1	01	01	H0169_002_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	175.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0169	003	0	1	01	01	H0169_003_0	4	2																																																																																VBID Transportation to Non-Benefit Related Locations	2	2			2			2			2		1	0.00	0.00	2	2																		
H0169	003	0	1	01	01	H0169_003_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	165.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0169	004	0	1	02	01	H0169_004_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	175.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0169	004	0	1	02	01	H0169_004_0	4	2																																																																																VBID Transportation to Non-Benefit Related Locations	2	2			2			2			2		1	0.00	0.00	2	2																		
H0251	002	0	1	01	01	H0251_002_0	5	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	150.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0251	004	0	1	01	01	H0251_004_0	5	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	200.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	005	0	1	04	01	H0271_005_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	75.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	006	0	1	04	01	H0271_006_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	60.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	013	0	1	04	01	H0271_013_0	5	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	100.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	014	0	1	04	01	H0271_014_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	40.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	016	0	1	04	01	H0271_016_0	5	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	155.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	020	0	1	04	01	H0271_020_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	50.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	023	0	1	04	01	H0271_023_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	125.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	024	0	1	04	01	H0271_024_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	40.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	028	0	1	04	01	H0271_028_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	90.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	029	0	1	04	01	H0271_029_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	150.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	030	0	1	04	01	H0271_030_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	50.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	037	0	1	04	01	H0271_037_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	100.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	038	0	1	04	01	H0271_038_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	100.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	039	0	1	04	01	H0271_039_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	40.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0271	042	0	1	04	01	H0271_042_0	5	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	50.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0292	001	0	1	01	01	H0292_001_0	7	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H0321	002	0	1	01	01	H0321_002_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	125.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0321	004	0	1	01	01	H0321_004_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	175.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0422	001	0	1	02	01	H0422_001_0	10	1																																											1	2	011	2			2			2			2		2			2	2																																																						
H0422	003	0	1	02	01	H0422_003_0	10	1																																											1	2	011	2			2			2			2		2			2	2																																																						
H0432	009	0	1	01	01	H0432_009_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	125.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0432	013	0	1	01	01	H0432_013_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	40.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0473	005	0	1	04	01	H0473_005_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H0523	801	0	1	01	01	H0523_801_0	2	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H0524	008	0	1	01	01	H0524_008_0	10	1																																											1	2	100	2			2			2			2		2			1	1																																																						
H0524	033	0	1	01	01	H0524_033_0	10	1																																											1	2	100	2			2			2			2		2			1	1																																																						
H0524	061	0	1	01	01	H0524_061_0	10	1																																											1	2	100	2			2			2			2		2			1	1																																																						
H0524	063	0	1	01	01	H0524_063_0	10	1																																											1	2	100	2			2			2			2		2			1	1																																																						
H0545	001	0	1	01	01	H0545_001_0	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H0624	001	0	1	01	01	H0624_001_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	130.00	6	2			2			2		1	0.00	0.00	2	2																																				
H0628	001	0	1	02	01	H0628_001_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H0628	005	0	1	02	01	H0628_005_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H0628	012	0	1	01	01	H0628_012_0	3	1																																																																																																																			
H0628	013	0	1	01	01	H0628_013_0	3	1																																																																																																																			
H0628	017	0	1	02	01	H0628_017_0	4	1																							1	2	2				2			2		2			2		1	0.00	0.00	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H0628	802	0	1	01	01	H0628_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H0838	024	0	1	01	01	H0838_024_0	5	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H0838	039	1	1	01	01	H0838_039_1	5	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H0838	039	2	1	01	01	H0838_039_2	5	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H0838	040	1	1	01	01	H0838_040_1	5	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H0838	040	2	1	01	01	H0838_040_2	5	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H0838	042	0	1	01	01	H0838_042_0	5	1																							1	2	1	80.00	6	2	2			2		2			2		1	0.00	0.00	2																																																																									
H0838	043	0	1	01	01	H0838_043_0	6	1																							1	2	1	50.00	6	2	2			2		2			2		1	0.00	0.00	2																																																																									
H0838	047	0	1	01	01	H0838_047_0	6	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H0913	013	0	1	01	01	H0913_013_0	7	1																							1	2	1	100.00	5	1	2			2		2			2		1	0.00	0.00	2																				Non-Medicare Covered Devices	2	1	100.00	5	2			2			2		1	0.00	0.00	1	1																																				
H0982	002	0	1	01	01	H0982_002_0	8	1																																																														Healthy Food Wallet	2	1	65.00	6	2			2			2		2			1	1																																				
H0982	006	0	1	01	01	H0982_006_0	8	1																																																														Healthy Food Wallet	2	1	35.00	6	2			2			2		2			1	1																																				
H0982	010	0	1	01	01	H0982_010_0	8	1																																																														Healthy Food Wallet	2	1	30.00	6	2			2			2		2			1	1																																				
H0982	012	0	1	01	01	H0982_012_0	8	1																																																														Healthy Food Wallet	2	1	65.00	6	2			2			2		2			1	1																																				
H0982	013	0	1	01	01	H0982_013_0	8	1																																																														Healthy Food Wallet	2	1	65.00	6	2			2			2		2			1	1																																				
H1016	023	0	1	01	01	H1016_023_0	6	1																							1	2	1	75.00	5	2	2			2		2			2		2			1	1	2	010	2			2			2			2		2			2	2																																																						
H1016	024	0	1	01	01	H1016_024_0	6	1																							1	2	1	75.00	5	2	2			2		2			2		2			1	1	2	010	2			2			2			2		2			2	2																																																						
H1019	001	0	1	01	01	H1019_001_0	7	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	006	0	1	01	01	H1019_006_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	023	0	1	01	01	H1019_023_0	6	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1019	023	0	1	01	01	H1019_023_0	6	1																																																																																																																			
H1019	026	0	1	01	01	H1019_026_0	6	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1019	026	0	1	01	01	H1019_026_0	6	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H1019	057	0	1	02	01	H1019_057_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	069	0	1	01	01	H1019_069_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	073	0	1	01	01	H1019_073_0	6	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1019	073	0	1	01	01	H1019_073_0	6	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H1019	098	0	1	01	01	H1019_098_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	102	0	1	01	01	H1019_102_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	103	1	1	01	01	H1019_103_1	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	103	2	1	01	01	H1019_103_2	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	105	0	1	01	01	H1019_105_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	106	0	1	01	01	H1019_106_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	107	0	1	01	01	H1019_107_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	108	0	1	01	01	H1019_108_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	109	0	1	01	01	H1019_109_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	114	0	1	01	01	H1019_114_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	115	0	1	01	01	H1019_115_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	116	0	1	01	01	H1019_116_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	117	0	1	01	01	H1019_117_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1019	118	0	1	01	01	H1019_118_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1035	022	0	1	01	01	H1035_022_0	5	1																							1	2	1	50.00	5	2	2			1	1	2			2		2			1																																																																									
H1035	023	0	1	01	01	H1035_023_0	5	1																							1	2	1	50.00	5	2	2			1	1	2			2		2			1																																																																									
H1035	024	0	1	01	01	H1035_024_0	5	1																							1	2	1	50.00	5	2	2			1	1	2			2		2			1																																																																									
H1035	025	0	1	01	01	H1035_025_0	5	1																							1	2	1	50.00	5	2	2			1	1	2			2		2			1																																																																									
H1035	026	0	1	01	01	H1035_026_0	6	1																							1	2	1	50.00	5	2	2			1	1	2			2		2			1																																																																									
H1035	033	0	1	01	01	H1035_033_0	5	1																							1	2	1	50.00	5	2	2			1	1	2			2		2			1																																																																									
H1035	034	0	1	01	01	H1035_034_0	5	1																							1	2	1	50.00	5	2	2			1	1	2			2		2			1																																																																									
H1035	045	0	1	01	01	H1035_045_0	5	1																							1	2	1	50.00	5	2	2			1	1	2			2		2			1																																																																									
H1035	048	0	1	01	01	H1035_048_0	6	1																							1	2	1	50.00	5	2	2			1	1	2			2		2			1																																																																									
H1036	054	0	1	01	01	H1036_054_0	9	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1036	054	0	1	01	01	H1036_054_0	9	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H1036	062	0	1	01	01	H1036_062_0	6	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H1036	062	0	1	01	01	H1036_062_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1036	065	0	1	01	01	H1036_065_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1036	065	0	1	01	01	H1036_065_0	6	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H1036	077	0	1	01	01	H1036_077_0	6	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1036	077	0	1	01	01	H1036_077_0	6	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H1036	077	0	1	01	01	H1036_077_0	6	3																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H1036	102	0	1	01	01	H1036_102_0	7	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1036	102	0	1	01	01	H1036_102_0	7	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H1036	103	0	1	01	01	H1036_103_0	6	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1036	103	0	1	01	01	H1036_103_0	6	3																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H1036	103	0	1	01	01	H1036_103_0	6	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H1036	104	0	1	01	01	H1036_104_0	6	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1036	104	0	1	01	01	H1036_104_0	6	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H1036	104	0	1	01	01	H1036_104_0	6	3																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H1036	121	0	1	01	01	H1036_121_0	6	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H1036	137	0	1	01	01	H1036_137_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H1036	156	0	1	01	01	H1036_156_0	8	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1036	167	0	1	01	01	H1036_167_0	4	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	010	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1036	167	0	1	01	01	H1036_167_0	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H1036	168	0	1	01	01	H1036_168_0	4	2																																											1	2	011	2			2			2			2		2			1	2																																																						
H1036	168	0	1	01	01	H1036_168_0	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H1036	175	0	1	01	01	H1036_175_0	8	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1036	199	0	1	01	01	H1036_199_0	6	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H1036	209	0	1	01	01	H1036_209_0	6	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H1036	209	0	1	01	01	H1036_209_0	6	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1036	210	0	1	01	01	H1036_210_0	6	1																																																														Healthy Foods Card	2	1	50	6	2			2			2		2			2	2																																				
H1036	210	0	1	01	01	H1036_210_0	6	2	1	1	2	1			1	1000	3	2			2			2		2			1	2	1	2	1	1000	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000	3	2			2			2		2			1	2																		
H1036	213	0	1	01	01	H1036_213_0	6	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H1036	213	0	1	01	01	H1036_213_0	6	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1036	214	0	1	01	01	H1036_214_0	6	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H1036	214	0	1	01	01	H1036_214_0	6	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1036	222	0	1	01	01	H1036_222_0	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H1036	226	0	1	01	01	H1036_226_0	5	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H1036	230	0	1	01	01	H1036_230_0	7	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1036	231	0	1	01	01	H1036_231_0	6	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1036	231	0	1	01	01	H1036_231_0	6	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H1036	233	0	1	01	01	H1036_233_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H1036	234	0	1	01	01	H1036_234_0	7	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1036	235	0	1	01	01	H1036_235_0	8	2	1	1	2	1			1	1000	3	2			2			2		2			1	2	1	2	1	1000	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000	3	2			2			2		2			1	2																		
H1036	235	0	1	01	01	H1036_235_0	8	1																																																														Healthy Foods Card	2	1	50	6	2			2			2		2			2	2																																				
H1036	236	0	1	01	01	H1036_236_0	7	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1036	237	1	1	01	01	H1036_237_1	6	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H1036	237	2	1	01	01	H1036_237_2	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H1036	243	0	1	01	01	H1036_243_0	6	2	1	1	2	1			1	1000	3	2			2			2		2			1	2	1	2	1	1000	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000	3	2			2			2		2			1	2																		
H1036	243	0	1	01	01	H1036_243_0	6	1																																																														Healthy Foods Card	2	1	50	6	2			2			2		2			2	2																																				
H1036	245	0	1	01	01	H1036_245_0	6	2	1	1	2	1			1	1000	3	2			2			2		2			1	2	1	2	1	1000	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000	3	2			2			2		2			1	2																		
H1036	245	0	1	01	01	H1036_245_0	6	1																																																														Healthy Foods Card	2	1	25	6	2			2			2		2			2	2																																				
H1036	261	0	1	01	01	H1036_261_0	6	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1036	261	0	1	01	01	H1036_261_0	6	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H1036	262	0	1	01	01	H1036_262_0	4	1																																																														Healthy Foods Card	2	1	25.00	6	2			2			2		2			2	2																																				
H1036	276	0	1	01	01	H1036_276_0	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H1036	276	0	1	01	01	H1036_276_0	4	2																																											1	2	011	2			2			2			2		2			1	2																																																						
H1036	279	0	1	01	01	H1036_279_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H1036	280	0	1	01	01	H1036_280_0	5	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H1036	280	0	1	01	01	H1036_280_0	5	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H1036	283	0	1	01	01	H1036_283_0	7	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H1036	283	0	1	01	01	H1036_283_0	7	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1036	284	0	1	01	01	H1036_284_0	6	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H1036	284	0	1	01	01	H1036_284_0	6	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1036	285	0	1	01	01	H1036_285_0	6	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H1036	285	0	1	01	01	H1036_285_0	6	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1036	291	0	1	01	01	H1036_291_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H1036	296	0	1	01	01	H1036_296_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H1045	012	0	1	01	01	H1045_012_0	3	1																																																														VBID Food Allowance	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																				
H1045	038	0	1	01	01	H1045_038_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	205.00	6	2			2			2		1	0.00	0.00	2	2																																				
H1045	039	0	1	01	01	H1045_039_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	140.00	6	2			2			2		1	0.00	0.00	2	2																																				
H1045	053	0	1	01	01	H1045_053_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	225.00	6	2			2			2		1	0.00	0.00	2	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	2			2		2			2	1	2	111	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H1360	001	0	1	01	01	H1360_001_0	4	2																																																														OTC and VBID Food Allowance Combined Benefit	2	1	80.00	6	2			2			2		1	0.00	0.00	2	2																																				
H1360	001	0	1	01	01	H1360_001_0	4	1																																																																																VBID Transportation to Non-Benefit Related Locations	2	2			2			2			2		1	0.00	0.00	2	2																		
H1365	001	0	1	04	01	H1365_001_0	6	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
H1365	004	1	1	04	01	H1365_004_1	5	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
H1365	004	2	1	04	01	H1365_004_2	5	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
H1375	001	0	1	01	01	H1375_001_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	75.00	6	2			2			2		1	0.00	0.00	2	2																																				
H1375	002	0	1	01	01	H1375_002_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	125.00	6	2			2			2		1	0.00	0.00	2	2																																				
H1416	036	0	1	01	01	H1416_036_0	4	1																							1	2	1	100.00	5	1	2			2		2			2		1	0.00	0.00	2																				Non-Medicare Covered Devices	2	1	100.00	5	2			2			2		1	0.00	0.00	1	1																																				
H1436	007	0	1	01	01	H1436_007_0	4	1																							1	2	1	100.00	5	1	2			2		2			2		1	0.00	0.00	2																				Non-Medicare Covered Devices	2	1	100.00	5	2			2			2		1	0.00	0.00	1	1																																				
H1468	017	0	1	01	01	H1468_017_0	7	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1468	019	0	1	01	01	H1468_019_0	8	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1468	020	0	1	01	01	H1468_020_0	5	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H1608	027	0	1	04	01	H1608_027_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2	1	2	001	2			2			2			2		1	0.00	0.00	2	2	Reminder Device	2	2			2			2			2		1	0.00	0.00	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H1608	802	0	1	04	01	H1608_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H1609	016	0	1	01	01	H1609_016_0	4	1																																																																																																																			
H1609	017	0	1	01	01	H1609_017_0	5	1																																																																																																																			
H1609	018	0	1	01	01	H1609_018_0	3	1																																																																																																																			
H1609	019	0	1	01	01	H1609_019_0	4	1																																																																																																																			
H1609	039	0	1	01	01	H1609_039_0	4	1																																																																																																																			
H1609	040	0	1	01	01	H1609_040_0	4	1																																																																																																																			
H1609	043	0	1	01	01	H1609_043_0	4	1																																																																																																																			
H1609	044	0	1	01	01	H1609_044_0	4	1																																																																																																																			
H1609	045	0	1	01	01	H1609_045_0	4	1																																																																																																																			
H1609	046	0	1	01	01	H1609_046_0	4	1																																																																																																																			
H1609	047	0	1	01	01	H1609_047_0	4	1																																																																																																																			
H1609	048	0	1	01	01	H1609_048_0	6	1																																																																																																																			
H1609	049	0	1	01	01	H1609_049_0	4	1																																																																																																																			
H1609	054	0	1	01	01	H1609_054_0	4	1																																																																																																																			
H1609	055	0	1	01	01	H1609_055_0	4	1																																																																																																																			
H1609	056	0	1	01	01	H1609_056_0	4	1																																																																																																																			
H1609	057	0	1	01	01	H1609_057_0	4	1																																																																																																																			
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	2			2		2			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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H1610	001	0	1	01	01	H1610_001_0	2	1																																																																																																																			
H1610	002	0	1	01	01	H1610_002_0	2	1																																																																																																																			
H1692	005	0	1	01	01	H1692_005_0	4	1																																																																																																																			
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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H1692	802	0	1	01	01	H1692_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H1799	001	0	1	01	01	H1799_001_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H1799	002	0	1	01	01	H1799_002_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H1889	002	1	1	04	01	H1889_002_1	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	125.00	6	2			2			2		1	0.00	0.00	2	2																																				
H1889	002	2	1	04	01	H1889_002_2	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	125.00	6	2			2			2		1	0.00	0.00	2	2																																				
H1951	032	0	1	01	01	H1951_032_0	4	1																																																														Healthy Foods Card	2	1	100.00	6	2			2			2		2			2	2																																				
H1951	033	0	1	01	01	H1951_033_0	5	1																																																														Healthy Foods Card	2	1	100.00	6	2			2			2		2			2	2																																				
H1951	034	0	1	01	01	H1951_034_0	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H1951	038	0	1	01	01	H1951_038_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H1951	039	0	1	01	01	H1951_039_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H1951	041	0	1	01	01	H1951_041_0	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H1951	056	0	1	01	01	H1951_056_0	4	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H1961	003	0	1	01	01	H1961_003_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	42.00	6	2			2			2		1	0.00	0.00	2	2																																				
H1961	019	0	1	01	01	H1961_019_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	175.00	6	2			2			2		1	0.00	0.00	2	2																																				
H2056	801	0	1	01	01	H2056_801_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H2056	802	0	1	01	01	H2056_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H2226	001	0	1	01	01	H2226_001_0	3	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	90.00	6	2			2			2		1	0.00	0.00	2	2																																				
H2226	003	0	1	01	01	H2226_003_0	3	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	90.00	6	2			2			2		1	0.00	0.00	2	2																																				
H2228	041	0	1	04	01	H2228_041_0	6	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	125.00	6	2			2			2		1	0.00	0.00	2	2																																				
H2228	043	0	1	04	01	H2228_043_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	150.00	6	2			2			2		1	0.00	0.00	2	2																																				
H2228	045	0	1	04	01	H2228_045_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	80.00	6	2			2			2		1	0.00	0.00	2	2																																				
H2235	001	0	1	01	01	H2235_001_0	10	1																							1	2	1	25.00	5	2	2			1	1	2			2		2			1																																																																									
H2235	003	0	1	01	01	H2235_003_0	10	1																							1	2	1	50.00	5	2	2			1	1	2			2		2			1																																																																									
H2237	001	0	1	01	01	H2237_001_0	13	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H2237	001	0	1	01	01	H2237_001_0	13	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H2237	007	0	1	01	01	H2237_007_0	12	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H2247	001	0	1	01	01	H2247_001_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	120.00	6	2			2			2		1	0.00	0.00	2	2																																				
H2256	001	1	1	01	01	H2256_001_1	6	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	120.00	120.00	2	1																																				
H2256	001	2	1	01	01	H2256_001_2	6	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	120.00	120.00	2	1																																				
H2256	001	6	1	01	01	H2256_001_6	6	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	120.00	120.00	2	1																																				
H2256	015	1	1	01	01	H2256_015_1	7	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	180.00	180.00	2	1																																				
H2256	015	2	1	01	01	H2256_015_2	7	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	180.00	180.00	2	1																																				
H2256	015	6	1	01	01	H2256_015_6	7	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	180.00	180.00	2	1																																				
H2256	016	1	1	01	01	H2256_016_1	7	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	180.00	180.00	2	1																																				
H2256	016	2	1	01	01	H2256_016_2	6	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	180.00	180.00	2	1																																				
H2256	018	1	1	01	01	H2256_018_1	6	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	600.00	600.00	2	1																																				
H2256	018	7	1	01	01	H2256_018_7	6	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	600.00	600.00	2	1																																				
H2256	018	8	1	01	01	H2256_018_8	6	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	600.00	600.00	2	1																																				
H2256	019	1	1	01	01	H2256_019_1	5	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	600.00	600.00	2	1																																				
H2256	019	7	1	01	01	H2256_019_7	5	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	600.00	600.00	2	1																																				
H2256	026	1	1	01	01	H2256_026_1	6	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	825.00	825.00	2	1																																				
H2256	026	2	1	01	01	H2256_026_2	6	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	825.00	825.00	2	1																																				
H2256	026	3	1	01	01	H2256_026_3	6	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	825.00	825.00	2	1																																				
H2256	028	0	1	01	01	H2256_028_0	6	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	1000.00	1000.00	2	1																																				
H2256	033	0	1	01	01	H2256_033_0	8	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	180.00	180.00	2	1																																				
H2256	034	0	1	01	01	H2256_034_0	6	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	600.00	600.00	2	1																																				
H2256	036	0	1	01	01	H2256_036_0	6	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	825.00	825.00	2	1																																				
H2256	039	0	1	01	01	H2256_039_0	6	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	180.00	180.00	2	1																																				
H2256	040	0	1	01	01	H2256_040_0	5	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	600.00	600.00	2	1																																				
H2256	041	0	1	01	01	H2256_041_0	5	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	825.00	825.00	2	1																																				
H2256	042	0	1	01	01	H2256_042_0	5	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	825.00	825.00	2	1																																				
H2256	046	0	1	01	01	H2256_046_0	7	1																																																														Flexible Supplemental Benefit Described in 19B	2	2			2			2			2		1	1000.00	1000.00	2	1																																				
H2288	003	0	1	01	01	H2288_003_0	5	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H2288	009	0	1	01	01	H2288_009_0	6	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H2288	010	0	1	01	01	H2288_010_0	5	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H2425	001	0	1	01	01	H2425_001_0	7	1																							1	2	1	50.00	3		2			2		2			2		2			2																																																																									
H2459	021	1	1	02	01	H2459_021_1	5	1																																											1	2	011	2			2			2			2		2			2	2																																																						
H2459	031	0	1	01	01	H2459_031_0	8	1																							1	2	2				2			2		2			2		1	0.00	20.00	2																																																																									
H2459	032	0	1	01	01	H2459_032_0	8	1																							1	2	2				2			2		2			2		1	0.00	10.00	2																																																																									
H2463	001	0	1	01	01	H2463_001_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H2486	003	0	1	01	01	H2486_003_0	8	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H2486	006	0	1	01	01	H2486_006_0	7	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H2486	007	0	1	01	01	H2486_007_0	8	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H2563	005	1	1	01	01	H2563_005_1	11	1																																																														Comprehensive Falls Risk Assessment	2	2			2			2			2		1	0.00	0.00	1	1																																				
H2563	005	2	1	01	01	H2563_005_2	11	1																																																														Comprehensive Falls Risk Assessment	2	2			2			2			2		1	0.00	0.00	1	1																																				
H2563	017	1	1	01	01	H2563_017_1	11	1																																																														Comprehensive Falls Risk Assessment	2	2			2			2			2		1	0.00	0.00	1	1																																				
H2563	017	2	1	01	01	H2563_017_2	11	1																																																														Comprehensive Falls Risk Assessment	2	2			2			2			2		1	0.00	0.00	1	1																																				
H2582	002	0	1	01	01	H2582_002_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	80.00	6	2			2			2		1	0.00	0.00	2	2																																				
H2610	005	0	1	01	01	H2610_005_0	5	1																							1	2	1	50.00	5	2	2			1	1	2			2		2			1																																																																									
H2610	006	0	1	01	01	H2610_006_0	6	1																							1	2	1	50.00	5	2	2			1	1	2			2		2			1																																																																									
H2663	002	0	1	01	01	H2663_002_0	4	1																																																																																																																			
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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H2663	810	0	1	01	01	H2663_810_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H2802	044	0	1	01	01	H2802_044_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	120.00	6	2			2			2		1	0.00	0.00	2	2																																				
H2802	053	0	1	01	01	H2802_053_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	165.00	6	2			2			2		1	0.00	0.00	2	2																																				
H2802	053	0	1	01	01	H2802_053_0	4	2																																																																																VBID Transportation to Non-Benefit Related Locations	2	2			2			2			2		1	0.00	0.00	2	2																		
H2879	001	0	1	01	01	H2879_001_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H2879	002	0	1	01	01	H2879_002_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H2879	003	0	1	01	01	H2879_003_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H3113	005	0	1	01	01	H3113_005_0	3	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	225.00	6	2			2			2		1	0.00	0.00	2	2																																				
H3113	009	0	1	01	01	H3113_009_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	125.00	6	2			2			2		1	0.00	0.00	2	2																																				
H3113	010	0	1	01	01	H3113_010_0	5	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	150.00	6	2			2			2		1	0.00	0.00	2	2																																				
H3113	011	0	1	01	01	H3113_011_0	5	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	155.00	6	2			2			2		1	0.00	0.00	2	2																																				
H3113	013	0	1	01	01	H3113_013_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	45.00	6	2			2			2		1	0.00	0.00	2	2																																				
H3113	014	0	1	01	01	H3113_014_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	45.00	6	2			2			2		1	0.00	0.00	2	2																																				
H3146	001	0	1	02	01	H3146_001_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H3146	002	0	1	01	01	H3146_002_0	4	1																																																																																																																			
H3146	003	0	1	01	01	H3146_003_0	4	1																																																																																																																			
H3146	004	0	1	02	01	H3146_004_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H3146	005	0	1	01	01	H3146_005_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H3146	006	0	1	01	01	H3146_006_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H3146	007	0	1	02	01	H3146_007_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H3146	008	0	1	01	01	H3146_008_0	4	1																																																																																																																			
H3146	009	0	1	01	01	H3146_009_0	4	1																																																																																																																			
H3146	010	0	1	01	01	H3146_010_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H3146	011	0	1	01	01	H3146_011_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H3146	012	0	1	01	01	H3146_012_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H3146	013	0	1	01	01	H3146_013_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H3146	014	0	1	02	01	H3146_014_0	4	1																							1	2	2				2			2		2			2		1	0.00	0.00	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H3146	802	0	1	01	01	H3146_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H3152	804	0	1	01	01	H3152_804_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H3186	001	0	1	04	01	H3186_001_0	12	1																																											1	2	111	2			2			2			2		2			2	1																																																						
H3186	002	0	1	04	01	H3186_002_0	12	1																																											1	2	111	2			2			2			2		2			2	1																																																						
H3192	001	0	1	02	01	H3192_001_0	6	1																																																																																																																			
H3192	002	0	1	02	01	H3192_002_0	6	1																																																																																																																			
H3192	003	0	1	02	01	H3192_003_0	6	1																																																																																																																			
H3192	004	0	1	02	01	H3192_004_0	6	1																																																																																																																			
H3192	005	0	1	02	01	H3192_005_0	6	1																																																																																																																			
H3192	006	0	1	02	01	H3192_006_0	5	1																																																																																																																			
H3192	007	0	1	01	01	H3192_007_0	5	1																																																																																																																			
H3192	008	0	1	01	01	H3192_008_0	5	1																																																																																																																			
H3192	009	0	1	01	01	H3192_009_0	6	1																																																																																																																			
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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H3192	802	0	1	01	01	H3192_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H3219	802	0	1	04	01	H3219_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H3239	001	0	1	01	01	H3239_001_0	5	1																																																																																																																			
H3239	002	0	1	01	01	H3239_002_0	5	1																																																																																																																			
H3239	003	0	1	01	01	H3239_003_0	5	1																																																																																																																			
H3239	005	0	1	01	01	H3239_005_0	5	1																																																																																																																			
H3239	006	0	1	01	01	H3239_006_0	5	1																																																																																																																			
H3239	007	0	1	01	01	H3239_007_0	5	1																																																																																																																			
H3239	008	0	1	01	01	H3239_008_0	6	1																																																																																																																			
H3256	001	0	1	04	01	H3256_001_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	100.00	6	2			2			2		1	0.00	0.00	2	2																																				
H3256	002	0	1	04	01	H3256_002_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	40.00	6	2			2			2		1	0.00	0.00	2	2																																				
H3276	001	0	1	01	01	H3276_001_0	5	1																							1	2	1	50.00	6	2	2			1	1	2			2		2			1																																																																									
H3288	047	0	1	04	01	H3288_047_0	2	1																							1	2	2				2			2		2			2		1	0.00	0.00	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H3288	802	0	1	04	01	H3288_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H3293	004	0	1	01	01	H3293_004_0	8	1																																																														Wellness Activity Visits	2	2			2			2			2		2			1	1																																				
H3305	007	0	1	02	01	H3305_007_0	5	1																							1	2	2				2			2		2			2		2			2																																																																									
H3305	015	0	1	02	01	H3305_015_0	8	1																							1	2	2				2			2		2			2		2			1																																																																									
H3305	020	0	1	02	01	H3305_020_0	5	1																							1	2	2				2			2		2			2		2			2																																																																									
H3305	021	0	1	02	01	H3305_021_0	7	1																							1	2	2				2			2		2			2		2			2																																																																									
H3305	022	0	1	02	01	H3305_022_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H3305	030	0	1	02	01	H3305_030_0	7	1																							1	2	2				2			2		2			2		2			2																																																																									
H3305	032	0	1	02	01	H3305_032_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H3312	069	0	1	01	01	H3312_069_0	3	1																																																																																																																			
H3312	070	0	1	01	01	H3312_070_0	4	1																																																																																																																			
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	2			2		2			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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H3330	042	1	1	01	01	H3330_042_1	5	1																							1	2	1	120.00	6	2	2			1	1	2			2		2			1																																																																									
H3330	042	2	1	01	01	H3330_042_2	5	1																							1	2	1	50.00	6	2	2			1	1	2			2		2			1																																																																									
H3330	042	3	1	01	01	H3330_042_3	5	1																							1	2	1	100.00	6	2	2			1	1	2			2		2			1																																																																									
H3359	021	0	1	01	01	H3359_021_0	8	1																																																														Healthy foods	2	2			2			2			2		2			2	2	Internet Service	2	2			2			2			2		2			2	2																		
H3359	038	0	1	01	01	H3359_038_0	7	1																																																														Healthy foods	2	2			2			2			2		2			2	2	Internet Service	2	2			2			2			2		2			2	2																		
H3387	014	1	1	01	01	H3387_014_1	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	150.00	6	2			2			2		1	0.00	0.00	2	2																																				
H3387	014	2	1	01	01	H3387_014_2	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	150.00	6	2			2			2		1	0.00	0.00	2	2																																				
H3387	015	1	1	01	01	H3387_015_1	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	50.00	6	2			2			2		1	0.00	0.00	2	2																																				
H3387	015	2	1	01	01	H3387_015_2	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	50.00	6	2			2			2		1	0.00	0.00	2	2																																				
H3533	001	0	1	01	01	H3533_001_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3533	002	0	1	01	01	H3533_002_0	4	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H3533	006	0	1	01	01	H3533_006_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3533	010	0	1	01	01	H3533_010_0	5	1																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H3533	013	0	1	01	01	H3533_013_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3533	027	0	1	01	01	H3533_027_0	4	1																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H3533	032	1	1	01	01	H3533_032_1	4	1																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H3533	032	2	1	01	01	H3533_032_2	4	1																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H3533	033	0	1	01	01	H3533_033_0	4	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H3533	033	0	1	01	01	H3533_033_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3533	034	1	1	01	01	H3533_034_1	4	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H3533	034	2	1	01	01	H3533_034_2	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H3597	011	0	1	02	01	H3597_011_0	5	1																																																																																																																			
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	2			2		2			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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H3653	004	0	1	01	01	H3653_004_0	6	1																																																														Acute Care at Home	2	2			2			2			2		2			1	1																																				
H3660	028	0	1	02	01	H3660_028_0	5	2																																											1	2	001	2			2			2			2		2			2	2																																																						
H3660	029	0	1	02	01	H3660_029_0	7	2																																											1	2	001	2			2			2			2		2			2	2																																																						
H3660	044	0	1	01	01	H3660_044_0	8	2																																											1	2	001	2			2			2			2		2			2	2																																																						
H3660	050	0	1	01	01	H3660_050_0	5	2																																											1	2	001	2			2			2			2		2			2	2																																																						
H3660	052	1	1	01	01	H3660_052_1	3	2																																											1	2	001	2			2			2			2		2			2	2																																																						
H3660	052	2	1	01	01	H3660_052_2	3	2																																											1	2	001	2			2			2			2		2			2	2																																																						
H3660	053	1	1	01	01	H3660_053_1	5	2																																											1	2	001	2			2			2			2		2			2	2																																																						
H3660	053	2	1	01	01	H3660_053_2	5	2																																											1	2	001	2			2			2			2		2			2	2																																																						
H3660	801	0	1	01	01	H3660_801_0	5	2																																											1	2	011	2			2			2			2		2			2	2																																																						
H3660	805	0	1	02	01	H3660_805_0	5	2																																											1	2	011	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H3748	802	0	1	01	01	H3748_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H3794	002	0	1	01	01	H3794_002_0	5	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	150.00	6	2			2			2		1	0.00	0.00	2	2																																				
H3907	002	0	1	01	01	H3907_002_0	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3907	006	0	1	01	01	H3907_006_0	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3907	029	0	1	01	01	H3907_029_0	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3907	037	0	1	01	01	H3907_037_0	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3907	045	0	1	01	01	H3907_045_0	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3907	046	0	1	01	01	H3907_046_0	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3907	049	0	1	01	01	H3907_049_0	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3907	050	0	1	01	01	H3907_050_0	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3907	051	0	1	01	01	H3907_051_0	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3907	052	0	1	01	01	H3907_052_0	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3907	053	0	1	01	01	H3907_053_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3907	054	0	1	01	01	H3907_054_0	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3907	055	0	1	01	01	H3907_055_0	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3907	056	0	1	01	01	H3907_056_0	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H3916	005	0	1	04	01	H3916_005_0	6	1																																																														Healthcare Kit	2	2			2			2			2		2			2	2																																				
H3916	012	0	1	04	01	H3916_012_0	5	1																																																														Healthcare Kit	2	2			2			2			2		2			2	2																																				
H3916	015	0	1	04	01	H3916_015_0	6	1																																																														Healthcare Kit	2	2			2			2			2		2			2	2																																				
H3924	059	21	1	04	01	H3924_059_21	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3924	059	22	1	04	01	H3924_059_22	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3924	062	21	1	04	01	H3924_062_21	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3924	062	22	1	04	01	H3924_062_22	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3924	062	23	1	04	01	H3924_062_23	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3924	065	0	1	04	01	H3924_065_0	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3924	066	0	1	04	01	H3924_066_0	5	1																																											1	2	010	2			2			2			2		2			1	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	2			2		2			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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H3931	004	0	1	01	01	H3931_004_0	2	1																							1	2	2				2			2		2			2		1	0.00	0.00	2	1	2	001	2			2			2			2		1	0.00	0.00	2	2	Reminder Device	2	2			2			2			2		1	0.00	0.00	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	2			2		2			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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H3952	053	0	1	02	01	H3952_053_0	3	2																							1	2	1	20.00	5	2	2			2		2			2		2			2																																																																									
H3952	054	0	1	02	01	H3952_054_0	2	2																							1	2	1	20.00	5	2	2			2		2			2		2			2																																																																									
H3954	097	0	1	01	01	H3954_097_0	7	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3954	156	21	1	01	01	H3954_156_21	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3954	156	22	1	01	01	H3954_156_22	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3954	156	23	1	01	01	H3954_156_23	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3954	157	21	1	01	01	H3954_157_21	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3954	157	22	1	01	01	H3954_157_22	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3954	157	23	1	01	01	H3954_157_23	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3954	158	13	1	01	01	H3954_158_13	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3954	158	14	1	01	01	H3954_158_14	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3954	160	0	1	01	01	H3954_160_0	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3954	161	0	1	01	01	H3954_161_0	5	1																																											1	2	010	2			2			2			2		2			1	2																																																						
H3957	042	1	1	01	01	H3957_042_1	6	1																																																														Healthcare Kit	2	2			2			2			2		2			2	2																																				
H3957	042	2	1	01	01	H3957_042_2	6	1																																																														Healthcare Kit	2	2			2			2			2		2			2	2																																				
H3957	042	4	1	01	01	H3957_042_4	6	1																																																														Healthcare Kit	2	2			2			2			2		2			2	2																																				
H3957	042	5	1	01	01	H3957_042_5	6	1																																																														Healthcare Kit	2	2			2			2			2		2			2	2																																				
H3957	043	1	1	02	01	H3957_043_1	5	1																																																														Healthcare Kit	2	2			2			2			2		2			2	2																																				
H3957	043	2	1	02	01	H3957_043_2	5	1																																																														Healthcare Kit	2	2			2			2			2		2			2	2																																				
H3957	044	1	1	02	01	H3957_044_1	6	1																																																														Healthcare Kit	2	2			2			2			2		2			2	2																																				
H3957	045	1	1	02	01	H3957_045_1	6	1																																																														Healthcare Kit	2	2			2			2			2		2			2	2																																				
H3957	045	2	1	02	01	H3957_045_2	6	1																																																														Healthcare Kit	2	2			2			2			2		2			2	2																																				
H3957	046	1	1	02	01	H3957_046_1	6	1																																																														Healthcare Kit	2	2			2			2			2		2			2	2																																				
H3957	046	2	1	02	01	H3957_046_2	6	1																																																														Healthcare Kit	2	2			2			2			2		2			2	2																																				
H3959	001	0	1	01	01	H3959_001_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2	1	2	001	2			2			2			2		1	0.00	0.00	2	2	Reminder Device	2	2			2			2			2		1	0.00	0.00	2	2																																				
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H3959	036	0	1	01	01	H3959_036_0	3	1																																																																																																																			
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H3959	041	0	1	01	01	H3959_041_0	2	1																																																																																																																			
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H3959	046	0	1	01	01	H3959_046_0	3	2																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
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H3959	047	0	1	01	01	H3959_047_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
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H3959	049	0	1	01	01	H3959_049_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H3959	051	0	1	01	01	H3959_051_0	3	1																																																																																																																			
H3959	053	0	1	01	01	H3959_053_0	3	1																																																																																																																			
H3959	063	0	1	01	01	H3959_063_0	5	1																																																																																																																			
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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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H4003	009	0	1	01	01	H4003_009_0	9	1																							1	2	1	50.00	6	2	2			1	1	2			2		2			2																																																																									
H4003	009	0	1	01	01	H4003_009_0	9	2																																																														NEW AND INNOVATIVE TECHNOLOGIES	2	2			2			2			2		2			1	1																																				
H4003	017	0	1	01	01	H4003_017_0	9	1																																																														NEW AND INNOVATIVE TECHNOLOGIES	2	2			2			2			2		2			1	1																																				
H4003	017	0	1	01	01	H4003_017_0	9	2																							1	2	1	90.00	6	2	2			1	1	2			2		2			2																																																																									
H4003	034	0	1	02	01	H4003_034_0	9	1																							1	2	1	20.00	6	2	2			1	1	2			2		2			2																																																																									
H4003	047	0	1	01	01	H4003_047_0	11	1																																																														NEW AND INNOVATIVE TECHNOLOGIES	2	2			2			2			2		2			1	1																																				
H4003	049	0	1	01	01	H4003_049_0	10	1																																																														NEW AND INNOVATIVE TECHNOLOGIES	2	2			2			2			2		2			1	1																																				
H4003	051	0	1	02	01	H4003_051_0	12	1																							1	2	1	60.00	6	2	2			1	1	2			2		2			2																																																																									
H4003	052	0	1	01	01	H4003_052_0	8	1																							1	2	1	110.00	6	2	2			1	1	2			2		2			2																																																																									
H4003	052	0	1	01	01	H4003_052_0	8	2																																																														NEW AND INNOVATIVE TECHNOLOGIES	2	2			2			2			2		2			1	1																																				
H4004	048	0	1	01	01	H4004_048_0	11	2																							1	2	1	50.00	6	2	2			1	1	2			2		2			2																																																																									
H4004	048	0	1	01	01	H4004_048_0	11	1																																																														NEW AND INNOVATIVE TECHNOLOGIES	2	2			2			2			2		2			1	1																																				
H4004	056	0	1	02	01	H4004_056_0	11	1																							1	2	1	35.00	6	2	2			1	1	2			2		2			2																																																																									
H4004	061	0	1	01	01	H4004_061_0	11	2																							1	2	1	75.00	6	2	2			1	1	2			2		2			2																																																																									
H4004	061	0	1	01	01	H4004_061_0	11	1																																																														NEW AND INNOVATIVE TECHNOLOGIES	2	2			2			2			2		2			1	1																																				
H4004	062	0	1	01	01	H4004_062_0	10	2																							1	2	1	225.00	6	2	2			1	1	2			2		2			2																																																																									
H4004	062	0	1	01	01	H4004_062_0	10	1																																																														NEW AND INNOVATIVE TECHNOLOGIES	2	2			2			2			2		2			1	1																																				
H4004	063	0	1	02	01	H4004_063_0	9	1																							1	2	1	100.00	6	2	2			1	1	2			2		2			2																																																																									
H4004	064	0	1	02	01	H4004_064_0	9	1																							1	2	1	200.00	6	2	2			1	1	2			2		2			2																																																																									
H4004	065	0	1	02	01	H4004_065_0	8	1																							1	2	1	60.00	6	2	2			1	1	2			2		2			2																																																																									
H4007	012	0	1	01	01	H4007_012_0	7	2																							1	2	1	100.00	6	2	2			2		2			2		2			2																																																																									
H4007	016	0	1	01	01	H4007_016_0	7	1																							1	2	1	200.00	6	2	2			2		2			2		2			2																																																																									
H4094	001	0	1	02	01	H4094_001_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	55.00	6	2			2			2		1	0.00	0.00	2	2																																				
H4141	003	0	1	01	01	H4141_003_0	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H4141	003	0	1	01	01	H4141_003_0	4	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H4141	015	0	1	01	01	H4141_015_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H4141	017	3	1	01	01	H4141_017_3	3	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H4141	017	4	1	01	01	H4141_017_4	3	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H4286	002	0	1	01	01	H4286_002_0	9	1																																											1	2	001	2			2			2			2		2			1	1																																																						
H4461	022	0	1	01	01	H4461_022_0	9	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H4461	022	0	1	01	01	H4461_022_0	9	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H4461	038	0	1	01	01	H4461_038_0	6	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H4461	038	0	1	01	01	H4461_038_0	6	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H4514	013	1	1	01	01	H4514_013_1	5	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	105.00	6	2			2			2		1	0.00	0.00	2	2																																				
H4514	013	2	1	01	01	H4514_013_2	5	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	105.00	6	2			2			2		1	0.00	0.00	2	2																																				
H4514	013	3	1	01	01	H4514_013_3	5	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	105.00	6	2			2			2		1	0.00	0.00	2	2																																				
H4514	016	0	1	01	01	H4514_016_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	110.00	6	2			2			2		1	0.00	0.00	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	2			2		2			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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H4527	003	0	1	01	01	H4527_003_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	65.00	6	2			2			2		1	0.00	0.00	2	2																																				
H4527	004	0	1	01	01	H4527_004_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	40.00	6	2			2			2		1	0.00	0.00	2	2																																				
H4527	006	0	1	01	01	H4527_006_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	85.00	6	2			2			2		1	0.00	0.00	2	2																																				
H4527	015	0	1	01	01	H4527_015_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	125.00	6	2			2			2		1	0.00	0.00	2	2																																				
H4590	020	0	1	01	01	H4590_020_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	105.00	6	2			2			2		1	0.00	0.00	2	2																																				
H4590	022	0	1	01	01	H4590_022_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	110.00	6	2			2			2		1	0.00	0.00	2	2																																				
H4590	033	0	1	01	01	H4590_033_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	110.00	6	2			2			2		1	0.00	0.00	2	2																																				
H4623	002	0	1	01	01	H4623_002_0	7	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H4709	027	0	1	01	01	H4709_027_0	5	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H4709	031	0	1	01	01	H4709_031_0	5	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H4709	033	0	1	01	01	H4709_033_0	5	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H4709	037	0	1	01	01	H4709_037_0	5	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H4709	039	0	1	01	01	H4709_039_0	5	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H4711	011	0	1	01	01	H4711_011_0	5	1																																																																																																																			
H4711	012	0	1	01	01	H4711_012_0	3	1																																																																																																																			
H4711	013	0	1	01	01	H4711_013_0	6	1																																																																																																																			
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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H4711	802	0	1	01	01	H4711_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H4835	802	0	1	01	01	H4835_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H4847	004	0	1	01	01	H4847_004_0	4	1																							1	2	1	100.00	5	1	2			2		2			2		1	0.00	0.00	2																				Non-Medicare Covered Devices	2	1	100.00	5	2			2			2		1	0.00	0.00	1	1																																				
H4853	016	0	1	01	01	H4853_016_0	6	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H4853	017	0	1	01	01	H4853_017_0	7	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H4853	020	0	1	01	01	H4853_020_0	6	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H4931	001	0	1	01	01	H4931_001_0	11	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H4931	001	0	1	01	01	H4931_001_0	11	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H4931	006	0	1	01	01	H4931_006_0	13	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H4931	006	0	1	01	01	H4931_006_0	13	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H4931	007	0	1	01	01	H4931_007_0	12	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H4931	007	0	1	01	01	H4931_007_0	12	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H4931	008	0	1	01	01	H4931_008_0	12	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H4931	008	0	1	01	01	H4931_008_0	12	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H4931	013	0	1	01	01	H4931_013_0	12	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H4931	013	0	1	01	01	H4931_013_0	12	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H4931	014	0	1	01	01	H4931_014_0	12	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H4931	014	0	1	01	01	H4931_014_0	12	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H4931	015	0	1	01	01	H4931_015_0	12	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H4931	015	0	1	01	01	H4931_015_0	12	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H4931	016	0	1	01	01	H4931_016_0	12	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H4931	016	0	1	01	01	H4931_016_0	12	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H4982	008	0	1	01	01	H4982_008_0	3	1																																																																																																																			
H4982	009	0	1	01	01	H4982_009_0	3	1																																																																																																																			
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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H4982	802	0	1	01	01	H4982_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5008	002	0	1	01	01	H5008_002_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	105.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5008	010	0	1	01	01	H5008_010_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	175.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5008	011	0	1	01	01	H5008_011_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	100.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5008	015	0	1	01	01	H5008_015_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	45.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5211	001	0	1	02	01	H5211_001_0	8	1																																											1	2	010	2			2			2			2		2			2	2																																																						
H5211	002	0	1	02	01	H5211_002_0	9	1																																											1	2	010	2			2			2			2		2			2	2																																																						
H5211	003	0	1	02	01	H5211_003_0	8	1																																											1	2	010	2			2			2			2		2			2	2																																																						
H5211	004	0	1	02	01	H5211_004_0	8	1																																											1	2	010	2			2			2			2		2			2	2																																																						
H5211	010	0	1	01	01	H5211_010_0	8	1																																											1	2	010	2			2			2			2		2			2	2																																																						
H5211	012	0	1	02	01	H5211_012_0	9	1																																											1	2	010	2			2			2			2		2			2	2																																																						
H5211	013	0	1	02	01	H5211_013_0	8	1																																											1	2	010	2			2			2			2		2			2	2																																																						
H5215	001	0	1	04	01	H5215_001_0	7	1	1	1	2	2	12	3	2			2			2			2		2			1	2																																																																																													
H5215	002	0	1	04	01	H5215_002_0	9	1	1	1	2	2	12	3	2			2			2			2		2			1	2																																																																																													
H5215	005	0	1	04	01	H5215_005_0	7	1	1	1	2	2	12	3	2			2			2			2		2			1	2																																																																																													
H5215	006	0	1	04	01	H5215_006_0	7	1	1	1	2	2	12	3	2			2			2			2		2			1	2																																																																																													
H5215	007	0	1	04	01	H5215_007_0	8	1	1	1	2	2	12	3	2			2			2			2		2			1	2																																																																																													
H5215	008	0	1	04	01	H5215_008_0	9	1	1	1	2	2	12	3	2			2			2			2		2			1	2																																																																																													
H5215	009	0	1	04	01	H5215_009_0	10	1	1	1	2	2	12	3	2			2			2			2		2			1	2																																																																																													
H5215	010	0	1	04	01	H5215_010_0	7	1	1	1	2	2	12	3	2			2			2			2		2			1	2																																																																																													
H5215	011	0	1	04	01	H5215_011_0	7	1	1	1	2	2	12	3	2			2			2			2		2			1	2																																																																																													
H5215	012	0	1	04	01	H5215_012_0	9	1	1	1	2	2	12	3	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			1	2																																																						
H5216	017	0	1	04	01	H5216_017_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5216	027	0	1	04	01	H5216_027_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5216	029	0	1	04	01	H5216_029_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5216	034	0	1	04	01	H5216_034_0	4	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	034	0	1	04	01	H5216_034_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	036	0	1	04	01	H5216_036_0	5	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	037	0	1	04	01	H5216_037_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	042	0	1	04	01	H5216_042_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	043	1	1	04	01	H5216_043_1	5	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	043	2	1	04	01	H5216_043_2	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	047	0	1	04	01	H5216_047_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	048	0	1	04	01	H5216_048_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	065	0	1	04	01	H5216_065_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	068	0	1	04	01	H5216_068_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	073	0	1	04	01	H5216_073_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	077	0	1	04	01	H5216_077_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	078	1	1	04	01	H5216_078_1	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	128	0	1	04	01	H5216_128_0	2	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	129	0	1	04	01	H5216_129_0	3	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5216	137	0	1	04	01	H5216_137_0	5	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	137	0	1	04	01	H5216_137_0	5	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	141	0	1	04	01	H5216_141_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	143	0	1	04	01	H5216_143_0	5	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	144	0	1	04	01	H5216_144_0	4	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	144	0	1	04	01	H5216_144_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5216	149	0	1	04	01	H5216_149_0	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5216	152	0	1	04	01	H5216_152_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5216	152	0	1	04	01	H5216_152_0	5	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	154	0	1	04	01	H5216_154_0	4	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	154	0	1	04	01	H5216_154_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	157	0	1	04	01	H5216_157_0	2	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	157	0	1	04	01	H5216_157_0	2	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	164	0	1	04	01	H5216_164_0	7	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H5216	164	0	1	04	01	H5216_164_0	7	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	165	0	1	04	01	H5216_165_0	7	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	166	0	1	04	01	H5216_166_0	7	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	195	0	1	04	01	H5216_195_0	5	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	197	0	1	04	01	H5216_197_0	5	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	197	0	1	04	01	H5216_197_0	5	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	203	1	1	04	01	H5216_203_1	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	205	0	1	04	01	H5216_205_0	7	3																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	205	0	1	04	01	H5216_205_0	7	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	205	0	1	04	01	H5216_205_0	7	1																																																																																																																			
H5216	206	0	1	04	01	H5216_206_0	4	1																																																														Healthy Foods Card	2	1	25.00	6	2			2			2		2			2	2																																				
H5216	206	0	1	04	01	H5216_206_0	4	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	211	0	1	04	01	H5216_211_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5216	213	0	1	04	01	H5216_213_0	2	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	213	0	1	04	01	H5216_213_0	2	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	216	0	1	04	01	H5216_216_0	2	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	217	0	1	04	01	H5216_217_0	3	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	217	0	1	04	01	H5216_217_0	3	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	219	0	1	04	01	H5216_219_0	7	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H5216	219	0	1	04	01	H5216_219_0	7	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H5216	220	0	1	04	01	H5216_220_0	7	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H5216	220	0	1	04	01	H5216_220_0	7	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H5216	223	0	1	04	01	H5216_223_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	224	0	1	04	01	H5216_224_0	5	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	224	0	1	04	01	H5216_224_0	5	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	227	0	1	04	01	H5216_227_0	6	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H5216	227	0	1	04	01	H5216_227_0	6	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H5216	228	0	1	04	01	H5216_228_0	8	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	228	0	1	04	01	H5216_228_0	8	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H5216	231	0	1	04	01	H5216_231_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	237	1	1	04	01	H5216_237_1	4	1																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	239	0	1	04	01	H5216_239_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	240	0	1	04	01	H5216_240_0	5	1																																																														Healthy Foods Card	2	1	25.00	6	2			2			2		2			2	2																																				
H5216	240	0	1	04	01	H5216_240_0	5	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	240	0	1	04	01	H5216_240_0	5	3																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	242	0	1	04	01	H5216_242_0	6	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H5216	242	0	1	04	01	H5216_242_0	6	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	243	0	1	04	01	H5216_243_0	6	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	243	0	1	04	01	H5216_243_0	6	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H5216	244	0	1	04	01	H5216_244_0	5	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	246	0	1	04	01	H5216_246_0	5	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	247	0	1	04	01	H5216_247_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	248	1	1	04	01	H5216_248_1	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5216	248	1	1	04	01	H5216_248_1	4	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	248	2	1	04	01	H5216_248_2	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5216	257	0	1	04	01	H5216_257_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	261	0	1	04	01	H5216_261_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	262	0	1	04	01	H5216_262_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	265	0	1	04	01	H5216_265_0	3	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	265	0	1	04	01	H5216_265_0	3	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	266	0	1	04	01	H5216_266_0	5	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	266	0	1	04	01	H5216_266_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5216	267	0	1	04	01	H5216_267_0	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H5216	267	0	1	04	01	H5216_267_0	4	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	268	0	1	04	01	H5216_268_0	7	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H5216	268	0	1	04	01	H5216_268_0	7	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	277	0	1	04	01	H5216_277_0	6	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H5216	277	0	1	04	01	H5216_277_0	6	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	277	0	1	04	01	H5216_277_0	6	3																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	279	0	1	04	01	H5216_279_0	4	1																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	280	1	1	04	01	H5216_280_1	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	280	2	1	04	01	H5216_280_2	5	1																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	281	0	1	04	01	H5216_281_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	282	1	1	04	01	H5216_282_1	4	1																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	282	2	1	04	01	H5216_282_2	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	286	0	1	04	01	H5216_286_0	3	3																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5216	286	0	1	04	01	H5216_286_0	3	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	286	0	1	04	01	H5216_286_0	3	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	290	0	1	04	01	H5216_290_0	5	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H5216	291	0	1	04	01	H5216_291_0	5	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H5216	292	0	1	04	01	H5216_292_0	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H5216	293	0	1	04	01	H5216_293_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	294	0	1	04	01	H5216_294_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	295	0	1	04	01	H5216_295_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	296	0	1	04	01	H5216_296_0	9	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H5216	296	0	1	04	01	H5216_296_0	9	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5216	298	0	1	04	01	H5216_298_0	4	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H5216	301	4	1	04	01	H5216_301_4	3	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	302	0	1	04	01	H5216_302_0	4	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5216	302	0	1	04	01	H5216_302_0	4	1																																																														Healthy Foods Card	2	1	35	6	2			2			2		2			2	2																																				
H5253	024	0	1	01	01	H5253_024_0	5	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	150.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5253	041	0	1	02	01	H5253_041_0	5	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	220.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5253	059	0	1	01	01	H5253_059_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	175.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5262	001	0	1	01	01	H5262_001_0	4	1																																																														Hospital at Home	2	2			2			2			2		2			2	2																																				
H5262	003	0	1	01	01	H5262_003_0	4	1																																																														Hospital at Home	2	2			2			2			2		2			2	2																																				
H5262	004	0	1	01	01	H5262_004_0	3	1																																																														Hospital at Home	2	2			2			2			2		2			2	2																																				
H5262	005	0	1	01	01	H5262_005_0	3	1																																																														Hospital at Home	2	2			2			2			2		2			2	2																																				
H5262	021	0	1	01	01	H5262_021_0	4	1																																																														Hospital at Home	2	2			2			2			2		2			2	2																																				
H5302	012	0	1	01	01	H5302_012_0	5	1																																																																																																																			
H5302	013	0	1	01	01	H5302_013_0	5	1																																																																																																																			
H5302	014	0	1	01	01	H5302_014_0	5	1																																																																																																																			
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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5302	810	0	1	01	01	H5302_810_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5322	025	0	1	01	01	H5322_025_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	100.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5322	026	0	1	01	01	H5322_026_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	85.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5322	028	0	1	02	01	H5322_028_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	110.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5322	029	0	1	02	01	H5322_029_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	175.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5322	029	0	1	02	01	H5322_029_0	4	2																																																																																VBID Transportation to Non-Benefit Related Locations	2	2			2			2			2		1	0.00	0.00	2	2																		
H5322	030	0	1	02	01	H5322_030_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	100.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5322	031	0	1	01	01	H5322_031_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	150.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5325	001	0	1	01	01	H5325_001_0	4	1																																																																																																																			
H5325	002	0	1	01	01	H5325_002_0	5	1																																																																																																																			
H5325	003	0	1	01	01	H5325_003_0	5	1																																																																																																																			
H5325	004	0	1	01	01	H5325_004_0	5	1																																																																																																																			
H5325	005	0	1	01	01	H5325_005_0	5	1																																																																																																																			
H5325	006	0	1	01	01	H5325_006_0	5	1																																																																																																																			
H5325	007	0	1	01	01	H5325_007_0	5	1																																																																																																																			
H5325	008	0	1	01	01	H5325_008_0	5	1																																																																																																																			
H5325	009	0	1	01	01	H5325_009_0	6	1																																																																																																																			
H5420	006	0	1	01	01	H5420_006_0	3	1																																																														VBID Food Allowance	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5420	013	0	1	01	01	H5420_013_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	175.00	6	2			2			2		1	0.00	0.00	2	2																																				
H5431	001	0	1	01	01	H5431_001_0	7	1																																											1	2	001	2			2			2			2		1	0.00	0.00	1	1																																																						
H5431	006	0	1	01	01	H5431_006_0	7	1																																											1	2	001	2			2			2			2		1	0.00	0.00	1	1																																																						
H5431	012	0	1	01	01	H5431_012_0	7	1																																											1	2	001	2			2			2			2		1	0.00	0.00	1	1																																																						
H5431	013	0	1	01	01	H5431_013_0	7	1																																											1	2	001	2			2			2			2		1	0.00	0.00	1	1																																																						
H5431	015	0	1	01	01	H5431_015_0	9	1																																											1	2	001	2			2			2			2		1	0.00	0.00	1	1																																																						
H5431	016	0	1	01	01	H5431_016_0	7	1																																											1	2	001	2			2			2			2		1	0.00	0.00	1	1																																																						
H5431	019	0	1	01	01	H5431_019_0	11	1																																											1	2	001	2			2			2			2		1	0.00	0.00	1	1																																																						
H5521	016	0	1	04	01	H5521_016_0	7	1																																																																																																																			
H5521	086	0	1	04	01	H5521_086_0	7	1																																																																																																																			
H5521	314	0	1	04	01	H5521_314_0	5	1																																																																																																																			
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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	802	0	1	04	01	H5521_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	806	0	2	04	01	H5521_806_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	809	0	1	04	01	H5521_809_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	810	0	1	04	01	H5521_810_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	812	0	1	04	01	H5521_812_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	814	0	2	04	01	H5521_814_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	815	0	2	04	01	H5521_815_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	816	0	2	04	01	H5521_816_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	817	0	1	04	01	H5521_817_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	818	0	2	04	01	H5521_818_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	819	0	1	04	01	H5521_819_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	820	0	1	04	01	H5521_820_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	821	0	1	04	01	H5521_821_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	822	0	1	04	01	H5521_822_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	823	0	2	04	01	H5521_823_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	824	0	2	04	01	H5521_824_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	825	0	1	04	01	H5521_825_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	826	0	1	04	01	H5521_826_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	827	0	2	04	01	H5521_827_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5521	828	0	2	04	01	H5521_828_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5522	001	0	1	04	01	H5522_001_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2	1	2	001	2			2			2			2		1	0.00	0.00	2	2	Reminder Device	2	2			2			2			2		1	0.00	0.00	2	2																																				
H5522	002	0	1	04	01	H5522_002_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H5522	002	0	1	04	01	H5522_002_0	3	2																							1	2	2				2			2		2			2		1	0.00	0.00	2	1	2	001	2			2			2			2		1	0.00	0.00	2	2	Reminder Device	2	2			2			2			2		1	0.00	0.00	2	2																																				
H5522	005	0	1	04	01	H5522_005_0	2	1																							1	2	2				2			2		2			2		1	0.00	0.00	2	1	2	001	2			2			2			2		1	0.00	0.00	2	2	Reminder Device	2	2			2			2			2		1	0.00	0.00	2	2																																				
H5522	018	0	1	04	01	H5522_018_0	3	2																																																																																																																			
H5522	018	0	1	04	01	H5522_018_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	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	2			2		2			2	1	2	111	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5525	026	0	1	04	01	H5525_026_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5525	034	0	1	04	01	H5525_034_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5525	035	0	1	04	01	H5525_035_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5525	036	0	1	04	01	H5525_036_0	6	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H5525	036	0	1	04	01	H5525_036_0	6	2																																											1	2	011	2			2			2			2		2			1	2																																																						
H5525	045	0	1	04	01	H5525_045_0	7	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H5525	045	0	1	04	01	H5525_045_0	7	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H5525	046	0	1	04	01	H5525_046_0	4	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H5525	048	0	1	04	01	H5525_048_0	4	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H5525	049	0	1	04	01	H5525_049_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5525	050	0	1	04	01	H5525_050_0	3	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5533	003	0	1	04	01	H5533_003_0	8	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5533	005	0	1	04	01	H5533_005_0	8	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5533	007	0	1	04	01	H5533_007_0	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5533	008	0	1	04	01	H5533_008_0	8	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5533	009	0	1	04	01	H5533_009_0	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5533	010	0	1	04	01	H5533_010_0	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5533	011	0	1	04	01	H5533_011_0	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5577	036	0	1	01	01	H5577_036_0	3	2																																																																																																																			
H5590	008	0	1	01	01	H5590_008_0	4	1																							1	2	1	50.00	5	1	2			2		2			2		1	0.00	0.00	2																				Non-Medicare Covered Devices	2	1	50.00	5	2			2			2		1	0.00	0.00	1	1																																				
H5590	009	0	1	01	01	H5590_009_0	4	1																							1	2	1	50.00	5	1	2			2		2			2		1	0	0	2																				Non-Medicare Covered Devices	2	1	50.00	5	2			2			2		1	0	0	1	1																																				
H5591	003	0	1	01	01	H5591_003_0	4	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
H5591	005	0	1	02	01	H5591_005_0	5	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
H5591	006	1	1	02	01	H5591_006_1	5	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
H5591	006	2	1	02	01	H5591_006_2	5	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
H5591	006	4	1	02	01	H5591_006_4	5	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
H5591	006	5	1	02	01	H5591_006_5	6	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
H5591	007	0	1	01	01	H5591_007_0	5	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
H5591	009	0	1	01	01	H5591_009_0	5	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
H5591	013	0	1	01	01	H5591_013_0	6	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
H5591	015	1	1	02	01	H5591_015_1	5	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
H5591	015	2	1	02	01	H5591_015_2	5	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
H5593	001	0	1	01	01	H5593_001_0	4	1																																																																																																																			
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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5593	802	0	1	01	01	H5593_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5608	001	0	1	01	01	H5608_001_0	7	1																							1	2	1	140.00	1		2			2		2			2		2			2																																																																									
H5608	002	0	1	01	01	H5608_002_0	9	1																							1	2	1	140.00	1		2			2		2			2		2			2																																																																									
H5619	001	0	1	01	01	H5619_001_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5619	003	0	1	01	01	H5619_003_0	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H5619	038	0	1	01	01	H5619_038_0	4	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H5619	041	0	1	01	01	H5619_041_0	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5619	046	0	1	01	01	H5619_046_0	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5619	046	0	1	01	01	H5619_046_0	7	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5619	047	0	1	01	01	H5619_047_0	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5619	054	0	1	01	01	H5619_054_0	5	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H5619	057	0	1	01	01	H5619_057_0	7	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5619	057	0	1	01	01	H5619_057_0	7	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5619	059	0	1	01	01	H5619_059_0	6	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5619	061	0	1	01	01	H5619_061_0	7	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5619	061	0	1	01	01	H5619_061_0	7	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5619	063	0	1	01	01	H5619_063_0	6	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5619	066	0	1	01	01	H5619_066_0	6	1																																											1	2	001	2			2			2			2		2			1	2																																																						
H5619	071	0	1	01	01	H5619_071_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5619	073	0	1	01	01	H5619_073_0	7	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5619	075	0	1	01	01	H5619_075_0	7	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H5619	075	0	1	01	01	H5619_075_0	7	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H5619	076	0	1	01	01	H5619_076_0	7	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H5619	076	0	1	01	01	H5619_076_0	7	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H5619	082	0	1	01	01	H5619_082_0	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H5619	082	0	1	01	01	H5619_082_0	4	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5619	087	0	1	01	01	H5619_087_0	4	1																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5619	093	0	1	01	01	H5619_093_0	5	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H5619	097	0	1	01	01	H5619_097_0	8	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5619	097	0	1	01	01	H5619_097_0	8	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5619	100	0	1	01	01	H5619_100_0	8	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5619	100	0	1	01	01	H5619_100_0	8	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5619	111	0	1	01	01	H5619_111_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5619	113	0	1	01	01	H5619_113_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5619	123	0	1	01	01	H5619_123_0	6	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H5619	123	0	1	01	01	H5619_123_0	6	2	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5619	126	0	1	01	01	H5619_126_0	7	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H5619	126	0	1	01	01	H5619_126_0	7	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H5619	134	0	1	01	01	H5619_134_0	7	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H5619	134	0	1	01	01	H5619_134_0	7	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5619	136	1	1	01	01	H5619_136_1	6	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H5619	136	2	1	01	01	H5619_136_2	5	1																																																														Healthy Foods Card	2	1	75	3	2			2			2		2			2	2																																				
H5619	136	2	1	01	01	H5619_136_2	5	3																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5619	136	3	1	01	01	H5619_136_3	6	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H5619	136	4	1	01	01	H5619_136_4	7	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H5619	136	4	1	01	01	H5619_136_4	7	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H5619	136	4	1	01	01	H5619_136_4	7	3																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5619	137	0	1	01	01	H5619_137_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5619	139	1	1	01	01	H5619_139_1	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5619	139	1	1	01	01	H5619_139_1	6	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5619	139	2	1	01	01	H5619_139_2	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5619	139	2	1	01	01	H5619_139_2	6	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H5619	140	1	1	01	01	H5619_140_1	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5619	140	2	1	01	01	H5619_140_2	7	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H5619	141	0	1	01	01	H5619_141_0	5	1	1	1	2	1			1	1000	3	2			2			2		2			1	2	1	2	1	1000	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	1000	3	2			2			2		2			1	2																		
H5619	144	1	1	01	01	H5619_144_1	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5619	144	1	1	01	01	H5619_144_1	6	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5619	144	2	1	01	01	H5619_144_2	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H5628	001	0	1	01	01	H5628_001_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5628	007	0	1	01	01	H5628_007_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5628	008	0	1	01	01	H5628_008_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5628	009	0	1	01	01	H5628_009_0	6	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5628	010	0	1	01	01	H5628_010_0	6	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5628	011	0	1	01	01	H5628_011_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5628	012	0	1	01	01	H5628_012_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5644	002	0	1	01	01	H5644_002_0	8	1	1	1	2	2	12	3	2			2			2			2		2			1	2																																																																																													
H5649	001	0	1	01	01	H5649_001_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H5649	002	0	1	01	01	H5649_002_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H5649	004	0	1	01	01	H5649_004_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H5649	006	0	1	01	01	H5649_006_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H5649	008	0	1	01	01	H5649_008_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H5649	009	0	1	01	01	H5649_009_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H5649	018	0	1	01	01	H5649_018_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H5649	019	0	1	01	01	H5649_019_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H5793	017	0	1	02	01	H5793_017_0	4	1																																																																																																																			
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	2			2		2			2	1	2	111	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H5810	001	0	1	01	01	H5810_001_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5810	013	0	1	01	01	H5810_013_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5810	014	0	1	01	01	H5810_014_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5823	006	0	1	01	01	H5823_006_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5823	010	0	1	01	01	H5823_010_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5823	011	0	1	01	01	H5823_011_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5826	006	0	1	01	01	H5826_006_0	4	3																							1	2	2				2			2		2			2		2			2																																																																									
H5826	008	0	1	01	01	H5826_008_0	5	3																							1	2	2				2			2		2			2		2			2																																																																									
H5826	009	0	1	01	01	H5826_009_0	5	3																							1	2	2				2			2		2			2		2			2																																																																									
H5826	010	0	1	01	01	H5826_010_0	7	1																							1	2	2				2			2		2			2		2			2																																																																									
H5826	014	0	1	01	01	H5826_014_0	5	3																							1	2	2				2			2		2			2		2			2																																																																									
H5826	016	0	1	01	01	H5826_016_0	5	3																							1	2	2				2			2		2			2		2			2																																																																									
H5843	001	0	1	01	01	H5843_001_0	12	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H5843	001	0	1	01	01	H5843_001_0	12	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H5843	002	0	1	01	01	H5843_002_0	12	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H5843	002	0	1	01	01	H5843_002_0	12	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H5843	004	0	1	01	01	H5843_004_0	12	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H5843	004	0	1	01	01	H5843_004_0	12	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H5843	005	0	1	01	01	H5843_005_0	12	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H5843	005	0	1	01	01	H5843_005_0	12	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H5859	001	0	1	02	01	H5859_001_0	6	2																							1	2	2				2			2		2			2		2			2																																																																									
H5926	001	0	1	01	01	H5926_001_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5926	005	0	1	01	01	H5926_005_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5926	006	0	1	01	01	H5926_006_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H5945	001	0	1	01	01	H5945_001_0	10	1																																											1	2	001	1	250.00	6	2			2			2		2			1	2																																																						
H5945	002	0	1	01	01	H5945_002_0	10	1																																											1	2	001	1	250.00	6	2			2			2		2			1	2																																																						
H5945	008	0	1	01	01	H5945_008_0	10	1																																											1	2	001	1	250.00	6	2			2			2		2			1	2																																																						
H5945	009	0	1	01	01	H5945_009_0	9	1																																											1	2	001	1	250.00	6	2			2			2		2			1	2																																																						
H5970	016	0	1	04	01	H5970_016_0	4	1																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5970	020	0	1	04	01	H5970_020_0	5	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H5970	024	1	1	04	01	H5970_024_1	4	1																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5970	024	2	1	04	01	H5970_024_2	4	1																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
H5970	026	0	1	04	01	H5970_026_0	5	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H5991	010	0	1	01	01	H5991_010_0	7	1																							1	2	1	147.00	6	2	2			1	1	2			2		2			1																																																																									
H6351	004	0	1	01	01	H6351_004_0	9	1																																											1	2	011	2			2			2			2		2			2	2																																																						
H6399	001	0	1	01	01	H6399_001_0	3	1																																																																																																																			
H6446	011	0	1	01	01	H6446_011_0	4	1																							1	2	1	50.00	5	1	2			2		2			2		1	0.00	0.00	2																				Non-Medicare Covered Devices	2	1	50.00	5	2			2			2		1	0.00	0.00	1	1																																				
H6446	012	0	1	01	01	H6446_012_0	4	1																							1	2	1	50.00	5	1	2			2		2			2		1	0.00	0.00	2																				Non-Medicare Covered Devices	2	1	50.00	5	2			2			2		1	0.00	0.00	1	1																																				
H6446	013	0	1	01	01	H6446_013_0	4	1																							1	2	1	50.00	5	1	2			2		2			2		1	0.00	0.00	2																				Non-Medicare Covered Devices	2	1	50.00	5	2			2			2		1	0.00	0.00	1	1																																				
H6446	014	0	1	01	01	H6446_014_0	4	1																							1	2	1	50.00	5	1	2			2		2			2		1	0.00	0.00	2																				Non-Medicare Covered Devices	2	1	50.00	5	2			2			2		1	0.00	0.00	1	1																																				
H6446	015	0	1	01	01	H6446_015_0	4	1																							1	2	1	50.00	5	1	2			2		2			2		1	0.00	0.00	2																				Non-Medicare Covered Devices	2	1	50.00	5	2			2			2		1	0.00	0.00	1	1																																				
H6446	016	0	1	01	01	H6446_016_0	4	1																							1	2	1	50.00	5	1	2			2		2			2		1	0.00	0.00	2																				Non-Medicare Covered Devices	2	1	50.00	5	2			2			2		1	0.00	0.00	1	1																																				
H6595	002	1	1	01	01	H6595_002_1	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	125.00	6	2			2			2		1	0.00	0.00	2	2																																				
H6595	002	2	1	01	01	H6595_002_2	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	125.00	6	2			2			2		1	0.00	0.00	2	2																																				
H6622	004	0	1	01	01	H6622_004_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H6622	004	0	1	01	01	H6622_004_0	4	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H6622	005	0	1	01	01	H6622_005_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H6622	008	0	1	01	01	H6622_008_0	7	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H6622	008	0	1	01	01	H6622_008_0	7	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H6622	010	0	1	01	01	H6622_010_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H6622	015	0	1	01	01	H6622_015_0	4	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H6622	018	0	1	01	01	H6622_018_0	4	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H6622	023	0	1	01	01	H6622_023_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H6622	025	0	1	02	01	H6622_025_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H6622	026	0	1	02	01	H6622_026_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H6622	027	0	1	01	01	H6622_027_0	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H6622	027	0	1	01	01	H6622_027_0	4	2																																											1	2	011	2			2			2			2		2			1	2																																																						
H6622	033	0	1	01	01	H6622_033_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H6622	035	0	1	01	01	H6622_035_0	7	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H6622	036	0	1	01	01	H6622_036_0	7	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H6622	037	0	1	01	01	H6622_037_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H6622	048	0	1	01	01	H6622_048_0	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H6622	049	0	1	01	01	H6622_049_0	4	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H6622	051	0	1	01	01	H6622_051_0	4	1																																																														Healthy Foods Card	2	1	75.00	6	2			2			2		2			2	2																																				
H6622	057	0	1	01	01	H6622_057_0	5	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H6622	060	0	1	01	01	H6622_060_0	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H6622	061	0	1	01	01	H6622_061_0	6	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H6622	063	0	1	01	01	H6622_063_0	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H6622	064	0	1	01	01	H6622_064_0	9	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H6622	071	0	1	01	01	H6622_071_0	6	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H6622	074	1	1	01	01	H6622_074_1	4	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H6622	074	1	1	01	01	H6622_074_1	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H6622	074	2	1	01	01	H6622_074_2	4	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H6622	074	2	1	01	01	H6622_074_2	4	1																																											1	2	011	2			2			2			2		2			1	2																																																						
H6622	076	0	1	01	01	H6622_076_0	6	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H6622	077	0	1	01	01	H6622_077_0	6	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H6622	078	1	1	01	01	H6622_078_1	8	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H6622	078	1	1	01	01	H6622_078_1	8	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H6622	078	2	1	01	01	H6622_078_2	7	2	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1																																						Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H6622	078	2	1	01	01	H6622_078_2	7	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H6622	079	0	1	01	01	H6622_079_0	4	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H6874	001	0	1	04	01	H6874_001_0	10	1																																											1	2	011	2			2			2			2		2			2	2																																																						
H6874	002	0	1	04	01	H6874_002_0	8	1																																											1	2	011	2			2			2			2		2			2	2																																																						
H6874	003	0	1	04	01	H6874_003_0	4	1																																											1	2	011	2			2			2			2		2			2	2																																																						
H7149	006	0	1	01	01	H7149_006_0	4	1																																																																																																																			
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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H7149	802	0	1	01	01	H7149_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H7220	002	0	1	01	01	H7220_002_0	4	1																																																														Hospital at Home	2	2			2			2			2		2			1	2																																				
H7220	004	0	1	02	01	H7220_004_0	7	1																																																														Hospital at Home	2	2			2			2			2		2			1	2																																				
H7220	009	1	1	01	01	H7220_009_1	6	1																																																														Hospital at Home	2	2			2			2			2		2			1	2																																				
H7220	009	2	1	01	01	H7220_009_2	6	1																																																														Hospital at Home	2	2			2			2			2		2			1	2																																				
H7220	009	3	1	01	01	H7220_009_3	6	1																																																														Hospital at Home	2	2			2			2			2		2			1	2																																				
H7220	010	0	1	01	01	H7220_010_0	7	1																																																														Hospital at Home	2	2			2			2			2		2			1	2																																				
H7220	011	0	1	02	01	H7220_011_0	8	1																																																														Hospital at Home	2	2			2			2			2		2			1	2																																				
H7273	001	0	1	04	01	H7273_001_0	12	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H7273	001	0	1	04	01	H7273_001_0	12	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H7273	002	0	1	04	01	H7273_002_0	12	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H7273	002	0	1	04	01	H7273_002_0	12	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H7273	004	0	1	04	01	H7273_004_0	12	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H7273	004	0	1	04	01	H7273_004_0	12	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H7273	005	0	1	04	01	H7273_005_0	12	1																																																														Exercise Physiologist for Dial a Diabetes	2	2			2			2			2		2			2	2																																				
H7273	005	0	1	04	01	H7273_005_0	12	2																																																														Simple Therapy	2	2			2			2			2		2			2	2																																				
H7284	003	0	1	04	01	H7284_003_0	6	1																																																														Healthy Foods Card	2	1	35.00	6	2			2			2		2			2	2																																				
H7284	007	0	1	04	01	H7284_007_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H7284	008	0	1	04	01	H7284_008_0	5	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
H7301	002	0	1	04	01	H7301_002_0	4	1																																																																																																																			
H7301	002	0	1	04	01	H7301_002_0	4	2																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H7301	006	0	1	04	01	H7301_006_0	4	1																																																																																																																			
H7301	006	0	1	04	01	H7301_006_0	4	2																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H7301	801	0	1	04	01	H7301_801_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H7464	001	0	1	01	01	H7464_001_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	225.00	6	2			2			2		1	0.00	0.00	2	2																																				
H7464	005	0	1	01	01	H7464_005_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	225.00	6	2			2			2		1	0.00	0.00	2	2																																				
H7464	006	0	1	01	01	H7464_006_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	75.00	6	2			2			2		1	0.00	0.00	2	2																																				
H7464	007	0	1	01	01	H7464_007_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	225.00	6	2			2			2		1	0.00	0.00	2	2																																				
H7464	008	1	1	02	01	H7464_008_1	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	80.00	6	2			2			2		1	0.00	0.00	2	2																																				
H7464	008	2	1	02	01	H7464_008_2	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	95.00	6	2			2			2		1	0.00	0.00	2	2																																				
H7607	002	1	1	01	01	H7607_002_1	13	1																																											1	2	001	2			2			2			2		2			1	1																																																						
H7607	002	2	1	01	01	H7607_002_2	13	1																																											1	2	001	2			2			2			2		2			1	1																																																						
H7607	002	3	1	01	01	H7607_002_3	13	1																																											1	2	001	2			2			2			2		2			1	1																																																						
H7607	003	1	1	01	01	H7607_003_1	13	1																																											1	2	001	2			2			2			2		2			1	1																																																						
H7607	003	2	1	01	01	H7607_003_2	13	1																																											1	2	001	2			2			2			2		2			1	1																																																						
H7607	003	3	1	01	01	H7607_003_3	13	1																																											1	2	001	2			2			2			2		2			1	1																																																						
H7607	007	1	1	01	01	H7607_007_1	13	1																																											1	2	001	2			2			2			2		2			1	1																																																						
H7607	007	2	1	01	01	H7607_007_2	13	1																																											1	2	001	2			2			2			2		2			1	1																																																						
H7607	007	3	1	01	01	H7607_007_3	13	1																																											1	2	001	2			2			2			2		2			1	1																																																						
H7607	008	1	1	01	01	H7607_008_1	13	1																																											1	2	001	2			2			2			2		2			1	1																																																						
H7607	008	2	1	01	01	H7607_008_2	13	1																																											1	2	001	2			2			2			2		2			1	1																																																						
H7607	008	3	1	01	01	H7607_008_3	13	1																																											1	2	001	2			2			2			2		2			1	1																																																						
H7621	001	0	1	01	01	H7621_001_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H7678	001	0	1	01	01	H7678_001_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H7678	003	0	1	01	01	H7678_003_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H7678	004	0	1	01	01	H7678_004_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H7680	001	0	1	01	01	H7680_001_0	11	1																																											1	2	001	1	250.00	6	2			2			2		2			1	2																																																						
H7680	002	0	1	01	01	H7680_002_0	12	1																																											1	2	001	1	250.00	6	2			2			2		2			1	2																																																						
H7680	007	0	1	01	01	H7680_007_0	11	1																																											1	2	001	1	250.00	6	2			2			2		2			1	2																																																						
H7853	011	0	1	01	01	H7853_011_0	6	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H7853	012	0	1	01	01	H7853_012_0	6	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H7853	013	0	1	01	01	H7853_013_0	7	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H7853	015	0	1	01	01	H7853_015_0	6	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H8087	003	0	1	04	01	H8087_003_0	4	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H8125	002	0	1	01	01	H8125_002_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	125.00	6	2			2			2		1	0.00	0.00	2	2																																				
H8130	001	0	1	01	01	H8130_001_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H8130	008	0	1	01	01	H8130_008_0	5	1																																																														Mental Health & Wellness Applications	2	1	450.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H8130	009	0	1	01	01	H8130_009_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H8130	010	0	1	01	01	H8130_010_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H8145	004	0	1	09	04	H8145_004_0	4	1																																																														Provider Referred	2	2			2			2			2		2																																								
H8145	042	0	1	09	04	H8145_042_0	3	1																																																														Provider Referred	2	2			2			2			2		2																																								
H8145	061	0	1	09	04	H8145_061_0	4	1																																																														Provider Referred	2	2			2			2			2		2																																								
H8145	069	0	1	09	04	H8145_069_0	4	1																																																														Provider Referred	2	2			2			2			2		2																																								
H8145	069	0	1	09	04	H8145_069_0	4	2																																																														Facility Referred	2	2			2			2			2		2																																								
H8145	084	0	1	09	04	H8145_084_0	3	1																																																														Provider Referred	2	2			2			2			2		2																																								
H8145	122	0	1	09	04	H8145_122_0	5	1	1	1	2	1			1	500.00	3	2			2			2		2					1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2																							Transitional Care	2	1	500.00	3	2			2			2		2																						
H8145	123	0	1	09	04	H8145_123_0	4	1																																																														Provider Referred	2	2			2			2			2		2																																								
H8145	126	0	1	09	04	H8145_126_0	2	1																																																														Provider Referred	2	2			2			2			2		2																																								
H8176	001	0	1	01	01	H8176_001_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H8176	003	0	1	01	01	H8176_003_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H8332	001	0	1	01	01	H8332_001_0	2	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H8332	002	0	1	01	01	H8332_002_0	2	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H8332	003	0	1	01	01	H8332_003_0	2	1																							1	2	2				2			2		2			2		1	0.00	0.00	2																																																																									
H8332	004	0	1	01	01	H8332_004_0	3	1																							1	2	2				2			2		2			2		1	0.00	0.00	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H8332	802	0	1	01	01	H8332_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H8385	001	0	1	04	01	H8385_001_0	12	1																																											1	2	111	2			2			2			2		2			2	1																																																						
H8385	002	0	1	04	01	H8385_002_0	12	1																																											1	2	111	2			2			2			2		2			2	1																																																						
H8385	003	0	1	04	01	H8385_003_0	12	1																																											1	2	111	2			2			2			2		2			2	1																																																						
H8385	004	0	1	04	01	H8385_004_0	12	1																																											1	2	111	2			2			2			2		2			2	1																																																						
H8597	001	0	1	01	01	H8597_001_0	3	1																																																																																																																			
H8597	002	0	1	01	01	H8597_002_0	3	1																																																																																																																			
H8597	003	0	1	01	01	H8597_003_0	4	1																																																																																																																			
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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H8649	803	0	1	01	01	H8649_803_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H8783	001	0	1	04	01	H8783_001_0	8	1																																											1	2	011	2			2			2			2		2			2	2																																																						
H8783	002	0	1	04	01	H8783_002_0	9	1																																											1	2	011	2			2			2			2		2			2	2																																																						
H8783	003	0	1	04	01	H8783_003_0	9	1																																											1	2	011	2			2			2			2		2			2	2																																																						
H8845	001	0	1	01	01	H8845_001_0	7	1																																																														Mental Health & Wellness Applications	2	2			2			2			2		2			1	2																																				
H8854	002	0	1	01	01	H8854_002_0	7	1																																											1	2	001	2			2			2			2		2			1	2																																																						
H8889	001	0	1	04	01	H8889_001_0	4	1																																											1	2	111	2			2			2			2		2			2	2	At Risk Osteoporosis Services	2	2			2			2			2		2			2	2																																				
H8889	003	0	1	04	01	H8889_003_0	4	1																																											1	2	111	2			2			2			2		2			2	2	At Risk Osteoporosis Services	2	2			2			2			2		2			2	2																																				
H8889	005	0	1	04	01	H8889_005_0	4	1																																											1	2	111	2			2			2			2		2			2	2	At Risk Osteoporosis Services	2	2			2			2			2		2			2	2																																				
H8908	005	0	1	01	01	H8908_005_0	4	1																																																														Healthy Foods Card	2	1	50.00	6	2			2			2		2			2	2																																				
H9003	001	0	1	01	01	H9003_001_0	8	1																																											1	2	100	2			2			2			2		2			1	1																																																						
H9003	006	0	1	01	01	H9003_006_0	8	1																																											1	2	100	2			2			2			2		2			1	1																																																						
H9003	009	0	1	01	01	H9003_009_0	8	1																																											1	2	100	2			2			2			2		2			1	1																																																						
H9070	003	0	1	04	01	H9070_003_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H9070	004	0	1	04	01	H9070_004_0	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H9070	006	1	1	04	01	H9070_006_1	6	1	1	1	2	1			1	1000.00	3	2			2			2		2			1	2	1	2	1	1000.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	1000.00	3	2			2			2		2			1	2																		
H9070	006	3	1	04	01	H9070_006_3	6	1	1	1	2	1			1	500.00	3	2			2			2		2			1	2	1	2	1	500.00	3		2			1	1	2			2		2			1	1	2	011	2			2			2			2		2			1	2																			Transitional Care	2	1	500.00	3	2			2			2		2			1	2																		
H9082	009	0	1	01	01	H9082_009_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H9082	010	0	1	01	01	H9082_010_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	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	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H9431	802	0	1	04	01	H9431_802_0	1	1	1	1	2	1			2			2			2			2		2			2	2	1	2	2				2			1	1	2			2		2			2	1	2	111	2			2			2			2		2			2	2																																																						
H9615	007	0	1	04	01	H9615_007_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H9615	008	0	1	04	01	H9615_008_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H9615	009	0	1	04	01	H9615_009_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H9615	010	0	1	04	01	H9615_010_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H9615	012	0	1	04	01	H9615_012_0	7	1																							1	2	2				2			2		2			2		2			2																																																																									
H9615	014	0	1	04	01	H9615_014_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H9615	015	0	1	04	01	H9615_015_0	7	1																							1	2	2				2			2		2			2		2			2																																																																									
H9615	016	0	1	04	01	H9615_016_0	7	1																							1	2	2				2			2		2			2		2			2																																																																									
H9615	017	0	1	04	01	H9615_017_0	6	1																							1	2	2				2			2		2			2		2			2																																																																									
H9834	001	0	1	01	01	H9834_001_0	4	1																																																														Hospital at Home	2	2			2			2			2		2			2	2																																				
H9834	003	0	1	01	01	H9834_003_0	4	1																																																														Hospital at Home	2	2			2			2			2		2			2	2																																				
H9834	004	0	1	01	01	H9834_004_0	3	1																																																														Hospital at Home	2	2			2			2			2		2			2	2																																				
H9834	005	0	1	01	01	H9834_005_0	3	1																																																														Hospital at Home	2	2			2			2			2		2			2	2																																				
H9834	006	0	1	01	01	H9834_006_0	4	1																																																														Hospital at Home	2	2			2			2			2		2			2	2																																				
H9955	001	0	1	01	01	H9955_001_0	7	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H9955	002	0	1	01	01	H9955_002_0	5	1																																																														Mental Health & Wellness Applications	2	1	150.00	5	2			2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5	2			2			2		2			1	2																		
H9986	002	0	1	01	01	H9986_002_0	6	1																																											1	2	001	2			2			2			2		2			2	2																																																						
R0802	001	0	1	31	11	R0802_001_0	7	1	1	1	2	1			2			2			2			2		2			2	1																																																																																													
R1390	001	0	1	31	11	R1390_001_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
R1390	002	0	1	31	11	R1390_002_0	3	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
R1390	003	0	1	31	11	R1390_003_0	3	2																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
R1390	003	0	1	31	11	R1390_003_0	3	1																																											1	2	011	2			2			2			2		2			1	2																																																						
R1548	001	0	1	31	11	R1548_001_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	175.00	6	2			2			2		1	0.00	0.00	2	2																																				
R3392	001	0	1	31	11	R3392_001_0	6	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
R3392	001	0	1	31	11	R3392_001_0	6	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
R3392	002	0	1	31	11	R3392_002_0	4	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
R3392	002	0	1	31	11	R3392_002_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
R4182	001	0	1	31	11	R4182_001_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
R4182	003	0	1	31	11	R4182_003_0	3	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
R4182	004	0	1	31	11	R4182_004_0	3	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
R5826	005	0	1	31	11	R5826_005_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
R5826	018	0	1	31	11	R5826_018_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
R5826	074	0	1	31	11	R5826_074_0	3	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
R6801	011	0	1	31	11	R6801_011_0	4	1																																																														OTC and VBID Food Allowance Combined Benefit	2	1	65.00	6	2			2			2		1	0.00	0.00	2	2																																				
R7220	001	0	1	31	11	R7220_001_0	4	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
R7220	001	0	1	31	11	R7220_001_0	4	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
R7220	002	0	1	31	11	R7220_002_0	3	2																																																														Facility Referred	2	2			2			2			2		2			1	2																																				
R7220	002	0	1	31	11	R7220_002_0	3	1																																																														Provider Referred	2	2			2			2			2		2			1	2																																				
