medicare home health pps payment ratesmedicare home health pps payment rates effective for episodes...

Medicare Home Health PPS Payment RatesEffective for Episodes Beginning and Ending in 2009

Service AreaCBSACode Urban or Rural Area99926 Rural Missouri

Payment RatesHIPPS Code

Nonroutine Nonroutine Case- Total Nonroutine TotalPayment Supplies Supplies HHRG Mix Therapy HHRG Supply EpisodeGrouping Billed Not Billed Code Weight Visits Payment Payment Payment

Early (1st and 2nd) Episodes With 0 to 13 Therapy Visits1 1AFKS 1AFK1 C1F1S1 0.5827 0 to 5 1,117.92$ 14.13$ 1,132.05$ 1 1AFKT 1AFK2 C1F1S1 0.5827 0 to 5 1,117.92$ 51.04$ 1,168.96$ 1 1AFKU 1AFK3 C1F1S1 0.5827 0 to 5 1,117.92$ 139.94$ 1,257.86$ 1 1AFKV 1AFK4 C1F1S1 0.5827 0 to 5 1,117.92$ 207.91$ 1,325.83$ 1 1AFKW 1AFK5 C1F1S1 0.5827 0 to 5 1,117.92$ 320.62$ 1,438.54$ 1 1AFKX 1AFK6 C1F1S1 0.5827 0 to 5 1,117.92$ 551.43$ 1,669.35$ 1 1AFLS 1AFL1 C1F1S2 0.8507 6 1,632.08$ 14.13$ 1,646.21$ 1 1AFLT 1AFL2 C1F1S2 0.8507 6 1,632.08$ 51.04$ 1,683.12$ 1 1AFLU 1AFL3 C1F1S2 0.8507 6 1,632.08$ 139.94$ 1,772.02$ 1 1AFLV 1AFL4 C1F1S2 0.8507 6 1,632.08$ 207.91$ 1,839.99$ 1 1AFLW 1AFL5 C1F1S2 0.8507 6 1,632.08$ 320.62$ 1,952.70$ 1 1AFLX 1AFL6 C1F1S2 0.8507 6 1,632.08$ 551.43$ 2,183.51$ 1 1AFMS 1AFM1 C1F1S3 1.0599 7 to 9 2,033.44$ 14.13$ 2,047.57$ 1 1AFMT 1AFM2 C1F1S3 1.0599 7 to 9 2,033.44$ 51.04$ 2,084.48$ 1 1AFMU 1AFM3 C1F1S3 1.0599 7 to 9 2,033.44$ 139.94$ 2,173.38$ 1 1AFMV 1AFM4 C1F1S3 1.0599 7 to 9 2,033.44$ 207.91$ 2,241.35$ 1 1AFMW 1AFM5 C1F1S3 1.0599 7 to 9 2,033.44$ 320.62$ 2,354.06$ 1 1AFMX 1AFM6 C1F1S3 1.0599 7 to 9 2,033.44$ 551.43$ 2,584.87$ 1 1AFNS 1AFN1 C1F1S4 1.2744 10 2,444.96$ 14.13$ 2,459.09$ 1 1AFNT 1AFN2 C1F1S4 1.2744 10 2,444.96$ 51.04$ 2,496.00$ 1 1AFNU 1AFN3 C1F1S4 1.2744 10 2,444.96$ 139.94$ 2,584.90$ 1 1AFNV 1AFN4 C1F1S4 1.2744 10 2,444.96$ 207.91$ 2,652.87$ 1 1AFNW 1AFN5 C1F1S4 1.2744 10 2,444.96$ 320.62$ 2,765.58$ 1 1AFNX 1AFN6 C1F1S4 1.2744 10 2,444.96$ 551.43$ 2,996.39$ 1 1AFPS 1AFP1 C1F1S5 1.4506 11 to 13 2,783.00$ 14.13$ 2,797.13$ 1 1AFPT 1AFP2 C1F1S5 1.4506 11 to 13 2,783.00$ 51.04$ 2,834.04$

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1 1AFPU 1AFP3 C1F1S5 1.4506 11 to 13 2,783.00$ 139.94$ 2,922.94$ 1 1AFPV 1AFP4 C1F1S5 1.4506 11 to 13 2,783.00$ 207.91$ 2,990.91$ 1 1AFPW 1AFP5 C1F1S5 1.4506 11 to 13 2,783.00$ 320.62$ 3,103.62$ 1 1AFPX 1AFP6 C1F1S5 1.4506 11 to 13 2,783.00$ 551.43$ 3,334.43$ 1 1AGKS 1AGK1 C1F2S1 0.6713 0 to 5 1,287.90$ 14.13$ 1,302.03$ 1 1AGKT 1AGK2 C1F2S1 0.6713 0 to 5 1,287.90$ 51.04$ 1,338.94$ 1 1AGKU 1AGK3 C1F2S1 0.6713 0 to 5 1,287.90$ 139.94$ 1,427.84$ 1 1AGKV 1AGK4 C1F2S1 0.6713 0 to 5 1,287.90$ 207.91$ 1,495.81$ 1 1AGKW 1AGK5 C1F2S1 0.6713 0 to 5 1,287.90$ 320.62$ 1,608.52$ 1 1AGKX 1AGK6 C1F2S1 0.6713 0 to 5 1,287.90$ 551.43$ 1,839.33$ 1 1AGLS 1AGL1 C1F2S2 0.9393 6 1,802.07$ 14.13$ 1,816.20$ 1 1AGLT 1AGL2 C1F2S2 0.9393 6 1,802.07$ 51.04$ 1,853.11$ 1 1AGLU 1AGL3 C1F2S2 0.9393 6 1,802.07$ 139.94$ 1,942.01$ 1 1AGLV 1AGL4 C1F2S2 0.9393 6 1,802.07$ 207.91$ 2,009.98$ 1 1AGLW 1AGL5 C1F2S2 0.9393 6 1,802.07$ 320.62$ 2,122.69$ 1 1AGLX 1AGL6 C1F2S2 0.9393 6 1,802.07$ 551.43$ 2,353.50$ 1 1AGMS 1AGM1 C1F2S3 1.1485 7 to 9 2,203.42$ 14.13$ 2,217.55$ 1 1AGMT 1AGM2 C1F2S3 1.1485 7 to 9 2,203.42$ 51.04$ 2,254.46$ 1 1AGMU 1AGM3 C1F2S3 1.1485 7 to 9 2,203.42$ 139.94$ 2,343.36$ 1 1AGMV 1AGM4 C1F2S3 1.1485 7 to 9 2,203.42$ 207.91$ 2,411.33$ 1 1AGMW 1AGM5 C1F2S3 1.1485 7 to 9 2,203.42$ 320.62$ 2,524.04$ 1 1AGMX 1AGM6 C1F2S3 1.1485 7 to 9 2,203.42$ 551.43$ 2,754.85$ 1 1AGNS 1AGN1 C1F2S4 1.3630 10 2,614.94$ 14.13$ 2,629.07$ 1 1AGNT 1AGN2 C1F2S4 1.3630 10 2,614.94$ 51.04$ 2,665.98$ 1 1AGNU 1AGN3 C1F2S4 1.3630 10 2,614.94$ 139.94$ 2,754.88$ 1 1AGNV 1AGN4 C1F2S4 1.3630 10 2,614.94$ 207.91$ 2,822.85$ 1 1AGNW 1AGN5 C1F2S4 1.3630 10 2,614.94$ 320.62$ 2,935.56$ 1 1AGNX 1AGN6 C1F2S4 1.3630 10 2,614.94$ 551.43$ 3,166.37$

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1 1AGPS 1AGP1 C1F2S5 1.5392 11 to 13 2,952.99$ 14.13$ 2,967.12$ 1 1AGPT 1AGP2 C1F2S5 1.5392 11 to 13 2,952.99$ 51.04$ 3,004.03$ 1 1AGPU 1AGP3 C1F2S5 1.5392 11 to 13 2,952.99$ 139.94$ 3,092.93$ 1 1AGPV 1AGP4 C1F2S5 1.5392 11 to 13 2,952.99$ 207.91$ 3,160.90$ 1 1AGPW 1AGP5 C1F2S5 1.5392 11 to 13 2,952.99$ 320.62$ 3,273.61$ 1 1AGPX 1AGP6 C1F2S5 1.5392 11 to 13 2,952.99$ 551.43$ 3,504.42$ 1 1AHKS 1AHK1 C1F3S1 0.7550 0 to 5 1,448.48$ 14.13$ 1,462.61$ 1 1AHKT 1AHK2 C1F3S1 0.7550 0 to 5 1,448.48$ 51.04$ 1,499.52$ 1 1AHKU 1AHK3 C1F3S1 0.7550 0 to 5 1,448.48$ 139.94$ 1,588.42$ 1 1AHKV 1AHK4 C1F3S1 0.7550 0 to 5 1,448.48$ 207.91$ 1,656.39$ 1 1AHKW 1AHK5 C1F3S1 0.7550 0 to 5 1,448.48$ 320.62$ 1,769.10$ 1 1AHKX 1AHK6 C1F3S1 0.7550 0 to 5 1,448.48$ 551.43$ 1,999.91$ 1 1AHLS 1AHL1 C1F3S2 1.0230 6 1,962.65$ 14.13$ 1,976.78$ 1 1AHLT 1AHL2 C1F3S2 1.0230 6 1,962.65$ 51.04$ 2,013.69$ 1 1AHLU 1AHL3 C1F3S2 1.0230 6 1,962.65$ 139.94$ 2,102.59$ 1 1AHLV 1AHL4 C1F3S2 1.0230 6 1,962.65$ 207.91$ 2,170.56$ 1 1AHLW 1AHL5 C1F3S2 1.0230 6 1,962.65$ 320.62$ 2,283.27$ 1 1AHLX 1AHL6 C1F3S2 1.0230 6 1,962.65$ 551.43$ 2,514.08$ 1 1AHMS 1AHM1 C1F3S3 1.2322 7 to 9 2,364.00$ 14.13$ 2,378.13$ 1 1AHMT 1AHM2 C1F3S3 1.2322 7 to 9 2,364.00$ 51.04$ 2,415.04$ 1 1AHMU 1AHM3 C1F3S3 1.2322 7 to 9 2,364.00$ 139.94$ 2,503.94$ 1 1AHMV 1AHM4 C1F3S3 1.2322 7 to 9 2,364.00$ 207.91$ 2,571.91$ 1 1AHMW 1AHM5 C1F3S3 1.2322 7 to 9 2,364.00$ 320.62$ 2,684.62$ 1 1AHMX 1AHM6 C1F3S3 1.2322 7 to 9 2,364.00$ 551.43$ 2,915.43$ 1 1AHNS 1AHN1 C1F3S4 1.4467 10 2,775.52$ 14.13$ 2,789.65$ 1 1AHNT 1AHN2 C1F3S4 1.4467 10 2,775.52$ 51.04$ 2,826.56$ 1 1AHNU 1AHN3 C1F3S4 1.4467 10 2,775.52$ 139.94$ 2,915.46$ 1 1AHNV 1AHN4 C1F3S4 1.4467 10 2,775.52$ 207.91$ 2,983.43$

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1 1AHNW 1AHN5 C1F3S4 1.4467 10 2,775.52$ 320.62$ 3,096.14$ 1 1AHNX 1AHN6 C1F3S4 1.4467 10 2,775.52$ 551.43$ 3,326.95$ 1 1AHPS 1AHP1 C1F3S5 1.6229 11 to 13 3,113.57$ 14.13$ 3,127.70$ 1 1AHPT 1AHP2 C1F3S5 1.6229 11 to 13 3,113.57$ 51.04$ 3,164.61$ 1 1AHPU 1AHP3 C1F3S5 1.6229 11 to 13 3,113.57$ 139.94$ 3,253.51$ 1 1AHPV 1AHP4 C1F3S5 1.6229 11 to 13 3,113.57$ 207.91$ 3,321.48$ 1 1AHPW 1AHP5 C1F3S5 1.6229 11 to 13 3,113.57$ 320.62$ 3,434.19$ 1 1AHPX 1AHP6 C1F3S5 1.6229 11 to 13 3,113.57$ 551.43$ 3,665.00$ 1 1BFKS 1BFK1 C2F1S1 0.7335 0 to 5 1,407.23$ 14.13$ 1,421.36$ 1 1BFKT 1BFK2 C2F1S1 0.7335 0 to 5 1,407.23$ 51.04$ 1,458.27$ 1 1BFKU 1BFK3 C2F1S1 0.7335 0 to 5 1,407.23$ 139.94$ 1,547.17$ 1 1BFKV 1BFK4 C2F1S1 0.7335 0 to 5 1,407.23$ 207.91$ 1,615.14$ 1 1BFKW 1BFK5 C2F1S1 0.7335 0 to 5 1,407.23$ 320.62$ 1,727.85$ 1 1BFKX 1BFK6 C2F1S1 0.7335 0 to 5 1,407.23$ 551.43$ 1,958.66$ 1 1BFLS 1BFL1 C2F1S2 1.0015 6 1,921.40$ 14.13$ 1,935.53$ 1 1BFLT 1BFL2 C2F1S2 1.0015 6 1,921.40$ 51.04$ 1,972.44$ 1 1BFLU 1BFL3 C2F1S2 1.0015 6 1,921.40$ 139.94$ 2,061.34$ 1 1BFLV 1BFL4 C2F1S2 1.0015 6 1,921.40$ 207.91$ 2,129.31$ 1 1BFLW 1BFL5 C2F1S2 1.0015 6 1,921.40$ 320.62$ 2,242.02$ 1 1BFLX 1BFL6 C2F1S2 1.0015 6 1,921.40$ 551.43$ 2,472.83$ 1 1BFMS 1BFM1 C2F1S3 1.2107 7 to 9 2,322.75$ 14.13$ 2,336.88$ 1 1BFMT 1BFM2 C2F1S3 1.2107 7 to 9 2,322.75$ 51.04$ 2,373.79$ 1 1BFMU 1BFM3 C2F1S3 1.2107 7 to 9 2,322.75$ 139.94$ 2,462.69$ 1 1BFMV 1BFM4 C2F1S3 1.2107 7 to 9 2,322.75$ 207.91$ 2,530.66$ 1 1BFMW 1BFM5 C2F1S3 1.2107 7 to 9 2,322.75$ 320.62$ 2,643.37$ 1 1BFMX 1BFM6 C2F1S3 1.2107 7 to 9 2,322.75$ 551.43$ 2,874.18$ 1 1BFNS 1BFN1 C2F1S4 1.4252 10 2,734.27$ 14.13$ 2,748.40$ 1 1BFNT 1BFN2 C2F1S4 1.4252 10 2,734.27$ 51.04$ 2,785.31$

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1 1BFNU 1BFN3 C2F1S4 1.4252 10 2,734.27$ 139.94$ 2,874.21$ 1 1BFNV 1BFN4 C2F1S4 1.4252 10 2,734.27$ 207.91$ 2,942.18$ 1 1BFNW 1BFN5 C2F1S4 1.4252 10 2,734.27$ 320.62$ 3,054.89$ 1 1BFNX 1BFN6 C2F1S4 1.4252 10 2,734.27$ 551.43$ 3,285.70$ 1 1BFPS 1BFP1 C2F1S5 1.6014 11 to 13 3,072.32$ 14.13$ 3,086.45$ 1 1BFPT 1BFP2 C2F1S5 1.6014 11 to 13 3,072.32$ 51.04$ 3,123.36$ 1 1BFPU 1BFP3 C2F1S5 1.6014 11 to 13 3,072.32$ 139.94$ 3,212.26$ 1 1BFPV 1BFP4 C2F1S5 1.6014 11 to 13 3,072.32$ 207.91$ 3,280.23$ 1 1BFPW 1BFP5 C2F1S5 1.6014 11 to 13 3,072.32$ 320.62$ 3,392.94$ 1 1BFPX 1BFP6 C2F1S5 1.6014 11 to 13 3,072.32$ 551.43$ 3,623.75$ 1 1BGKS 1BGK1 C2F2S1 0.8221 0 to 5 1,577.21$ 14.13$ 1,591.34$ 1 1BGKT 1BGK2 C2F2S1 0.8221 0 to 5 1,577.21$ 51.04$ 1,628.25$ 1 1BGKU 1BGK3 C2F2S1 0.8221 0 to 5 1,577.21$ 139.94$ 1,717.15$ 1 1BGKV 1BGK4 C2F2S1 0.8221 0 to 5 1,577.21$ 207.91$ 1,785.12$ 1 1BGKW 1BGK5 C2F2S1 0.8221 0 to 5 1,577.21$ 320.62$ 1,897.83$ 1 1BGKX 1BGK6 C2F2S1 0.8221 0 to 5 1,577.21$ 551.43$ 2,128.64$ 1 1BGLS 1BGL1 C2F2S2 1.0901 6 2,091.38$ 14.13$ 2,105.51$ 1 1BGLT 1BGL2 C2F2S2 1.0901 6 2,091.38$ 51.04$ 2,142.42$ 1 1BGLU 1BGL3 C2F2S2 1.0901 6 2,091.38$ 139.94$ 2,231.32$ 1 1BGLV 1BGL4 C2F2S2 1.0901 6 2,091.38$ 207.91$ 2,299.29$ 1 1BGLW 1BGL5 C2F2S2 1.0901 6 2,091.38$ 320.62$ 2,412.00$ 1 1BGLX 1BGL6 C2F2S2 1.0901 6 2,091.38$ 551.43$ 2,642.81$ 1 1BGMS 1BGM1 C2F2S3 1.2993 7 to 9 2,492.73$ 14.13$ 2,506.86$ 1 1BGMT 1BGM2 C2F2S3 1.2993 7 to 9 2,492.73$ 51.04$ 2,543.77$ 1 1BGMU 1BGM3 C2F2S3 1.2993 7 to 9 2,492.73$ 139.94$ 2,632.67$ 1 1BGMV 1BGM4 C2F2S3 1.2993 7 to 9 2,492.73$ 207.91$ 2,700.64$ 1 1BGMW 1BGM5 C2F2S3 1.2993 7 to 9 2,492.73$ 320.62$ 2,813.35$ 1 1BGMX 1BGM6 C2F2S3 1.2993 7 to 9 2,492.73$ 551.43$ 3,044.16$

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1 1BGNS 1BGN1 C2F2S4 1.5138 10 2,904.25$ 14.13$ 2,918.38$ 1 1BGNT 1BGN2 C2F2S4 1.5138 10 2,904.25$ 51.04$ 2,955.29$ 1 1BGNU 1BGN3 C2F2S4 1.5138 10 2,904.25$ 139.94$ 3,044.19$ 1 1BGNV 1BGN4 C2F2S4 1.5138 10 2,904.25$ 207.91$ 3,112.16$ 1 1BGNW 1BGN5 C2F2S4 1.5138 10 2,904.25$ 320.62$ 3,224.87$ 1 1BGNX 1BGN6 C2F2S4 1.5138 10 2,904.25$ 551.43$ 3,455.68$ 1 1BGPS 1BGP1 C2F2S5 1.6900 11 to 13 3,242.30$ 14.13$ 3,256.43$ 1 1BGPT 1BGP2 C2F2S5 1.6900 11 to 13 3,242.30$ 51.04$ 3,293.34$ 1 1BGPU 1BGP3 C2F2S5 1.6900 11 to 13 3,242.30$ 139.94$ 3,382.24$ 1 1BGPV 1BGP4 C2F2S5 1.6900 11 to 13 3,242.30$ 207.91$ 3,450.21$ 1 1BGPW 1BGP5 C2F2S5 1.6900 11 to 13 3,242.30$ 320.62$ 3,562.92$ 1 1BGPX 1BGP6 C2F2S5 1.6900 11 to 13 3,242.30$ 551.43$ 3,793.73$ 1 1BHKS 1BHK1 C2F3S1 0.9058 0 to 5 1,737.79$ 14.13$ 1,751.92$ 1 1BHKT 1BHK2 C2F3S1 0.9058 0 to 5 1,737.79$ 51.04$ 1,788.83$ 1 1BHKU 1BHK3 C2F3S1 0.9058 0 to 5 1,737.79$ 139.94$ 1,877.73$ 1 1BHKV 1BHK4 C2F3S1 0.9058 0 to 5 1,737.79$ 207.91$ 1,945.70$ 1 1BHKW 1BHK5 C2F3S1 0.9058 0 to 5 1,737.79$ 320.62$ 2,058.41$ 1 1BHKX 1BHK6 C2F3S1 0.9058 0 to 5 1,737.79$ 551.43$ 2,289.22$ 1 1BHLS 1BHL1 C2F3S2 1.1738 6 2,251.96$ 14.13$ 2,266.09$ 1 1BHLT 1BHL2 C2F3S2 1.1738 6 2,251.96$ 51.04$ 2,303.00$ 1 1BHLU 1BHL3 C2F3S2 1.1738 6 2,251.96$ 139.94$ 2,391.90$ 1 1BHLV 1BHL4 C2F3S2 1.1738 6 2,251.96$ 207.91$ 2,459.87$ 1 1BHLW 1BHL5 C2F3S2 1.1738 6 2,251.96$ 320.62$ 2,572.58$ 1 1BHLX 1BHL6 C2F3S2 1.1738 6 2,251.96$ 551.43$ 2,803.39$ 1 1BHMS 1BHM1 C2F3S3 1.3830 7 to 9 2,653.31$ 14.13$ 2,667.44$ 1 1BHMT 1BHM2 C2F3S3 1.3830 7 to 9 2,653.31$ 51.04$ 2,704.35$ 1 1BHMU 1BHM3 C2F3S3 1.3830 7 to 9 2,653.31$ 139.94$ 2,793.25$ 1 1BHMV 1BHM4 C2F3S3 1.3830 7 to 9 2,653.31$ 207.91$ 2,861.22$

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1 1BHMW 1BHM5 C2F3S3 1.3830 7 to 9 2,653.31$ 320.62$ 2,973.93$ 1 1BHMX 1BHM6 C2F3S3 1.3830 7 to 9 2,653.31$ 551.43$ 3,204.74$ 1 1BHNS 1BHN1 C2F3S4 1.5975 10 3,064.83$ 14.13$ 3,078.96$ 1 1BHNT 1BHN2 C2F3S4 1.5975 10 3,064.83$ 51.04$ 3,115.87$ 1 1BHNU 1BHN3 C2F3S4 1.5975 10 3,064.83$ 139.94$ 3,204.77$ 1 1BHNV 1BHN4 C2F3S4 1.5975 10 3,064.83$ 207.91$ 3,272.74$ 1 1BHNW 1BHN5 C2F3S4 1.5975 10 3,064.83$ 320.62$ 3,385.45$ 1 1BHNX 1BHN6 C2F3S4 1.5975 10 3,064.83$ 551.43$ 3,616.26$ 1 1BHPS 1BHP1 C2F3S5 1.7737 11 to 13 3,402.88$ 14.13$ 3,417.01$ 1 1BHPT 1BHP2 C2F3S5 1.7737 11 to 13 3,402.88$ 51.04$ 3,453.92$ 1 1BHPU 1BHP3 C2F3S5 1.7737 11 to 13 3,402.88$ 139.94$ 3,542.82$ 1 1BHPV 1BHP4 C2F3S5 1.7737 11 to 13 3,402.88$ 207.91$ 3,610.79$ 1 1BHPW 1BHP5 C2F3S5 1.7737 11 to 13 3,402.88$ 320.62$ 3,723.50$ 1 1BHPX 1BHP6 C2F3S5 1.7737 11 to 13 3,402.88$ 551.43$ 3,954.31$ 1 1CFKS 1CFK1 C3F1S1 0.9010 0 to 5 1,728.59$ 14.13$ 1,742.72$ 1 1CFKT 1CFK2 C3F1S1 0.9010 0 to 5 1,728.59$ 51.04$ 1,779.63$ 1 1CFKU 1CFK3 C3F1S1 0.9010 0 to 5 1,728.59$ 139.94$ 1,868.53$ 1 1CFKV 1CFK4 C3F1S1 0.9010 0 to 5 1,728.59$ 207.91$ 1,936.50$ 1 1CFKW 1CFK5 C3F1S1 0.9010 0 to 5 1,728.59$ 320.62$ 2,049.21$ 1 1CFKX 1CFK6 C3F1S1 0.9010 0 to 5 1,728.59$ 551.43$ 2,280.02$ 1 1CFLS 1CFL1 C3F1S2 1.1691 6 2,242.94$ 14.13$ 2,257.07$ 1 1CFLT 1CFL2 C3F1S2 1.1691 6 2,242.94$ 51.04$ 2,293.98$ 1 1CFLU 1CFL3 C3F1S2 1.1691 6 2,242.94$ 139.94$ 2,382.88$ 1 1CFLV 1CFL4 C3F1S2 1.1691 6 2,242.94$ 207.91$ 2,450.85$ 1 1CFLW 1CFL5 C3F1S2 1.1691 6 2,242.94$ 320.62$ 2,563.56$ 1 1CFLX 1CFL6 C3F1S2 1.1691 6 2,242.94$ 551.43$ 2,794.37$ 1 1CFMS 1CFM1 C3F1S3 1.3783 7 to 9 2,644.30$ 14.13$ 2,658.43$ 1 1CFMT 1CFM2 C3F1S3 1.3783 7 to 9 2,644.30$ 51.04$ 2,695.34$

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1 1CFMU 1CFM3 C3F1S3 1.3783 7 to 9 2,644.30$ 139.94$ 2,784.24$ 1 1CFMV 1CFM4 C3F1S3 1.3783 7 to 9 2,644.30$ 207.91$ 2,852.21$ 1 1CFMW 1CFM5 C3F1S3 1.3783 7 to 9 2,644.30$ 320.62$ 2,964.92$ 1 1CFMX 1CFM6 C3F1S3 1.3783 7 to 9 2,644.30$ 551.43$ 3,195.73$ 1 1CFNS 1CFN1 C3F1S4 1.5927 10 3,055.63$ 14.13$ 3,069.76$ 1 1CFNT 1CFN2 C3F1S4 1.5927 10 3,055.63$ 51.04$ 3,106.67$ 1 1CFNU 1CFN3 C3F1S4 1.5927 10 3,055.63$ 139.94$ 3,195.57$ 1 1CFNV 1CFN4 C3F1S4 1.5927 10 3,055.63$ 207.91$ 3,263.54$ 1 1CFNW 1CFN5 C3F1S4 1.5927 10 3,055.63$ 320.62$ 3,376.25$ 1 1CFNX 1CFN6 C3F1S4 1.5927 10 3,055.63$ 551.43$ 3,607.06$ 1 1CFPS 1CFP1 C3F1S5 1.7690 11 to 13 3,393.86$ 14.13$ 3,407.99$ 1 1CFPT 1CFP2 C3F1S5 1.7690 11 to 13 3,393.86$ 51.04$ 3,444.90$ 1 1CFPU 1CFP3 C3F1S5 1.7690 11 to 13 3,393.86$ 139.94$ 3,533.80$ 1 1CFPV 1CFP4 C3F1S5 1.7690 11 to 13 3,393.86$ 207.91$ 3,601.77$ 1 1CFPW 1CFP5 C3F1S5 1.7690 11 to 13 3,393.86$ 320.62$ 3,714.48$ 1 1CFPX 1CFP6 C3F1S5 1.7690 11 to 13 3,393.86$ 551.43$ 3,945.29$ 1 1CGKS 1CGK1 C3F2S1 0.9896 0 to 5 1,898.57$ 14.13$ 1,912.70$ 1 1CGKT 1CGK2 C3F2S1 0.9896 0 to 5 1,898.57$ 51.04$ 1,949.61$ 1 1CGKU 1CGK3 C3F2S1 0.9896 0 to 5 1,898.57$ 139.94$ 2,038.51$ 1 1CGKV 1CGK4 C3F2S1 0.9896 0 to 5 1,898.57$ 207.91$ 2,106.48$ 1 1CGKW 1CGK5 C3F2S1 0.9896 0 to 5 1,898.57$ 320.62$ 2,219.19$ 1 1CGKX 1CGK6 C3F2S1 0.9896 0 to 5 1,898.57$ 551.43$ 2,450.00$ 1 1CGLS 1CGL1 C3F2S2 1.2577 6 2,412.92$ 14.13$ 2,427.05$ 1 1CGLT 1CGL2 C3F2S2 1.2577 6 2,412.92$ 51.04$ 2,463.96$ 1 1CGLU 1CGL3 C3F2S2 1.2577 6 2,412.92$ 139.94$ 2,552.86$ 1 1CGLV 1CGL4 C3F2S2 1.2577 6 2,412.92$ 207.91$ 2,620.83$ 1 1CGLW 1CGL5 C3F2S2 1.2577 6 2,412.92$ 320.62$ 2,733.54$ 1 1CGLX 1CGL6 C3F2S2 1.2577 6 2,412.92$ 551.43$ 2,964.35$

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1 1CGMS 1CGM1 C3F2S3 1.4669 7 to 9 2,814.28$ 14.13$ 2,828.41$ 1 1CGMT 1CGM2 C3F2S3 1.4669 7 to 9 2,814.28$ 51.04$ 2,865.32$ 1 1CGMU 1CGM3 C3F2S3 1.4669 7 to 9 2,814.28$ 139.94$ 2,954.22$ 1 1CGMV 1CGM4 C3F2S3 1.4669 7 to 9 2,814.28$ 207.91$ 3,022.19$ 1 1CGMW 1CGM5 C3F2S3 1.4669 7 to 9 2,814.28$ 320.62$ 3,134.90$ 1 1CGMX 1CGM6 C3F2S3 1.4669 7 to 9 2,814.28$ 551.43$ 3,365.71$ 1 1CGNS 1CGN1 C3F2S4 1.6813 10 3,225.61$ 14.13$ 3,239.74$ 1 1CGNT 1CGN2 C3F2S4 1.6813 10 3,225.61$ 51.04$ 3,276.65$ 1 1CGNU 1CGN3 C3F2S4 1.6813 10 3,225.61$ 139.94$ 3,365.55$ 1 1CGNV 1CGN4 C3F2S4 1.6813 10 3,225.61$ 207.91$ 3,433.52$ 1 1CGNW 1CGN5 C3F2S4 1.6813 10 3,225.61$ 320.62$ 3,546.23$ 1 1CGNX 1CGN6 C3F2S4 1.6813 10 3,225.61$ 551.43$ 3,777.04$ 1 1CGPS 1CGP1 C3F2S5 1.8576 11 to 13 3,563.84$ 14.13$ 3,577.97$ 1 1CGPT 1CGP2 C3F2S5 1.8576 11 to 13 3,563.84$ 51.04$ 3,614.88$ 1 1CGPU 1CGP3 C3F2S5 1.8576 11 to 13 3,563.84$ 139.94$ 3,703.78$ 1 1CGPV 1CGP4 C3F2S5 1.8576 11 to 13 3,563.84$ 207.91$ 3,771.75$ 1 1CGPW 1CGP5 C3F2S5 1.8576 11 to 13 3,563.84$ 320.62$ 3,884.46$ 1 1CGPX 1CGP6 C3F2S5 1.8576 11 to 13 3,563.84$ 551.43$ 4,115.27$ 1 1CHKS 1CHK1 C3F3S1 1.0733 0 to 5 2,059.15$ 14.13$ 2,073.28$ 1 1CHKT 1CHK2 C3F3S1 1.0733 0 to 5 2,059.15$ 51.04$ 2,110.19$ 1 1CHKU 1CHK3 C3F3S1 1.0733 0 to 5 2,059.15$ 139.94$ 2,199.09$ 1 1CHKV 1CHK4 C3F3S1 1.0733 0 to 5 2,059.15$ 207.91$ 2,267.06$ 1 1CHKW 1CHK5 C3F3S1 1.0733 0 to 5 2,059.15$ 320.62$ 2,379.77$ 1 1CHKX 1CHK6 C3F3S1 1.0733 0 to 5 2,059.15$ 551.43$ 2,610.58$ 1 1CHLS 1CHL1 C3F3S2 1.3414 6 2,573.50$ 14.13$ 2,587.63$ 1 1CHLT 1CHL2 C3F3S2 1.3414 6 2,573.50$ 51.04$ 2,624.54$ 1 1CHLU 1CHL3 C3F3S2 1.3414 6 2,573.50$ 139.94$ 2,713.44$ 1 1CHLV 1CHL4 C3F3S2 1.3414 6 2,573.50$ 207.91$ 2,781.41$

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1 1CHLW 1CHL5 C3F3S2 1.3414 6 2,573.50$ 320.62$ 2,894.12$ 1 1CHLX 1CHL6 C3F3S2 1.3414 6 2,573.50$ 551.43$ 3,124.93$ 1 1CHMS 1CHM1 C3F3S3 1.5506 7 to 9 2,974.86$ 14.13$ 2,988.99$ 1 1CHMT 1CHM2 C3F3S3 1.5506 7 to 9 2,974.86$ 51.04$ 3,025.90$ 1 1CHMU 1CHM3 C3F3S3 1.5506 7 to 9 2,974.86$ 139.94$ 3,114.80$ 1 1CHMV 1CHM4 C3F3S3 1.5506 7 to 9 2,974.86$ 207.91$ 3,182.77$ 1 1CHMW 1CHM5 C3F3S3 1.5506 7 to 9 2,974.86$ 320.62$ 3,295.48$ 1 1CHMX 1CHM6 C3F3S3 1.5506 7 to 9 2,974.86$ 551.43$ 3,526.29$ 1 1CHNS 1CHN1 C3F3S4 1.7650 10 3,386.19$ 14.13$ 3,400.32$ 1 1CHNT 1CHN2 C3F3S4 1.7650 10 3,386.19$ 51.04$ 3,437.23$ 1 1CHNU 1CHN3 C3F3S4 1.7650 10 3,386.19$ 139.94$ 3,526.13$ 1 1CHNV 1CHN4 C3F3S4 1.7650 10 3,386.19$ 207.91$ 3,594.10$ 1 1CHNW 1CHN5 C3F3S4 1.7650 10 3,386.19$ 320.62$ 3,706.81$ 1 1CHNX 1CHN6 C3F3S4 1.7650 10 3,386.19$ 551.43$ 3,937.62$ 1 1CHPS 1CHP1 C3F3S5 1.9413 11 to 13 3,724.42$ 14.13$ 3,738.55$ 1 1CHPT 1CHP2 C3F3S5 1.9413 11 to 13 3,724.42$ 51.04$ 3,775.46$ 1 1CHPU 1CHP3 C3F3S5 1.9413 11 to 13 3,724.42$ 139.94$ 3,864.36$ 1 1CHPV 1CHP4 C3F3S5 1.9413 11 to 13 3,724.42$ 207.91$ 3,932.33$ 1 1CHPW 1CHP5 C3F3S5 1.9413 11 to 13 3,724.42$ 320.62$ 4,045.04$ 1 1CHPX 1CHP6 C3F3S5 1.9413 11 to 13 3,724.42$ 551.43$ 4,275.85$

Early (1st and 2nd) Episodes With 14 to 19 Therapy Visits2 2AFKS 2AFK1 C1F1S1 1.6118 14 to 15 3,092.27$ 14.13$ 3,106.40$ 2 2AFKT 2AFK2 C1F1S1 1.6118 14 to 15 3,092.27$ 51.04$ 3,143.31$ 2 2AFKU 2AFK3 C1F1S1 1.6118 14 to 15 3,092.27$ 139.94$ 3,232.21$ 2 2AFKV 2AFK4 C1F1S1 1.6118 14 to 15 3,092.27$ 207.91$ 3,300.18$ 2 2AFKW 2AFK5 C1F1S1 1.6118 14 to 15 3,092.27$ 320.62$ 3,412.89$ 2 2AFKX 2AFK6 C1F1S1 1.6118 14 to 15 3,092.27$ 551.43$ 3,643.70$

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2 2AFLS 2AFL1 C1F1S2 1.7675 16 to 17 3,390.98$ 14.13$ 3,405.11$ 2 2AFLT 2AFL2 C1F1S2 1.7675 16 to 17 3,390.98$ 51.04$ 3,442.02$ 2 2AFLU 2AFL3 C1F1S2 1.7675 16 to 17 3,390.98$ 139.94$ 3,530.92$ 2 2AFLV 2AFL4 C1F1S2 1.7675 16 to 17 3,390.98$ 207.91$ 3,598.89$ 2 2AFLW 2AFL5 C1F1S2 1.7675 16 to 17 3,390.98$ 320.62$ 3,711.60$ 2 2AFLX 2AFL6 C1F1S2 1.7675 16 to 17 3,390.98$ 551.43$ 3,942.41$ 2 2AFMS 2AFM1 C1F1S3 1.9046 18 to 19 3,654.01$ 14.13$ 3,668.14$ 2 2AFMT 2AFM2 C1F1S3 1.9046 18 to 19 3,654.01$ 51.04$ 3,705.05$ 2 2AFMU 2AFM3 C1F1S3 1.9046 18 to 19 3,654.01$ 139.94$ 3,793.95$ 2 2AFMV 2AFM4 C1F1S3 1.9046 18 to 19 3,654.01$ 207.91$ 3,861.92$ 2 2AFMW 2AFM5 C1F1S3 1.9046 18 to 19 3,654.01$ 320.62$ 3,974.63$ 2 2AFMX 2AFM6 C1F1S3 1.9046 18 to 19 3,654.01$ 551.43$ 4,205.44$ 2 2AGKS 2AGK1 C1F2S1 1.7281 14 to 15 3,315.39$ 14.13$ 3,329.52$ 2 2AGKT 2AGK2 C1F2S1 1.7281 14 to 15 3,315.39$ 51.04$ 3,366.43$ 2 2AGKU 2AGK3 C1F2S1 1.7281 14 to 15 3,315.39$ 139.94$ 3,455.33$ 2 2AGKV 2AGK4 C1F2S1 1.7281 14 to 15 3,315.39$ 207.91$ 3,523.30$ 2 2AGKW 2AGK5 C1F2S1 1.7281 14 to 15 3,315.39$ 320.62$ 3,636.01$ 2 2AGKX 2AGK6 C1F2S1 1.7281 14 to 15 3,315.39$ 551.43$ 3,866.82$ 2 2AGLS 2AGL1 C1F2S2 1.8837 16 to 17 3,613.92$ 14.13$ 3,628.05$ 2 2AGLT 2AGL2 C1F2S2 1.8837 16 to 17 3,613.92$ 51.04$ 3,664.96$ 2 2AGLU 2AGL3 C1F2S2 1.8837 16 to 17 3,613.92$ 139.94$ 3,753.86$ 2 2AGLV 2AGL4 C1F2S2 1.8837 16 to 17 3,613.92$ 207.91$ 3,821.83$ 2 2AGLW 2AGL5 C1F2S2 1.8837 16 to 17 3,613.92$ 320.62$ 3,934.54$ 2 2AGLX 2AGL6 C1F2S2 1.8837 16 to 17 3,613.92$ 551.43$ 4,165.35$ 2 2AGMS 2AGM1 C1F2S3 2.0208 18 to 19 3,876.94$ 14.13$ 3,891.07$ 2 2AGMT 2AGM2 C1F2S3 2.0208 18 to 19 3,876.94$ 51.04$ 3,927.98$ 2 2AGMU 2AGM3 C1F2S3 2.0208 18 to 19 3,876.94$ 139.94$ 4,016.88$ 2 2AGMV 2AGM4 C1F2S3 2.0208 18 to 19 3,876.94$ 207.91$ 4,084.85$

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2 2AGMW 2AGM5 C1F2S3 2.0208 18 to 19 3,876.94$ 320.62$ 4,197.56$ 2 2AGMX 2AGM6 C1F2S3 2.0208 18 to 19 3,876.94$ 551.43$ 4,428.37$ 2 2AHKS 2AHK1 C1F3S1 1.8010 14 to 15 3,455.25$ 14.13$ 3,469.38$ 2 2AHKT 2AHK2 C1F3S1 1.8010 14 to 15 3,455.25$ 51.04$ 3,506.29$ 2 2AHKU 2AHK3 C1F3S1 1.8010 14 to 15 3,455.25$ 139.94$ 3,595.19$ 2 2AHKV 2AHK4 C1F3S1 1.8010 14 to 15 3,455.25$ 207.91$ 3,663.16$ 2 2AHKW 2AHK5 C1F3S1 1.8010 14 to 15 3,455.25$ 320.62$ 3,775.87$ 2 2AHKX 2AHK6 C1F3S1 1.8010 14 to 15 3,455.25$ 551.43$ 4,006.68$ 2 2AHLS 2AHL1 C1F3S2 1.9566 16 to 17 3,753.78$ 14.13$ 3,767.91$ 2 2AHLT 2AHL2 C1F3S2 1.9566 16 to 17 3,753.78$ 51.04$ 3,804.82$ 2 2AHLU 2AHL3 C1F3S2 1.9566 16 to 17 3,753.78$ 139.94$ 3,893.72$ 2 2AHLV 2AHL4 C1F3S2 1.9566 16 to 17 3,753.78$ 207.91$ 3,961.69$ 2 2AHLW 2AHL5 C1F3S2 1.9566 16 to 17 3,753.78$ 320.62$ 4,074.40$ 2 2AHLX 2AHL6 C1F3S2 1.9566 16 to 17 3,753.78$ 551.43$ 4,305.21$ 2 2AHMS 2AHM1 C1F3S3 2.0937 18 to 19 4,016.80$ 14.13$ 4,030.93$ 2 2AHMT 2AHM2 C1F3S3 2.0937 18 to 19 4,016.80$ 51.04$ 4,067.84$ 2 2AHMU 2AHM3 C1F3S3 2.0937 18 to 19 4,016.80$ 139.94$ 4,156.74$ 2 2AHMV 2AHM4 C1F3S3 2.0937 18 to 19 4,016.80$ 207.91$ 4,224.71$ 2 2AHMW 2AHM5 C1F3S3 2.0937 18 to 19 4,016.80$ 320.62$ 4,337.42$ 2 2AHMX 2AHM6 C1F3S3 2.0937 18 to 19 4,016.80$ 551.43$ 4,568.23$ 2 2BFKS 2BFK1 C2F1S1 1.8626 14 to 15 3,573.43$ 14.13$ 3,587.56$ 2 2BFKT 2BFK2 C2F1S1 1.8626 14 to 15 3,573.43$ 51.04$ 3,624.47$ 2 2BFKU 2BFK3 C2F1S1 1.8626 14 to 15 3,573.43$ 139.94$ 3,713.37$ 2 2BFKV 2BFK4 C2F1S1 1.8626 14 to 15 3,573.43$ 207.91$ 3,781.34$ 2 2BFKW 2BFK5 C2F1S1 1.8626 14 to 15 3,573.43$ 320.62$ 3,894.05$ 2 2BFKX 2BFK6 C2F1S1 1.8626 14 to 15 3,573.43$ 551.43$ 4,124.86$ 2 2BFLS 2BFL1 C2F1S2 2.0183 16 to 17 3,872.15$ 14.13$ 3,886.28$ 2 2BFLT 2BFL2 C2F1S2 2.0183 16 to 17 3,872.15$ 51.04$ 3,923.19$

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2 2BFLU 2BFL3 C2F1S2 2.0183 16 to 17 3,872.15$ 139.94$ 4,012.09$ 2 2BFLV 2BFL4 C2F1S2 2.0183 16 to 17 3,872.15$ 207.91$ 4,080.06$ 2 2BFLW 2BFL5 C2F1S2 2.0183 16 to 17 3,872.15$ 320.62$ 4,192.77$ 2 2BFLX 2BFL6 C2F1S2 2.0183 16 to 17 3,872.15$ 551.43$ 4,423.58$ 2 2BFMS 2BFM1 C2F1S3 2.1554 18 to 19 4,135.18$ 14.13$ 4,149.31$ 2 2BFMT 2BFM2 C2F1S3 2.1554 18 to 19 4,135.18$ 51.04$ 4,186.22$ 2 2BFMU 2BFM3 C2F1S3 2.1554 18 to 19 4,135.18$ 139.94$ 4,275.12$ 2 2BFMV 2BFM4 C2F1S3 2.1554 18 to 19 4,135.18$ 207.91$ 4,343.09$ 2 2BFMW 2BFM5 C2F1S3 2.1554 18 to 19 4,135.18$ 320.62$ 4,455.80$ 2 2BFMX 2BFM6 C2F1S3 2.1554 18 to 19 4,135.18$ 551.43$ 4,686.61$ 2 2BGKS 2BGK1 C2F2S1 1.9789 14 to 15 3,796.56$ 14.13$ 3,810.69$ 2 2BGKT 2BGK2 C2F2S1 1.9789 14 to 15 3,796.56$ 51.04$ 3,847.60$ 2 2BGKU 2BGK3 C2F2S1 1.9789 14 to 15 3,796.56$ 139.94$ 3,936.50$ 2 2BGKV 2BGK4 C2F2S1 1.9789 14 to 15 3,796.56$ 207.91$ 4,004.47$ 2 2BGKW 2BGK5 C2F2S1 1.9789 14 to 15 3,796.56$ 320.62$ 4,117.18$ 2 2BGKX 2BGK6 C2F2S1 1.9789 14 to 15 3,796.56$ 551.43$ 4,347.99$ 2 2BGLS 2BGL1 C2F2S2 2.1345 16 to 17 4,095.08$ 14.13$ 4,109.21$ 2 2BGLT 2BGL2 C2F2S2 2.1345 16 to 17 4,095.08$ 51.04$ 4,146.12$ 2 2BGLU 2BGL3 C2F2S2 2.1345 16 to 17 4,095.08$ 139.94$ 4,235.02$ 2 2BGLV 2BGL4 C2F2S2 2.1345 16 to 17 4,095.08$ 207.91$ 4,302.99$ 2 2BGLW 2BGL5 C2F2S2 2.1345 16 to 17 4,095.08$ 320.62$ 4,415.70$ 2 2BGLX 2BGL6 C2F2S2 2.1345 16 to 17 4,095.08$ 551.43$ 4,646.51$ 2 2BGMS 2BGM1 C2F2S3 2.2716 18 to 19 4,358.11$ 14.13$ 4,372.24$ 2 2BGMT 2BGM2 C2F2S3 2.2716 18 to 19 4,358.11$ 51.04$ 4,409.15$ 2 2BGMU 2BGM3 C2F2S3 2.2716 18 to 19 4,358.11$ 139.94$ 4,498.05$ 2 2BGMV 2BGM4 C2F2S3 2.2716 18 to 19 4,358.11$ 207.91$ 4,566.02$ 2 2BGMW 2BGM5 C2F2S3 2.2716 18 to 19 4,358.11$ 320.62$ 4,678.73$ 2 2BGMX 2BGM6 C2F2S3 2.2716 18 to 19 4,358.11$ 551.43$ 4,909.54$

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2 2BHKS 2BHK1 C2F3S1 2.0518 14 to 15 3,936.42$ 14.13$ 3,950.55$ 2 2BHKT 2BHK2 C2F3S1 2.0518 14 to 15 3,936.42$ 51.04$ 3,987.46$ 2 2BHKU 2BHK3 C2F3S1 2.0518 14 to 15 3,936.42$ 139.94$ 4,076.36$ 2 2BHKV 2BHK4 C2F3S1 2.0518 14 to 15 3,936.42$ 207.91$ 4,144.33$ 2 2BHKW 2BHK5 C2F3S1 2.0518 14 to 15 3,936.42$ 320.62$ 4,257.04$ 2 2BHKX 2BHK6 C2F3S1 2.0518 14 to 15 3,936.42$ 551.43$ 4,487.85$ 2 2BHLS 2BHL1 C2F3S2 2.2074 16 to 17 4,234.94$ 14.13$ 4,249.07$ 2 2BHLT 2BHL2 C2F3S2 2.2074 16 to 17 4,234.94$ 51.04$ 4,285.98$ 2 2BHLU 2BHL3 C2F3S2 2.2074 16 to 17 4,234.94$ 139.94$ 4,374.88$ 2 2BHLV 2BHL4 C2F3S2 2.2074 16 to 17 4,234.94$ 207.91$ 4,442.85$ 2 2BHLW 2BHL5 C2F3S2 2.2074 16 to 17 4,234.94$ 320.62$ 4,555.56$ 2 2BHLX 2BHL6 C2F3S2 2.2074 16 to 17 4,234.94$ 551.43$ 4,786.37$ 2 2BHMS 2BHM1 C2F3S3 2.3445 18 to 19 4,497.97$ 14.13$ 4,512.10$ 2 2BHMT 2BHM2 C2F3S3 2.3445 18 to 19 4,497.97$ 51.04$ 4,549.01$ 2 2BHMU 2BHM3 C2F3S3 2.3445 18 to 19 4,497.97$ 139.94$ 4,637.91$ 2 2BHMV 2BHM4 C2F3S3 2.3445 18 to 19 4,497.97$ 207.91$ 4,705.88$ 2 2BHMW 2BHM5 C2F3S3 2.3445 18 to 19 4,497.97$ 320.62$ 4,818.59$ 2 2BHMX 2BHM6 C2F3S3 2.3445 18 to 19 4,497.97$ 551.43$ 5,049.40$ 2 2CFKS 2CFK1 C3F1S1 2.1524 14 to 15 4,129.42$ 14.13$ 4,143.55$ 2 2CFKT 2CFK2 C3F1S1 2.1524 14 to 15 4,129.42$ 51.04$ 4,180.46$ 2 2CFKU 2CFK3 C3F1S1 2.1524 14 to 15 4,129.42$ 139.94$ 4,269.36$ 2 2CFKV 2CFK4 C3F1S1 2.1524 14 to 15 4,129.42$ 207.91$ 4,337.33$ 2 2CFKW 2CFK5 C3F1S1 2.1524 14 to 15 4,129.42$ 320.62$ 4,450.04$ 2 2CFKX 2CFK6 C3F1S1 2.1524 14 to 15 4,129.42$ 551.43$ 4,680.85$ 2 2CFLS 2CFL1 C3F1S2 2.3081 16 to 17 4,428.13$ 14.13$ 4,442.26$ 2 2CFLT 2CFL2 C3F1S2 2.3081 16 to 17 4,428.13$ 51.04$ 4,479.17$ 2 2CFLU 2CFL3 C3F1S2 2.3081 16 to 17 4,428.13$ 139.94$ 4,568.07$ 2 2CFLV 2CFL4 C3F1S2 2.3081 16 to 17 4,428.13$ 207.91$ 4,636.04$

11/20/08 14 of 34





2 2CFLW 2CFL5 C3F1S2 2.3081 16 to 17 4,428.13$ 320.62$ 4,748.75$ 2 2CFLX 2CFL6 C3F1S2 2.3081 16 to 17 4,428.13$ 551.43$ 4,979.56$ 2 2CFMS 2CFM1 C3F1S3 2.4451 18 to 19 4,690.97$ 14.13$ 4,705.10$ 2 2CFMT 2CFM2 C3F1S3 2.4451 18 to 19 4,690.97$ 51.04$ 4,742.01$ 2 2CFMU 2CFM3 C3F1S3 2.4451 18 to 19 4,690.97$ 139.94$ 4,830.91$ 2 2CFMV 2CFM4 C3F1S3 2.4451 18 to 19 4,690.97$ 207.91$ 4,898.88$ 2 2CFMW 2CFM5 C3F1S3 2.4451 18 to 19 4,690.97$ 320.62$ 5,011.59$ 2 2CFMX 2CFM6 C3F1S3 2.4451 18 to 19 4,690.97$ 551.43$ 5,242.40$ 2 2CGKS 2CGK1 C3F2S1 2.2686 14 to 15 4,352.35$ 14.13$ 4,366.48$ 2 2CGKT 2CGK2 C3F2S1 2.2686 14 to 15 4,352.35$ 51.04$ 4,403.39$ 2 2CGKU 2CGK3 C3F2S1 2.2686 14 to 15 4,352.35$ 139.94$ 4,492.29$ 2 2CGKV 2CGK4 C3F2S1 2.2686 14 to 15 4,352.35$ 207.91$ 4,560.26$ 2 2CGKW 2CGK5 C3F2S1 2.2686 14 to 15 4,352.35$ 320.62$ 4,672.97$ 2 2CGKX 2CGK6 C3F2S1 2.2686 14 to 15 4,352.35$ 551.43$ 4,903.78$ 2 2CGLS 2CGL1 C3F2S2 2.4243 16 to 17 4,651.07$ 14.13$ 4,665.20$ 2 2CGLT 2CGL2 C3F2S2 2.4243 16 to 17 4,651.07$ 51.04$ 4,702.11$ 2 2CGLU 2CGL3 C3F2S2 2.4243 16 to 17 4,651.07$ 139.94$ 4,791.01$ 2 2CGLV 2CGL4 C3F2S2 2.4243 16 to 17 4,651.07$ 207.91$ 4,858.98$ 2 2CGLW 2CGL5 C3F2S2 2.4243 16 to 17 4,651.07$ 320.62$ 4,971.69$ 2 2CGLX 2CGL6 C3F2S2 2.4243 16 to 17 4,651.07$ 551.43$ 5,202.50$ 2 2CGMS 2CGM1 C3F2S3 2.5613 18 to 19 4,913.90$ 14.13$ 4,928.03$ 2 2CGMT 2CGM2 C3F2S3 2.5613 18 to 19 4,913.90$ 51.04$ 4,964.94$ 2 2CGMU 2CGM3 C3F2S3 2.5613 18 to 19 4,913.90$ 139.94$ 5,053.84$ 2 2CGMV 2CGM4 C3F2S3 2.5613 18 to 19 4,913.90$ 207.91$ 5,121.81$ 2 2CGMW 2CGM5 C3F2S3 2.5613 18 to 19 4,913.90$ 320.62$ 5,234.52$ 2 2CGMX 2CGM6 C3F2S3 2.5613 18 to 19 4,913.90$ 551.43$ 5,465.33$ 2 2CHKS 2CHK1 C3F3S1 2.3415 14 to 15 4,492.21$ 14.13$ 4,506.34$ 2 2CHKT 2CHK2 C3F3S1 2.3415 14 to 15 4,492.21$ 51.04$ 4,543.25$

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2 2CHKU 2CHK3 C3F3S1 2.3415 14 to 15 4,492.21$ 139.94$ 4,632.15$ 2 2CHKV 2CHK4 C3F3S1 2.3415 14 to 15 4,492.21$ 207.91$ 4,700.12$ 2 2CHKW 2CHK5 C3F3S1 2.3415 14 to 15 4,492.21$ 320.62$ 4,812.83$ 2 2CHKX 2CHK6 C3F3S1 2.3415 14 to 15 4,492.21$ 551.43$ 5,043.64$ 2 2CHLS 2CHL1 C3F3S2 2.4972 16 to 17 4,790.93$ 14.13$ 4,805.06$ 2 2CHLT 2CHL2 C3F3S2 2.4972 16 to 17 4,790.93$ 51.04$ 4,841.97$ 2 2CHLU 2CHL3 C3F3S2 2.4972 16 to 17 4,790.93$ 139.94$ 4,930.87$ 2 2CHLV 2CHL4 C3F3S2 2.4972 16 to 17 4,790.93$ 207.91$ 4,998.84$ 2 2CHLW 2CHL5 C3F3S2 2.4972 16 to 17 4,790.93$ 320.62$ 5,111.55$ 2 2CHLX 2CHL6 C3F3S2 2.4972 16 to 17 4,790.93$ 551.43$ 5,342.36$ 2 2CHMS 2CHM1 C3F3S3 2.6342 18 to 19 5,053.76$ 14.13$ 5,067.89$ 2 2CHMT 2CHM2 C3F3S3 2.6342 18 to 19 5,053.76$ 51.04$ 5,104.80$ 2 2CHMU 2CHM3 C3F3S3 2.6342 18 to 19 5,053.76$ 139.94$ 5,193.70$ 2 2CHMV 2CHM4 C3F3S3 2.6342 18 to 19 5,053.76$ 207.91$ 5,261.67$ 2 2CHMW 2CHM5 C3F3S3 2.6342 18 to 19 5,053.76$ 320.62$ 5,374.38$ 2 2CHMX 2CHM6 C3F3S3 2.6342 18 to 19 5,053.76$ 551.43$ 5,605.19$

Late (3rd+) Episodes With 0 to 13 Therapy Visits3 3AFKS 3AFK1 C1F1S1 0.6543 0 to 5 1,255.29$ 14.13$ 1,269.42$ 3 3AFKT 3AFK2 C1F1S1 0.6543 0 to 5 1,255.29$ 51.04$ 1,306.33$ 3 3AFKU 3AFK3 C1F1S1 0.6543 0 to 5 1,255.29$ 139.94$ 1,395.23$ 3 3AFKV 3AFK4 C1F1S1 0.6543 0 to 5 1,255.29$ 207.91$ 1,463.20$ 3 3AFKW 3AFK5 C1F1S1 0.6543 0 to 5 1,255.29$ 320.62$ 1,575.91$ 3 3AFKX 3AFK6 C1F1S1 0.6543 0 to 5 1,255.29$ 551.43$ 1,806.72$ 3 3AFLS 3AFL1 C1F1S2 1.0041 6 1,926.39$ 14.13$ 1,940.52$ 3 3AFLT 3AFL2 C1F1S2 1.0041 6 1,926.39$ 51.04$ 1,977.43$ 3 3AFLU 3AFL3 C1F1S2 1.0041 6 1,926.39$ 139.94$ 2,066.33$ 3 3AFLV 3AFL4 C1F1S2 1.0041 6 1,926.39$ 207.91$ 2,134.30$

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3 3AFLW 3AFL5 C1F1S2 1.0041 6 1,926.39$ 320.62$ 2,247.01$ 3 3AFLX 3AFL6 C1F1S2 1.0041 6 1,926.39$ 551.43$ 2,477.82$ 3 3AFMS 3AFM1 C1F1S3 1.2065 7 to 9 2,314.69$ 14.13$ 2,328.82$ 3 3AFMT 3AFM2 C1F1S3 1.2065 7 to 9 2,314.69$ 51.04$ 2,365.73$ 3 3AFMU 3AFM3 C1F1S3 1.2065 7 to 9 2,314.69$ 139.94$ 2,454.63$ 3 3AFMV 3AFM4 C1F1S3 1.2065 7 to 9 2,314.69$ 207.91$ 2,522.60$ 3 3AFMW 3AFM5 C1F1S3 1.2065 7 to 9 2,314.69$ 320.62$ 2,635.31$ 3 3AFMX 3AFM6 C1F1S3 1.2065 7 to 9 2,314.69$ 551.43$ 2,866.12$ 3 3AFNS 3AFN1 C1F1S4 1.4277 10 2,739.07$ 14.13$ 2,753.20$ 3 3AFNT 3AFN2 C1F1S4 1.4277 10 2,739.07$ 51.04$ 2,790.11$ 3 3AFNU 3AFN3 C1F1S4 1.4277 10 2,739.07$ 139.94$ 2,879.01$ 3 3AFNV 3AFN4 C1F1S4 1.4277 10 2,739.07$ 207.91$ 2,946.98$ 3 3AFNW 3AFN5 C1F1S4 1.4277 10 2,739.07$ 320.62$ 3,059.69$ 3 3AFNX 3AFN6 C1F1S4 1.4277 10 2,739.07$ 551.43$ 3,290.50$ 3 3AFPS 3AFP1 C1F1S5 1.6024 11 to 13 3,074.24$ 14.13$ 3,088.37$ 3 3AFPT 3AFP2 C1F1S5 1.6024 11 to 13 3,074.24$ 51.04$ 3,125.28$ 3 3AFPU 3AFP3 C1F1S5 1.6024 11 to 13 3,074.24$ 139.94$ 3,214.18$ 3 3AFPV 3AFP4 C1F1S5 1.6024 11 to 13 3,074.24$ 207.91$ 3,282.15$ 3 3AFPW 3AFP5 C1F1S5 1.6024 11 to 13 3,074.24$ 320.62$ 3,394.86$ 3 3AFPX 3AFP6 C1F1S5 1.6024 11 to 13 3,074.24$ 551.43$ 3,625.67$ 3 3AGKS 3AGK1 C1F2S1 0.7882 0 to 5 1,512.18$ 14.13$ 1,526.31$ 3 3AGKT 3AGK2 C1F2S1 0.7882 0 to 5 1,512.18$ 51.04$ 1,563.22$ 3 3AGKU 3AGK3 C1F2S1 0.7882 0 to 5 1,512.18$ 139.94$ 1,652.12$ 3 3AGKV 3AGK4 C1F2S1 0.7882 0 to 5 1,512.18$ 207.91$ 1,720.09$ 3 3AGKW 3AGK5 C1F2S1 0.7882 0 to 5 1,512.18$ 320.62$ 1,832.80$ 3 3AGKX 3AGK6 C1F2S1 0.7882 0 to 5 1,512.18$ 551.43$ 2,063.61$ 3 3AGLS 3AGL1 C1F2S2 1.1380 6 2,183.28$ 14.13$ 2,197.41$ 3 3AGLT 3AGL2 C1F2S2 1.1380 6 2,183.28$ 51.04$ 2,234.32$

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3 3AGLU 3AGL3 C1F2S2 1.1380 6 2,183.28$ 139.94$ 2,323.22$ 3 3AGLV 3AGL4 C1F2S2 1.1380 6 2,183.28$ 207.91$ 2,391.19$ 3 3AGLW 3AGL5 C1F2S2 1.1380 6 2,183.28$ 320.62$ 2,503.90$ 3 3AGLX 3AGL6 C1F2S2 1.1380 6 2,183.28$ 551.43$ 2,734.71$ 3 3AGMS 3AGM1 C1F2S3 1.3405 7 to 9 2,571.78$ 14.13$ 2,585.91$ 3 3AGMT 3AGM2 C1F2S3 1.3405 7 to 9 2,571.78$ 51.04$ 2,622.82$ 3 3AGMU 3AGM3 C1F2S3 1.3405 7 to 9 2,571.78$ 139.94$ 2,711.72$ 3 3AGMV 3AGM4 C1F2S3 1.3405 7 to 9 2,571.78$ 207.91$ 2,779.69$ 3 3AGMW 3AGM5 C1F2S3 1.3405 7 to 9 2,571.78$ 320.62$ 2,892.40$ 3 3AGMX 3AGM6 C1F2S3 1.3405 7 to 9 2,571.78$ 551.43$ 3,123.21$ 3 3AGNS 3AGN1 C1F2S4 1.5617 10 2,996.15$ 14.13$ 3,010.28$ 3 3AGNT 3AGN2 C1F2S4 1.5617 10 2,996.15$ 51.04$ 3,047.19$ 3 3AGNU 3AGN3 C1F2S4 1.5617 10 2,996.15$ 139.94$ 3,136.09$ 3 3AGNV 3AGN4 C1F2S4 1.5617 10 2,996.15$ 207.91$ 3,204.06$ 3 3AGNW 3AGN5 C1F2S4 1.5617 10 2,996.15$ 320.62$ 3,316.77$ 3 3AGNX 3AGN6 C1F2S4 1.5617 10 2,996.15$ 551.43$ 3,547.58$ 3 3AGPS 3AGP1 C1F2S5 1.7364 11 to 13 3,331.32$ 14.13$ 3,345.45$ 3 3AGPT 3AGP2 C1F2S5 1.7364 11 to 13 3,331.32$ 51.04$ 3,382.36$ 3 3AGPU 3AGP3 C1F2S5 1.7364 11 to 13 3,331.32$ 139.94$ 3,471.26$ 3 3AGPV 3AGP4 C1F2S5 1.7364 11 to 13 3,331.32$ 207.91$ 3,539.23$ 3 3AGPW 3AGP5 C1F2S5 1.7364 11 to 13 3,331.32$ 320.62$ 3,651.94$ 3 3AGPX 3AGP6 C1F2S5 1.7364 11 to 13 3,331.32$ 551.43$ 3,882.75$ 3 3AHKS 3AHK1 C1F3S1 0.9151 0 to 5 1,755.64$ 14.13$ 1,769.77$ 3 3AHKT 3AHK2 C1F3S1 0.9151 0 to 5 1,755.64$ 51.04$ 1,806.68$ 3 3AHKU 3AHK3 C1F3S1 0.9151 0 to 5 1,755.64$ 139.94$ 1,895.58$ 3 3AHKV 3AHK4 C1F3S1 0.9151 0 to 5 1,755.64$ 207.91$ 1,963.55$ 3 3AHKW 3AHK5 C1F3S1 0.9151 0 to 5 1,755.64$ 320.62$ 2,076.26$ 3 3AHKX 3AHK6 C1F3S1 0.9151 0 to 5 1,755.64$ 551.43$ 2,307.07$

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3 3AHLS 3AHL1 C1F3S2 1.2649 6 2,426.74$ 14.13$ 2,440.87$ 3 3AHLT 3AHL2 C1F3S2 1.2649 6 2,426.74$ 51.04$ 2,477.78$ 3 3AHLU 3AHL3 C1F3S2 1.2649 6 2,426.74$ 139.94$ 2,566.68$ 3 3AHLV 3AHL4 C1F3S2 1.2649 6 2,426.74$ 207.91$ 2,634.65$ 3 3AHLW 3AHL5 C1F3S2 1.2649 6 2,426.74$ 320.62$ 2,747.36$ 3 3AHLX 3AHL6 C1F3S2 1.2649 6 2,426.74$ 551.43$ 2,978.17$ 3 3AHMS 3AHM1 C1F3S3 1.4674 7 to 9 2,815.24$ 14.13$ 2,829.37$ 3 3AHMT 3AHM2 C1F3S3 1.4674 7 to 9 2,815.24$ 51.04$ 2,866.28$ 3 3AHMU 3AHM3 C1F3S3 1.4674 7 to 9 2,815.24$ 139.94$ 2,955.18$ 3 3AHMV 3AHM4 C1F3S3 1.4674 7 to 9 2,815.24$ 207.91$ 3,023.15$ 3 3AHMW 3AHM5 C1F3S3 1.4674 7 to 9 2,815.24$ 320.62$ 3,135.86$ 3 3AHMX 3AHM6 C1F3S3 1.4674 7 to 9 2,815.24$ 551.43$ 3,366.67$ 3 3AHNS 3AHN1 C1F3S4 1.6886 10 3,239.61$ 14.13$ 3,253.74$ 3 3AHNT 3AHN2 C1F3S4 1.6886 10 3,239.61$ 51.04$ 3,290.65$ 3 3AHNU 3AHN3 C1F3S4 1.6886 10 3,239.61$ 139.94$ 3,379.55$ 3 3AHNV 3AHN4 C1F3S4 1.6886 10 3,239.61$ 207.91$ 3,447.52$ 3 3AHNW 3AHN5 C1F3S4 1.6886 10 3,239.61$ 320.62$ 3,560.23$ 3 3AHNX 3AHN6 C1F3S4 1.6886 10 3,239.61$ 551.43$ 3,791.04$ 3 3AHPS 3AHP1 C1F3S5 1.8632 11 to 13 3,574.59$ 14.13$ 3,588.72$ 3 3AHPT 3AHP2 C1F3S5 1.8632 11 to 13 3,574.59$ 51.04$ 3,625.63$ 3 3AHPU 3AHP3 C1F3S5 1.8632 11 to 13 3,574.59$ 139.94$ 3,714.53$ 3 3AHPV 3AHP4 C1F3S5 1.8632 11 to 13 3,574.59$ 207.91$ 3,782.50$ 3 3AHPW 3AHP5 C1F3S5 1.8632 11 to 13 3,574.59$ 320.62$ 3,895.21$ 3 3AHPX 3AHP6 C1F3S5 1.8632 11 to 13 3,574.59$ 551.43$ 4,126.02$ 3 3BFKS 3BFK1 C2F1S1 0.7124 0 to 5 1,366.75$ 14.13$ 1,380.88$ 3 3BFKT 3BFK2 C2F1S1 0.7124 0 to 5 1,366.75$ 51.04$ 1,417.79$ 3 3BFKU 3BFK3 C2F1S1 0.7124 0 to 5 1,366.75$ 139.94$ 1,506.69$ 3 3BFKV 3BFK4 C2F1S1 0.7124 0 to 5 1,366.75$ 207.91$ 1,574.66$

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3 3BFKW 3BFK5 C2F1S1 0.7124 0 to 5 1,366.75$ 320.62$ 1,687.37$ 3 3BFKX 3BFK6 C2F1S1 0.7124 0 to 5 1,366.75$ 551.43$ 1,918.18$ 3 3BFLS 3BFL1 C2F1S2 1.0622 6 2,037.85$ 14.13$ 2,051.98$ 3 3BFLT 3BFL2 C2F1S2 1.0622 6 2,037.85$ 51.04$ 2,088.89$ 3 3BFLU 3BFL3 C2F1S2 1.0622 6 2,037.85$ 139.94$ 2,177.79$ 3 3BFLV 3BFL4 C2F1S2 1.0622 6 2,037.85$ 207.91$ 2,245.76$ 3 3BFLW 3BFL5 C2F1S2 1.0622 6 2,037.85$ 320.62$ 2,358.47$ 3 3BFLX 3BFL6 C2F1S2 1.0622 6 2,037.85$ 551.43$ 2,589.28$ 3 3BFMS 3BFM1 C2F1S3 1.2646 7 to 9 2,426.16$ 14.13$ 2,440.29$ 3 3BFMT 3BFM2 C2F1S3 1.2646 7 to 9 2,426.16$ 51.04$ 2,477.20$ 3 3BFMU 3BFM3 C2F1S3 1.2646 7 to 9 2,426.16$ 139.94$ 2,566.10$ 3 3BFMV 3BFM4 C2F1S3 1.2646 7 to 9 2,426.16$ 207.91$ 2,634.07$ 3 3BFMW 3BFM5 C2F1S3 1.2646 7 to 9 2,426.16$ 320.62$ 2,746.78$ 3 3BFMX 3BFM6 C2F1S3 1.2646 7 to 9 2,426.16$ 551.43$ 2,977.59$ 3 3BFNS 3BFN1 C2F1S4 1.4858 10 2,850.54$ 14.13$ 2,864.67$ 3 3BFNT 3BFN2 C2F1S4 1.4858 10 2,850.54$ 51.04$ 2,901.58$ 3 3BFNU 3BFN3 C2F1S4 1.4858 10 2,850.54$ 139.94$ 2,990.48$ 3 3BFNV 3BFN4 C2F1S4 1.4858 10 2,850.54$ 207.91$ 3,058.45$ 3 3BFNW 3BFN5 C2F1S4 1.4858 10 2,850.54$ 320.62$ 3,171.16$ 3 3BFNX 3BFN6 C2F1S4 1.4858 10 2,850.54$ 551.43$ 3,401.97$ 3 3BFPS 3BFP1 C2F1S5 1.6605 11 to 13 3,185.70$ 14.13$ 3,199.83$ 3 3BFPT 3BFP2 C2F1S5 1.6605 11 to 13 3,185.70$ 51.04$ 3,236.74$ 3 3BFPU 3BFP3 C2F1S5 1.6605 11 to 13 3,185.70$ 139.94$ 3,325.64$ 3 3BFPV 3BFP4 C2F1S5 1.6605 11 to 13 3,185.70$ 207.91$ 3,393.61$ 3 3BFPW 3BFP5 C2F1S5 1.6605 11 to 13 3,185.70$ 320.62$ 3,506.32$ 3 3BFPX 3BFP6 C2F1S5 1.6605 11 to 13 3,185.70$ 551.43$ 3,737.13$ 3 3BGKS 3BGK1 C2F2S1 0.8463 0 to 5 1,623.64$ 14.13$ 1,637.77$ 3 3BGKT 3BGK2 C2F2S1 0.8463 0 to 5 1,623.64$ 51.04$ 1,674.68$

11/20/08 20 of 34





3 3BGKU 3BGK3 C2F2S1 0.8463 0 to 5 1,623.64$ 139.94$ 1,763.58$ 3 3BGKV 3BGK4 C2F2S1 0.8463 0 to 5 1,623.64$ 207.91$ 1,831.55$ 3 3BGKW 3BGK5 C2F2S1 0.8463 0 to 5 1,623.64$ 320.62$ 1,944.26$ 3 3BGKX 3BGK6 C2F2S1 0.8463 0 to 5 1,623.64$ 551.43$ 2,175.07$ 3 3BGLS 3BGL1 C2F2S2 1.1962 6 2,294.93$ 14.13$ 2,309.06$ 3 3BGLT 3BGL2 C2F2S2 1.1962 6 2,294.93$ 51.04$ 2,345.97$ 3 3BGLU 3BGL3 C2F2S2 1.1962 6 2,294.93$ 139.94$ 2,434.87$ 3 3BGLV 3BGL4 C2F2S2 1.1962 6 2,294.93$ 207.91$ 2,502.84$ 3 3BGLW 3BGL5 C2F2S2 1.1962 6 2,294.93$ 320.62$ 2,615.55$ 3 3BGLX 3BGL6 C2F2S2 1.1962 6 2,294.93$ 551.43$ 2,846.36$ 3 3BGMS 3BGM1 C2F2S3 1.3986 7 to 9 2,683.24$ 14.13$ 2,697.37$ 3 3BGMT 3BGM2 C2F2S3 1.3986 7 to 9 2,683.24$ 51.04$ 2,734.28$ 3 3BGMU 3BGM3 C2F2S3 1.3986 7 to 9 2,683.24$ 139.94$ 2,823.18$ 3 3BGMV 3BGM4 C2F2S3 1.3986 7 to 9 2,683.24$ 207.91$ 2,891.15$ 3 3BGMW 3BGM5 C2F2S3 1.3986 7 to 9 2,683.24$ 320.62$ 3,003.86$ 3 3BGMX 3BGM6 C2F2S3 1.3986 7 to 9 2,683.24$ 551.43$ 3,234.67$ 3 3BGNS 3BGN1 C2F2S4 1.6198 10 3,107.62$ 14.13$ 3,121.75$ 3 3BGNT 3BGN2 C2F2S4 1.6198 10 3,107.62$ 51.04$ 3,158.66$ 3 3BGNU 3BGN3 C2F2S4 1.6198 10 3,107.62$ 139.94$ 3,247.56$ 3 3BGNV 3BGN4 C2F2S4 1.6198 10 3,107.62$ 207.91$ 3,315.53$ 3 3BGNW 3BGN5 C2F2S4 1.6198 10 3,107.62$ 320.62$ 3,428.24$ 3 3BGNX 3BGN6 C2F2S4 1.6198 10 3,107.62$ 551.43$ 3,659.05$ 3 3BGPS 3BGP1 C2F2S5 1.7945 11 to 13 3,442.78$ 14.13$ 3,456.91$ 3 3BGPT 3BGP2 C2F2S5 1.7945 11 to 13 3,442.78$ 51.04$ 3,493.82$ 3 3BGPU 3BGP3 C2F2S5 1.7945 11 to 13 3,442.78$ 139.94$ 3,582.72$ 3 3BGPV 3BGP4 C2F2S5 1.7945 11 to 13 3,442.78$ 207.91$ 3,650.69$ 3 3BGPW 3BGP5 C2F2S5 1.7945 11 to 13 3,442.78$ 320.62$ 3,763.40$ 3 3BGPX 3BGP6 C2F2S5 1.7945 11 to 13 3,442.78$ 551.43$ 3,994.21$

11/20/08 21 of 34





3 3BHKS 3BHK1 C2F3S1 0.9732 0 to 5 1,867.10$ 14.13$ 1,881.23$ 3 3BHKT 3BHK2 C2F3S1 0.9732 0 to 5 1,867.10$ 51.04$ 1,918.14$ 3 3BHKU 3BHK3 C2F3S1 0.9732 0 to 5 1,867.10$ 139.94$ 2,007.04$ 3 3BHKV 3BHK4 C2F3S1 0.9732 0 to 5 1,867.10$ 207.91$ 2,075.01$ 3 3BHKW 3BHK5 C2F3S1 0.9732 0 to 5 1,867.10$ 320.62$ 2,187.72$ 3 3BHKX 3BHK6 C2F3S1 0.9732 0 to 5 1,867.10$ 551.43$ 2,418.53$ 3 3BHLS 3BHL1 C2F3S2 1.3230 6 2,538.20$ 14.13$ 2,552.33$ 3 3BHLT 3BHL2 C2F3S2 1.3230 6 2,538.20$ 51.04$ 2,589.24$ 3 3BHLU 3BHL3 C2F3S2 1.3230 6 2,538.20$ 139.94$ 2,678.14$ 3 3BHLV 3BHL4 C2F3S2 1.3230 6 2,538.20$ 207.91$ 2,746.11$ 3 3BHLW 3BHL5 C2F3S2 1.3230 6 2,538.20$ 320.62$ 2,858.82$ 3 3BHLX 3BHL6 C2F3S2 1.3230 6 2,538.20$ 551.43$ 3,089.63$ 3 3BHMS 3BHM1 C2F3S3 1.5255 7 to 9 2,926.70$ 14.13$ 2,940.83$ 3 3BHMT 3BHM2 C2F3S3 1.5255 7 to 9 2,926.70$ 51.04$ 2,977.74$ 3 3BHMU 3BHM3 C2F3S3 1.5255 7 to 9 2,926.70$ 139.94$ 3,066.64$ 3 3BHMV 3BHM4 C2F3S3 1.5255 7 to 9 2,926.70$ 207.91$ 3,134.61$ 3 3BHMW 3BHM5 C2F3S3 1.5255 7 to 9 2,926.70$ 320.62$ 3,247.32$ 3 3BHMX 3BHM6 C2F3S3 1.5255 7 to 9 2,926.70$ 551.43$ 3,478.13$ 3 3BHNS 3BHN1 C2F3S4 1.7467 10 3,351.08$ 14.13$ 3,365.21$ 3 3BHNT 3BHN2 C2F3S4 1.7467 10 3,351.08$ 51.04$ 3,402.12$ 3 3BHNU 3BHN3 C2F3S4 1.7467 10 3,351.08$ 139.94$ 3,491.02$ 3 3BHNV 3BHN4 C2F3S4 1.7467 10 3,351.08$ 207.91$ 3,558.99$ 3 3BHNW 3BHN5 C2F3S4 1.7467 10 3,351.08$ 320.62$ 3,671.70$ 3 3BHNX 3BHN6 C2F3S4 1.7467 10 3,351.08$ 551.43$ 3,902.51$ 3 3BHPS 3BHP1 C2F3S5 1.9213 11 to 13 3,686.05$ 14.13$ 3,700.18$ 3 3BHPT 3BHP2 C2F3S5 1.9213 11 to 13 3,686.05$ 51.04$ 3,737.09$ 3 3BHPU 3BHP3 C2F3S5 1.9213 11 to 13 3,686.05$ 139.94$ 3,825.99$ 3 3BHPV 3BHP4 C2F3S5 1.9213 11 to 13 3,686.05$ 207.91$ 3,893.96$

11/20/08 22 of 34





3 3BHPW 3BHP5 C2F3S5 1.9213 11 to 13 3,686.05$ 320.62$ 4,006.67$ 3 3BHPX 3BHP6 C2F3S5 1.9213 11 to 13 3,686.05$ 551.43$ 4,237.48$ 3 3CFKS 3CFK1 C3F1S1 0.9399 0 to 5 1,803.22$ 14.13$ 1,817.35$ 3 3CFKT 3CFK2 C3F1S1 0.9399 0 to 5 1,803.22$ 51.04$ 1,854.26$ 3 3CFKU 3CFK3 C3F1S1 0.9399 0 to 5 1,803.22$ 139.94$ 1,943.16$ 3 3CFKV 3CFK4 C3F1S1 0.9399 0 to 5 1,803.22$ 207.91$ 2,011.13$ 3 3CFKW 3CFK5 C3F1S1 0.9399 0 to 5 1,803.22$ 320.62$ 2,123.84$ 3 3CFKX 3CFK6 C3F1S1 0.9399 0 to 5 1,803.22$ 551.43$ 2,354.65$ 3 3CFLS 3CFL1 C3F1S2 1.2897 6 2,474.31$ 14.13$ 2,488.44$ 3 3CFLT 3CFL2 C3F1S2 1.2897 6 2,474.31$ 51.04$ 2,525.35$ 3 3CFLU 3CFL3 C3F1S2 1.2897 6 2,474.31$ 139.94$ 2,614.25$ 3 3CFLV 3CFL4 C3F1S2 1.2897 6 2,474.31$ 207.91$ 2,682.22$ 3 3CFLW 3CFL5 C3F1S2 1.2897 6 2,474.31$ 320.62$ 2,794.93$ 3 3CFLX 3CFL6 C3F1S2 1.2897 6 2,474.31$ 551.43$ 3,025.74$ 3 3CFMS 3CFM1 C3F1S3 1.4922 7 to 9 2,862.81$ 14.13$ 2,876.94$ 3 3CFMT 3CFM2 C3F1S3 1.4922 7 to 9 2,862.81$ 51.04$ 2,913.85$ 3 3CFMU 3CFM3 C3F1S3 1.4922 7 to 9 2,862.81$ 139.94$ 3,002.75$ 3 3CFMV 3CFM4 C3F1S3 1.4922 7 to 9 2,862.81$ 207.91$ 3,070.72$ 3 3CFMW 3CFM5 C3F1S3 1.4922 7 to 9 2,862.81$ 320.62$ 3,183.43$ 3 3CFMX 3CFM6 C3F1S3 1.4922 7 to 9 2,862.81$ 551.43$ 3,414.24$ 3 3CFNS 3CFN1 C3F1S4 1.7134 10 3,287.19$ 14.13$ 3,301.32$ 3 3CFNT 3CFN2 C3F1S4 1.7134 10 3,287.19$ 51.04$ 3,338.23$ 3 3CFNU 3CFN3 C3F1S4 1.7134 10 3,287.19$ 139.94$ 3,427.13$ 3 3CFNV 3CFN4 C3F1S4 1.7134 10 3,287.19$ 207.91$ 3,495.10$ 3 3CFNW 3CFN5 C3F1S4 1.7134 10 3,287.19$ 320.62$ 3,607.81$ 3 3CFNX 3CFN6 C3F1S4 1.7134 10 3,287.19$ 551.43$ 3,838.62$ 3 3CFPS 3CFP1 C3F1S5 1.8880 11 to 13 3,622.16$ 14.13$ 3,636.29$ 3 3CFPT 3CFP2 C3F1S5 1.8880 11 to 13 3,622.16$ 51.04$ 3,673.20$

11/20/08 23 of 34





3 3CFPU 3CFP3 C3F1S5 1.8880 11 to 13 3,622.16$ 139.94$ 3,762.10$ 3 3CFPV 3CFP4 C3F1S5 1.8880 11 to 13 3,622.16$ 207.91$ 3,830.07$ 3 3CFPW 3CFP5 C3F1S5 1.8880 11 to 13 3,622.16$ 320.62$ 3,942.78$ 3 3CFPX 3CFP6 C3F1S5 1.8880 11 to 13 3,622.16$ 551.43$ 4,173.59$ 3 3CGKS 3CGK1 C3F2S1 1.0738 0 to 5 2,060.11$ 14.13$ 2,074.24$ 3 3CGKT 3CGK2 C3F2S1 1.0738 0 to 5 2,060.11$ 51.04$ 2,111.15$ 3 3CGKU 3CGK3 C3F2S1 1.0738 0 to 5 2,060.11$ 139.94$ 2,200.05$ 3 3CGKV 3CGK4 C3F2S1 1.0738 0 to 5 2,060.11$ 207.91$ 2,268.02$ 3 3CGKW 3CGK5 C3F2S1 1.0738 0 to 5 2,060.11$ 320.62$ 2,380.73$ 3 3CGKX 3CGK6 C3F2S1 1.0738 0 to 5 2,060.11$ 551.43$ 2,611.54$ 3 3CGLS 3CGL1 C3F2S2 1.4237 6 2,731.40$ 14.13$ 2,745.53$ 3 3CGLT 3CGL2 C3F2S2 1.4237 6 2,731.40$ 51.04$ 2,782.44$ 3 3CGLU 3CGL3 C3F2S2 1.4237 6 2,731.40$ 139.94$ 2,871.34$ 3 3CGLV 3CGL4 C3F2S2 1.4237 6 2,731.40$ 207.91$ 2,939.31$ 3 3CGLW 3CGL5 C3F2S2 1.4237 6 2,731.40$ 320.62$ 3,052.02$ 3 3CGLX 3CGL6 C3F2S2 1.4237 6 2,731.40$ 551.43$ 3,282.83$ 3 3CGMS 3CGM1 C3F2S3 1.6261 7 to 9 3,119.70$ 14.13$ 3,133.83$ 3 3CGMT 3CGM2 C3F2S3 1.6261 7 to 9 3,119.70$ 51.04$ 3,170.74$ 3 3CGMU 3CGM3 C3F2S3 1.6261 7 to 9 3,119.70$ 139.94$ 3,259.64$ 3 3CGMV 3CGM4 C3F2S3 1.6261 7 to 9 3,119.70$ 207.91$ 3,327.61$ 3 3CGMW 3CGM5 C3F2S3 1.6261 7 to 9 3,119.70$ 320.62$ 3,440.32$ 3 3CGMX 3CGM6 C3F2S3 1.6261 7 to 9 3,119.70$ 551.43$ 3,671.13$ 3 3CGNS 3CGN1 C3F2S4 1.8473 10 3,544.08$ 14.13$ 3,558.21$ 3 3CGNT 3CGN2 C3F2S4 1.8473 10 3,544.08$ 51.04$ 3,595.12$ 3 3CGNU 3CGN3 C3F2S4 1.8473 10 3,544.08$ 139.94$ 3,684.02$ 3 3CGNV 3CGN4 C3F2S4 1.8473 10 3,544.08$ 207.91$ 3,751.99$ 3 3CGNW 3CGN5 C3F2S4 1.8473 10 3,544.08$ 320.62$ 3,864.70$ 3 3CGNX 3CGN6 C3F2S4 1.8473 10 3,544.08$ 551.43$ 4,095.51$

11/20/08 24 of 34





3 3CGPS 3CGP1 C3F2S5 2.0220 11 to 13 3,879.25$ 14.13$ 3,893.38$ 3 3CGPT 3CGP2 C3F2S5 2.0220 11 to 13 3,879.25$ 51.04$ 3,930.29$ 3 3CGPU 3CGP3 C3F2S5 2.0220 11 to 13 3,879.25$ 139.94$ 4,019.19$ 3 3CGPV 3CGP4 C3F2S5 2.0220 11 to 13 3,879.25$ 207.91$ 4,087.16$ 3 3CGPW 3CGP5 C3F2S5 2.0220 11 to 13 3,879.25$ 320.62$ 4,199.87$ 3 3CGPX 3CGP6 C3F2S5 2.0220 11 to 13 3,879.25$ 551.43$ 4,430.68$ 3 3CHKS 3CHK1 C3F3S1 1.2007 0 to 5 2,303.57$ 14.13$ 2,317.70$ 3 3CHKT 3CHK2 C3F3S1 1.2007 0 to 5 2,303.57$ 51.04$ 2,354.61$ 3 3CHKU 3CHK3 C3F3S1 1.2007 0 to 5 2,303.57$ 139.94$ 2,443.51$ 3 3CHKV 3CHK4 C3F3S1 1.2007 0 to 5 2,303.57$ 207.91$ 2,511.48$ 3 3CHKW 3CHK5 C3F3S1 1.2007 0 to 5 2,303.57$ 320.62$ 2,624.19$ 3 3CHKX 3CHK6 C3F3S1 1.2007 0 to 5 2,303.57$ 551.43$ 2,855.00$ 3 3CHLS 3CHL1 C3F3S2 1.5506 6 2,974.86$ 14.13$ 2,988.99$ 3 3CHLT 3CHL2 C3F3S2 1.5506 6 2,974.86$ 51.04$ 3,025.90$ 3 3CHLU 3CHL3 C3F3S2 1.5506 6 2,974.86$ 139.94$ 3,114.80$ 3 3CHLV 3CHL4 C3F3S2 1.5506 6 2,974.86$ 207.91$ 3,182.77$ 3 3CHLW 3CHL5 C3F3S2 1.5506 6 2,974.86$ 320.62$ 3,295.48$ 3 3CHLX 3CHL6 C3F3S2 1.5506 6 2,974.86$ 551.43$ 3,526.29$ 3 3CHMS 3CHM1 C3F3S3 1.7530 7 to 9 3,363.16$ 14.13$ 3,377.29$ 3 3CHMT 3CHM2 C3F3S3 1.7530 7 to 9 3,363.16$ 51.04$ 3,414.20$ 3 3CHMU 3CHM3 C3F3S3 1.7530 7 to 9 3,363.16$ 139.94$ 3,503.10$ 3 3CHMV 3CHM4 C3F3S3 1.7530 7 to 9 3,363.16$ 207.91$ 3,571.07$ 3 3CHMW 3CHM5 C3F3S3 1.7530 7 to 9 3,363.16$ 320.62$ 3,683.78$ 3 3CHMX 3CHM6 C3F3S3 1.7530 7 to 9 3,363.16$ 551.43$ 3,914.59$ 3 3CHNS 3CHN1 C3F3S4 1.9742 10 3,787.54$ 14.13$ 3,801.67$ 3 3CHNT 3CHN2 C3F3S4 1.9742 10 3,787.54$ 51.04$ 3,838.58$ 3 3CHNU 3CHN3 C3F3S4 1.9742 10 3,787.54$ 139.94$ 3,927.48$ 3 3CHNV 3CHN4 C3F3S4 1.9742 10 3,787.54$ 207.91$ 3,995.45$

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3 3CHNW 3CHN5 C3F3S4 1.9742 10 3,787.54$ 320.62$ 4,108.16$ 3 3CHNX 3CHN6 C3F3S4 1.9742 10 3,787.54$ 551.43$ 4,338.97$ 3 3CHPS 3CHP1 C3F3S5 2.1489 11 to 13 4,122.71$ 14.13$ 4,136.84$ 3 3CHPT 3CHP2 C3F3S5 2.1489 11 to 13 4,122.71$ 51.04$ 4,173.75$ 3 3CHPU 3CHP3 C3F3S5 2.1489 11 to 13 4,122.71$ 139.94$ 4,262.65$ 3 3CHPV 3CHP4 C3F3S5 2.1489 11 to 13 4,122.71$ 207.91$ 4,330.62$ 3 3CHPW 3CHP5 C3F3S5 2.1489 11 to 13 4,122.71$ 320.62$ 4,443.33$ 3 3CHPX 3CHP6 C3F3S5 2.1489 11 to 13 4,122.71$ 551.43$ 4,674.14$

Late (3rd+) Episodes With 14 to 19 Therapy Visits4 4AFKS 4AFK1 C1F1S1 1.7530 14 to 15 3,363.16$ 14.13$ 3,377.29$ 4 4AFKT 4AFK2 C1F1S1 1.7530 14 to 15 3,363.16$ 51.04$ 3,414.20$ 4 4AFKU 4AFK3 C1F1S1 1.7530 14 to 15 3,363.16$ 139.94$ 3,503.10$ 4 4AFKV 4AFK4 C1F1S1 1.7530 14 to 15 3,363.16$ 207.91$ 3,571.07$ 4 4AFKW 4AFK5 C1F1S1 1.7530 14 to 15 3,363.16$ 320.62$ 3,683.78$ 4 4AFKX 4AFK6 C1F1S1 1.7530 14 to 15 3,363.16$ 551.43$ 3,914.59$ 4 4AFLS 4AFL1 C1F1S2 1.8689 16 to 17 3,585.52$ 14.13$ 3,599.65$ 4 4AFLT 4AFL2 C1F1S2 1.8689 16 to 17 3,585.52$ 51.04$ 3,636.56$ 4 4AFLU 4AFL3 C1F1S2 1.8689 16 to 17 3,585.52$ 139.94$ 3,725.46$ 4 4AFLV 4AFL4 C1F1S2 1.8689 16 to 17 3,585.52$ 207.91$ 3,793.43$ 4 4AFLW 4AFL5 C1F1S2 1.8689 16 to 17 3,585.52$ 320.62$ 3,906.14$ 4 4AFLX 4AFL6 C1F1S2 1.8689 16 to 17 3,585.52$ 551.43$ 4,136.95$ 4 4AFMS 4AFM1 C1F1S3 2.0252 18 to 19 3,885.39$ 14.13$ 3,899.52$ 4 4AFMT 4AFM2 C1F1S3 2.0252 18 to 19 3,885.39$ 51.04$ 3,936.43$ 4 4AFMU 4AFM3 C1F1S3 2.0252 18 to 19 3,885.39$ 139.94$ 4,025.33$ 4 4AFMV 4AFM4 C1F1S3 2.0252 18 to 19 3,885.39$ 207.91$ 4,093.30$ 4 4AFMW 4AFM5 C1F1S3 2.0252 18 to 19 3,885.39$ 320.62$ 4,206.01$ 4 4AFMX 4AFM6 C1F1S3 2.0252 18 to 19 3,885.39$ 551.43$ 4,436.82$

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4 4AGKS 4AGK1 C1F2S1 1.8839 14 to 15 3,614.30$ 14.13$ 3,628.43$ 4 4AGKT 4AGK2 C1F2S1 1.8839 14 to 15 3,614.30$ 51.04$ 3,665.34$ 4 4AGKU 4AGK3 C1F2S1 1.8839 14 to 15 3,614.30$ 139.94$ 3,754.24$ 4 4AGKV 4AGK4 C1F2S1 1.8839 14 to 15 3,614.30$ 207.91$ 3,822.21$ 4 4AGKW 4AGK5 C1F2S1 1.8839 14 to 15 3,614.30$ 320.62$ 3,934.92$ 4 4AGKX 4AGK6 C1F2S1 1.8839 14 to 15 3,614.30$ 551.43$ 4,165.73$ 4 4AGLS 4AGL1 C1F2S2 1.9998 16 to 17 3,836.66$ 14.13$ 3,850.79$ 4 4AGLT 4AGL2 C1F2S2 1.9998 16 to 17 3,836.66$ 51.04$ 3,887.70$ 4 4AGLU 4AGL3 C1F2S2 1.9998 16 to 17 3,836.66$ 139.94$ 3,976.60$ 4 4AGLV 4AGL4 C1F2S2 1.9998 16 to 17 3,836.66$ 207.91$ 4,044.57$ 4 4AGLW 4AGL5 C1F2S2 1.9998 16 to 17 3,836.66$ 320.62$ 4,157.28$ 4 4AGLX 4AGL6 C1F2S2 1.9998 16 to 17 3,836.66$ 551.43$ 4,388.09$ 4 4AGMS 4AGM1 C1F2S3 2.1560 18 to 19 4,136.33$ 14.13$ 4,150.46$ 4 4AGMT 4AGM2 C1F2S3 2.1560 18 to 19 4,136.33$ 51.04$ 4,187.37$ 4 4AGMU 4AGM3 C1F2S3 2.1560 18 to 19 4,136.33$ 139.94$ 4,276.27$ 4 4AGMV 4AGM4 C1F2S3 2.1560 18 to 19 4,136.33$ 207.91$ 4,344.24$ 4 4AGMW 4AGM5 C1F2S3 2.1560 18 to 19 4,136.33$ 320.62$ 4,456.95$ 4 4AGMX 4AGM6 C1F2S3 2.1560 18 to 19 4,136.33$ 551.43$ 4,687.76$ 4 4AHKS 4AHK1 C1F3S1 2.0531 14 to 15 3,938.91$ 14.13$ 3,953.04$ 4 4AHKT 4AHK2 C1F3S1 2.0531 14 to 15 3,938.91$ 51.04$ 3,989.95$ 4 4AHKU 4AHK3 C1F3S1 2.0531 14 to 15 3,938.91$ 139.94$ 4,078.85$ 4 4AHKV 4AHK4 C1F3S1 2.0531 14 to 15 3,938.91$ 207.91$ 4,146.82$ 4 4AHKW 4AHK5 C1F3S1 2.0531 14 to 15 3,938.91$ 320.62$ 4,259.53$ 4 4AHKX 4AHK6 C1F3S1 2.0531 14 to 15 3,938.91$ 551.43$ 4,490.34$ 4 4AHLS 4AHL1 C1F3S2 2.1690 16 to 17 4,161.27$ 14.13$ 4,175.40$ 4 4AHLT 4AHL2 C1F3S2 2.1690 16 to 17 4,161.27$ 51.04$ 4,212.31$ 4 4AHLU 4AHL3 C1F3S2 2.1690 16 to 17 4,161.27$ 139.94$ 4,301.21$ 4 4AHLV 4AHL4 C1F3S2 2.1690 16 to 17 4,161.27$ 207.91$ 4,369.18$

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4 4AHLW 4AHL5 C1F3S2 2.1690 16 to 17 4,161.27$ 320.62$ 4,481.89$ 4 4AHLX 4AHL6 C1F3S2 2.1690 16 to 17 4,161.27$ 551.43$ 4,712.70$ 4 4AHMS 4AHM1 C1F3S3 2.3252 18 to 19 4,460.94$ 14.13$ 4,475.07$ 4 4AHMT 4AHM2 C1F3S3 2.3252 18 to 19 4,460.94$ 51.04$ 4,511.98$ 4 4AHMU 4AHM3 C1F3S3 2.3252 18 to 19 4,460.94$ 139.94$ 4,600.88$ 4 4AHMV 4AHM4 C1F3S3 2.3252 18 to 19 4,460.94$ 207.91$ 4,668.85$ 4 4AHMW 4AHM5 C1F3S3 2.3252 18 to 19 4,460.94$ 320.62$ 4,781.56$ 4 4AHMX 4AHM6 C1F3S3 2.3252 18 to 19 4,460.94$ 551.43$ 5,012.37$ 4 4BFKS 4BFK1 C2F1S1 2.0276 14 to 15 3,889.99$ 14.13$ 3,904.12$ 4 4BFKT 4BFK2 C2F1S1 2.0276 14 to 15 3,889.99$ 51.04$ 3,941.03$ 4 4BFKU 4BFK3 C2F1S1 2.0276 14 to 15 3,889.99$ 139.94$ 4,029.93$ 4 4BFKV 4BFK4 C2F1S1 2.0276 14 to 15 3,889.99$ 207.91$ 4,097.90$ 4 4BFKW 4BFK5 C2F1S1 2.0276 14 to 15 3,889.99$ 320.62$ 4,210.61$ 4 4BFKX 4BFK6 C2F1S1 2.0276 14 to 15 3,889.99$ 551.43$ 4,441.42$ 4 4BFLS 4BFL1 C2F1S2 2.1435 16 to 17 4,112.35$ 14.13$ 4,126.48$ 4 4BFLT 4BFL2 C2F1S2 2.1435 16 to 17 4,112.35$ 51.04$ 4,163.39$ 4 4BFLU 4BFL3 C2F1S2 2.1435 16 to 17 4,112.35$ 139.94$ 4,252.29$ 4 4BFLV 4BFL4 C2F1S2 2.1435 16 to 17 4,112.35$ 207.91$ 4,320.26$ 4 4BFLW 4BFL5 C2F1S2 2.1435 16 to 17 4,112.35$ 320.62$ 4,432.97$ 4 4BFLX 4BFL6 C2F1S2 2.1435 16 to 17 4,112.35$ 551.43$ 4,663.78$ 4 4BFMS 4BFM1 C2F1S3 2.2998 18 to 19 4,412.21$ 14.13$ 4,426.34$ 4 4BFMT 4BFM2 C2F1S3 2.2998 18 to 19 4,412.21$ 51.04$ 4,463.25$ 4 4BFMU 4BFM3 C2F1S3 2.2998 18 to 19 4,412.21$ 139.94$ 4,552.15$ 4 4BFMV 4BFM4 C2F1S3 2.2998 18 to 19 4,412.21$ 207.91$ 4,620.12$ 4 4BFMW 4BFM5 C2F1S3 2.2998 18 to 19 4,412.21$ 320.62$ 4,732.83$ 4 4BFMX 4BFM6 C2F1S3 2.2998 18 to 19 4,412.21$ 551.43$ 4,963.64$ 4 4BGKS 4BGK1 C2F2S1 2.1585 14 to 15 4,141.12$ 14.13$ 4,155.25$ 4 4BGKT 4BGK2 C2F2S1 2.1585 14 to 15 4,141.12$ 51.04$ 4,192.16$

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4 4BGKU 4BGK3 C2F2S1 2.1585 14 to 15 4,141.12$ 139.94$ 4,281.06$ 4 4BGKV 4BGK4 C2F2S1 2.1585 14 to 15 4,141.12$ 207.91$ 4,349.03$ 4 4BGKW 4BGK5 C2F2S1 2.1585 14 to 15 4,141.12$ 320.62$ 4,461.74$ 4 4BGKX 4BGK6 C2F2S1 2.1585 14 to 15 4,141.12$ 551.43$ 4,692.55$ 4 4BGLS 4BGL1 C2F2S2 2.2744 16 to 17 4,363.48$ 14.13$ 4,377.61$ 4 4BGLT 4BGL2 C2F2S2 2.2744 16 to 17 4,363.48$ 51.04$ 4,414.52$ 4 4BGLU 4BGL3 C2F2S2 2.2744 16 to 17 4,363.48$ 139.94$ 4,503.42$ 4 4BGLV 4BGL4 C2F2S2 2.2744 16 to 17 4,363.48$ 207.91$ 4,571.39$ 4 4BGLW 4BGL5 C2F2S2 2.2744 16 to 17 4,363.48$ 320.62$ 4,684.10$ 4 4BGLX 4BGL6 C2F2S2 2.2744 16 to 17 4,363.48$ 551.43$ 4,914.91$ 4 4BGMS 4BGM1 C2F2S3 2.4306 18 to 19 4,663.15$ 14.13$ 4,677.28$ 4 4BGMT 4BGM2 C2F2S3 2.4306 18 to 19 4,663.15$ 51.04$ 4,714.19$ 4 4BGMU 4BGM3 C2F2S3 2.4306 18 to 19 4,663.15$ 139.94$ 4,803.09$ 4 4BGMV 4BGM4 C2F2S3 2.4306 18 to 19 4,663.15$ 207.91$ 4,871.06$ 4 4BGMW 4BGM5 C2F2S3 2.4306 18 to 19 4,663.15$ 320.62$ 4,983.77$ 4 4BGMX 4BGM6 C2F2S3 2.4306 18 to 19 4,663.15$ 551.43$ 5,214.58$ 4 4BHKS 4BHK1 C2F3S1 2.3277 14 to 15 4,465.74$ 14.13$ 4,479.87$ 4 4BHKT 4BHK2 C2F3S1 2.3277 14 to 15 4,465.74$ 51.04$ 4,516.78$ 4 4BHKU 4BHK3 C2F3S1 2.3277 14 to 15 4,465.74$ 139.94$ 4,605.68$ 4 4BHKV 4BHK4 C2F3S1 2.3277 14 to 15 4,465.74$ 207.91$ 4,673.65$ 4 4BHKW 4BHK5 C2F3S1 2.3277 14 to 15 4,465.74$ 320.62$ 4,786.36$ 4 4BHKX 4BHK6 C2F3S1 2.3277 14 to 15 4,465.74$ 551.43$ 5,017.17$ 4 4BHLS 4BHL1 C2F3S2 2.4436 16 to 17 4,688.09$ 14.13$ 4,702.22$ 4 4BHLT 4BHL2 C2F3S2 2.4436 16 to 17 4,688.09$ 51.04$ 4,739.13$ 4 4BHLU 4BHL3 C2F3S2 2.4436 16 to 17 4,688.09$ 139.94$ 4,828.03$ 4 4BHLV 4BHL4 C2F3S2 2.4436 16 to 17 4,688.09$ 207.91$ 4,896.00$ 4 4BHLW 4BHL5 C2F3S2 2.4436 16 to 17 4,688.09$ 320.62$ 5,008.71$ 4 4BHLX 4BHL6 C2F3S2 2.4436 16 to 17 4,688.09$ 551.43$ 5,239.52$

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4 4BHMS 4BHM1 C2F3S3 2.5998 18 to 19 4,987.77$ 14.13$ 5,001.90$ 4 4BHMT 4BHM2 C2F3S3 2.5998 18 to 19 4,987.77$ 51.04$ 5,038.81$ 4 4BHMU 4BHM3 C2F3S3 2.5998 18 to 19 4,987.77$ 139.94$ 5,127.71$ 4 4BHMV 4BHM4 C2F3S3 2.5998 18 to 19 4,987.77$ 207.91$ 5,195.68$ 4 4BHMW 4BHM5 C2F3S3 2.5998 18 to 19 4,987.77$ 320.62$ 5,308.39$ 4 4BHMX 4BHM6 C2F3S3 2.5998 18 to 19 4,987.77$ 551.43$ 5,539.20$ 4 4CFKS 4CFK1 C3F1S1 2.3479 14 to 15 4,504.49$ 14.13$ 4,518.62$ 4 4CFKT 4CFK2 C3F1S1 2.3479 14 to 15 4,504.49$ 51.04$ 4,555.53$ 4 4CFKU 4CFK3 C3F1S1 2.3479 14 to 15 4,504.49$ 139.94$ 4,644.43$ 4 4CFKV 4CFK4 C3F1S1 2.3479 14 to 15 4,504.49$ 207.91$ 4,712.40$ 4 4CFKW 4CFK5 C3F1S1 2.3479 14 to 15 4,504.49$ 320.62$ 4,825.11$ 4 4CFKX 4CFK6 C3F1S1 2.3479 14 to 15 4,504.49$ 551.43$ 5,055.92$ 4 4CFLS 4CFL1 C3F1S2 2.4637 16 to 17 4,726.66$ 14.13$ 4,740.79$ 4 4CFLT 4CFL2 C3F1S2 2.4637 16 to 17 4,726.66$ 51.04$ 4,777.70$ 4 4CFLU 4CFL3 C3F1S2 2.4637 16 to 17 4,726.66$ 139.94$ 4,866.60$ 4 4CFLV 4CFL4 C3F1S2 2.4637 16 to 17 4,726.66$ 207.91$ 4,934.57$ 4 4CFLW 4CFL5 C3F1S2 2.4637 16 to 17 4,726.66$ 320.62$ 5,047.28$ 4 4CFLX 4CFL6 C3F1S2 2.4637 16 to 17 4,726.66$ 551.43$ 5,278.09$ 4 4CFMS 4CFM1 C3F1S3 2.6200 18 to 19 5,026.52$ 14.13$ 5,040.65$ 4 4CFMT 4CFM2 C3F1S3 2.6200 18 to 19 5,026.52$ 51.04$ 5,077.56$ 4 4CFMU 4CFM3 C3F1S3 2.6200 18 to 19 5,026.52$ 139.94$ 5,166.46$ 4 4CFMV 4CFM4 C3F1S3 2.6200 18 to 19 5,026.52$ 207.91$ 5,234.43$ 4 4CFMW 4CFM5 C3F1S3 2.6200 18 to 19 5,026.52$ 320.62$ 5,347.14$ 4 4CFMX 4CFM6 C3F1S3 2.6200 18 to 19 5,026.52$ 551.43$ 5,577.95$ 4 4CGKS 4CGK1 C3F2S1 2.4787 14 to 15 4,755.43$ 14.13$ 4,769.56$ 4 4CGKT 4CGK2 C3F2S1 2.4787 14 to 15 4,755.43$ 51.04$ 4,806.47$ 4 4CGKU 4CGK3 C3F2S1 2.4787 14 to 15 4,755.43$ 139.94$ 4,895.37$ 4 4CGKV 4CGK4 C3F2S1 2.4787 14 to 15 4,755.43$ 207.91$ 4,963.34$

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4 4CGKW 4CGK5 C3F2S1 2.4787 14 to 15 4,755.43$ 320.62$ 5,076.05$ 4 4CGKX 4CGK6 C3F2S1 2.4787 14 to 15 4,755.43$ 551.43$ 5,306.86$ 4 4CGLS 4CGL1 C3F2S2 2.5946 16 to 17 4,977.79$ 14.13$ 4,991.92$ 4 4CGLT 4CGL2 C3F2S2 2.5946 16 to 17 4,977.79$ 51.04$ 5,028.83$ 4 4CGLU 4CGL3 C3F2S2 2.5946 16 to 17 4,977.79$ 139.94$ 5,117.73$ 4 4CGLV 4CGL4 C3F2S2 2.5946 16 to 17 4,977.79$ 207.91$ 5,185.70$ 4 4CGLW 4CGL5 C3F2S2 2.5946 16 to 17 4,977.79$ 320.62$ 5,298.41$ 4 4CGLX 4CGL6 C3F2S2 2.5946 16 to 17 4,977.79$ 551.43$ 5,529.22$ 4 4CGMS 4CGM1 C3F2S3 2.7509 18 to 19 5,277.66$ 14.13$ 5,291.79$ 4 4CGMT 4CGM2 C3F2S3 2.7509 18 to 19 5,277.66$ 51.04$ 5,328.70$ 4 4CGMU 4CGM3 C3F2S3 2.7509 18 to 19 5,277.66$ 139.94$ 5,417.60$ 4 4CGMV 4CGM4 C3F2S3 2.7509 18 to 19 5,277.66$ 207.91$ 5,485.57$ 4 4CGMW 4CGM5 C3F2S3 2.7509 18 to 19 5,277.66$ 320.62$ 5,598.28$ 4 4CGMX 4CGM6 C3F2S3 2.7509 18 to 19 5,277.66$ 551.43$ 5,829.09$ 4 4CHKS 4CHK1 C3F3S1 2.6479 14 to 15 5,080.05$ 14.13$ 5,094.18$ 4 4CHKT 4CHK2 C3F3S1 2.6479 14 to 15 5,080.05$ 51.04$ 5,131.09$ 4 4CHKU 4CHK3 C3F3S1 2.6479 14 to 15 5,080.05$ 139.94$ 5,219.99$ 4 4CHKV 4CHK4 C3F3S1 2.6479 14 to 15 5,080.05$ 207.91$ 5,287.96$ 4 4CHKW 4CHK5 C3F3S1 2.6479 14 to 15 5,080.05$ 320.62$ 5,400.67$ 4 4CHKX 4CHK6 C3F3S1 2.6479 14 to 15 5,080.05$ 551.43$ 5,631.48$ 4 4CHLS 4CHL1 C3F3S2 2.7638 16 to 17 5,302.40$ 14.13$ 5,316.53$ 4 4CHLT 4CHL2 C3F3S2 2.7638 16 to 17 5,302.40$ 51.04$ 5,353.44$ 4 4CHLU 4CHL3 C3F3S2 2.7638 16 to 17 5,302.40$ 139.94$ 5,442.34$ 4 4CHLV 4CHL4 C3F3S2 2.7638 16 to 17 5,302.40$ 207.91$ 5,510.31$ 4 4CHLW 4CHL5 C3F3S2 2.7638 16 to 17 5,302.40$ 320.62$ 5,623.02$ 4 4CHLX 4CHL6 C3F3S2 2.7638 16 to 17 5,302.40$ 551.43$ 5,853.83$ 4 4CHMS 4CHM1 C3F3S3 2.9201 18 to 19 5,602.27$ 14.13$ 5,616.40$ 4 4CHMT 4CHM2 C3F3S3 2.9201 18 to 19 5,602.27$ 51.04$ 5,653.31$

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4 4CHMU 4CHM3 C3F3S3 2.9201 18 to 19 5,602.27$ 139.94$ 5,742.21$ 4 4CHMV 4CHM4 C3F3S3 2.9201 18 to 19 5,602.27$ 207.91$ 5,810.18$ 4 4CHMW 4CHM5 C3F3S3 2.9201 18 to 19 5,602.27$ 320.62$ 5,922.89$ 4 4CHMX 4CHM6 C3F3S3 2.9201 18 to 19 5,602.27$ 551.43$ 6,153.70$

All Episodes With 20 or More Therapy Visits5 5AFKS 5AFK1 C1F1S1 2.5495 20+ 4,891.27$ 14.13$ 4,905.40$ 5 5AFKT 5AFK2 C1F1S1 2.5495 20+ 4,891.27$ 51.04$ 4,942.31$ 5 5AFKU 5AFK3 C1F1S1 2.5495 20+ 4,891.27$ 139.94$ 5,031.21$ 5 5AFKV 5AFK4 C1F1S1 2.5495 20+ 4,891.27$ 207.91$ 5,099.18$ 5 5AFKW 5AFK5 C1F1S1 2.5495 20+ 4,891.27$ 320.62$ 5,211.89$ 5 5AFKX 5AFK6 C1F1S1 2.5495 20+ 4,891.27$ 551.43$ 5,442.70$ 5 5AGKS 5AGK1 C1F2S1 2.7390 20+ 5,254.82$ 14.13$ 5,268.95$ 5 5AGKT 5AGK2 C1F2S1 2.7390 20+ 5,254.82$ 51.04$ 5,305.86$ 5 5AGKU 5AGK3 C1F2S1 2.7390 20+ 5,254.82$ 139.94$ 5,394.76$ 5 5AGKV 5AGK4 C1F2S1 2.7390 20+ 5,254.82$ 207.91$ 5,462.73$ 5 5AGKW 5AGK5 C1F2S1 2.7390 20+ 5,254.82$ 320.62$ 5,575.44$ 5 5AGKX 5AGK6 C1F2S1 2.7390 20+ 5,254.82$ 551.43$ 5,806.25$ 5 5AHKS 5AHK1 C1F3S1 2.9532 20+ 5,665.77$ 14.13$ 5,679.90$ 5 5AHKT 5AHK2 C1F3S1 2.9532 20+ 5,665.77$ 51.04$ 5,716.81$ 5 5AHKU 5AHK3 C1F3S1 2.9532 20+ 5,665.77$ 139.94$ 5,805.71$ 5 5AHKV 5AHK4 C1F3S1 2.9532 20+ 5,665.77$ 207.91$ 5,873.68$ 5 5AHKW 5AHK5 C1F3S1 2.9532 20+ 5,665.77$ 320.62$ 5,986.39$ 5 5AHKX 5AHK6 C1F3S1 2.9532 20+ 5,665.77$ 551.43$ 6,217.20$ 5 5BFKS 5BFK1 C2F1S1 2.7632 20+ 5,301.25$ 14.13$ 5,315.38$ 5 5BFKT 5BFK2 C2F1S1 2.7632 20+ 5,301.25$ 51.04$ 5,352.29$ 5 5BFKU 5BFK3 C2F1S1 2.7632 20+ 5,301.25$ 139.94$ 5,441.19$ 5 5BFKV 5BFK4 C2F1S1 2.7632 20+ 5,301.25$ 207.91$ 5,509.16$ 5 5BFKW 5BFK5 C2F1S1 2.7632 20+ 5,301.25$ 320.62$ 5,621.87$

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5 5BFKX 5BFK6 C2F1S1 2.7632 20+ 5,301.25$ 551.43$ 5,852.68$ 5 5BGKS 5BGK1 C2F2S1 2.9527 20+ 5,664.81$ 14.13$ 5,678.94$ 5 5BGKT 5BGK2 C2F2S1 2.9527 20+ 5,664.81$ 51.04$ 5,715.85$ 5 5BGKU 5BGK3 C2F2S1 2.9527 20+ 5,664.81$ 139.94$ 5,804.75$ 5 5BGKV 5BGK4 C2F2S1 2.9527 20+ 5,664.81$ 207.91$ 5,872.72$ 5 5BGKW 5BGK5 C2F2S1 2.9527 20+ 5,664.81$ 320.62$ 5,985.43$ 5 5BGKX 5BGK6 C2F2S1 2.9527 20+ 5,664.81$ 551.43$ 6,216.24$ 5 5BHKS 5BHK1 C2F3S1 3.1669 20+ 6,075.76$ 14.13$ 6,089.89$ 5 5BHKT 5BHK2 C2F3S1 3.1669 20+ 6,075.76$ 51.04$ 6,126.80$ 5 5BHKU 5BHK3 C2F3S1 3.1669 20+ 6,075.76$ 139.94$ 6,215.70$ 5 5BHKV 5BHK4 C2F3S1 3.1669 20+ 6,075.76$ 207.91$ 6,283.67$ 5 5BHKW 5BHK5 C2F3S1 3.1669 20+ 6,075.76$ 320.62$ 6,396.38$ 5 5BHKX 5BHK6 C2F3S1 3.1669 20+ 6,075.76$ 551.43$ 6,627.19$ 5 5CFKS 5CFK1 C3F1S1 3.0835 20+ 5,915.75$ 14.13$ 5,929.88$ 5 5CFKT 5CFK2 C3F1S1 3.0835 20+ 5,915.75$ 51.04$ 5,966.79$ 5 5CFKU 5CFK3 C3F1S1 3.0835 20+ 5,915.75$ 139.94$ 6,055.69$ 5 5CFKV 5CFK4 C3F1S1 3.0835 20+ 5,915.75$ 207.91$ 6,123.66$ 5 5CFKW 5CFK5 C3F1S1 3.0835 20+ 5,915.75$ 320.62$ 6,236.37$ 5 5CFKX 5CFK6 C3F1S1 3.0835 20+ 5,915.75$ 551.43$ 6,467.18$ 5 5CGKS 5CGK1 C3F2S1 3.2730 20+ 6,279.31$ 14.13$ 6,293.44$ 5 5CGKT 5CGK2 C3F2S1 3.2730 20+ 6,279.31$ 51.04$ 6,330.35$ 5 5CGKU 5CGK3 C3F2S1 3.2730 20+ 6,279.31$ 139.94$ 6,419.25$ 5 5CGKV 5CGK4 C3F2S1 3.2730 20+ 6,279.31$ 207.91$ 6,487.22$ 5 5CGKW 5CGK5 C3F2S1 3.2730 20+ 6,279.31$ 320.62$ 6,599.93$ 5 5CGKX 5CGK6 C3F2S1 3.2730 20+ 6,279.31$ 551.43$ 6,830.74$ 5 5CHKS 5CHK1 C3F3S1 3.4872 20+ 6,690.26$ 14.13$ 6,704.39$ 5 5CHKT 5CHK2 C3F3S1 3.4872 20+ 6,690.26$ 51.04$ 6,741.30$ 5 5CHKU 5CHK3 C3F3S1 3.4872 20+ 6,690.26$ 139.94$ 6,830.20$

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5 5CHKV 5CHK4 C3F3S1 3.4872 20+ 6,690.26$ 207.91$ 6,898.17$ 5 5CHKW 5CHK5 C3F3S1 3.4872 20+ 6,690.26$ 320.62$ 7,010.88$ 5 5CHKX 5CHK6 C3F3S1 3.4872 20+ 6,690.26$ 551.43$ 7,241.69$

LUPA Payment RatesSkilled nursing per-visit rate 91.16$ Physical therapy per-visit rate 99.68$ Occupational therapy per-visit rate 100.35$ Speech therapy per-visit rate 108.31$ Medical social worker per-visit rate 146.13$ Home health aide per-visit rate 41.29$

LUPA add-on payment 76.41$

All rates are effective for episodes beginning January 1, 2009, and are based on the Federal Register dated November 3, 2008.

BKD Health Care Group is a division of BKD, LLP, a top 10 accounting and consulting firm, that provides a full range of services specifically for home health and hospice agencies throughout the nation. Contact Aaron Little at 417.865.8701 or [email protected] with questions regarding this information. Or, browse our website to learn more about how you can...

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medicare home health pps payment ratesmedicare home health pps payment rates effective for episodes...

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