Medicare Home Health PPS Payment RatesMedicare Home Health PPS Payment Rates Effective for Episodes...

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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$

11/20/08 10 of 34

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$

11/20/08 15 of 34

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$

11/20/08 16 of 34

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$

11/20/08 19 of 34

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 mlittle@bkd.com 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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