36C24522Q0044 Pricing Quotation Form.xlsx

XLSX spreadsheet 32 KB Posted Mar 11, 2022

Attached to: Q402--Open Solicitation for Nursing Home Services in Huntington Catchment Area Now Closed (7/15/2022)
Solicitation number: 36C24522Q0044
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 5

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S02 36C24522Q0044 0001.pdf	PDF	Jul 15, 2022
S02 36C24522Q0044.pdf	PDF	Mar 11, 2022

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Pricing Quotation Form

		Select Your Locality (County/State):	Boone, WV
		Enter Your Quoted Discount Rate:
	LINE ITEM	RUGS IV CATEGORY DESCRIPTION	Medicare Base Rate	Discount
Percentage	Line Item

Per Diem Rate

1	RUX – Extensive Services criteria + RU Criteria – ADL 16-18	778.43	0.0%	778.43
2	RUL – Extensive Services criteria + RU Criteria – ADL 7-15	761.47	0.0%	761.47
3	RVX – Extensive Services criteria + RV Criteria – ADL 16-18	692.87	0.0%	692.87
4	RVL - Extensive Services criteria + RV Criteria – ADL 7-15	621.62	0.0%	621.62
5	RHX - Extensive Services criteria + Rehab High Criteria – ADL 13-18	627.74	0.0%	627.74
6	RHL- Extensive Services criteria + Rehab High Criteria – ADL 7-12	559.90	0.0%	559.90
7	RMX - Extensive Services criteria + RM Criteria – ADL 15-18	575.85	0.0%	575.85
8	RML - Extensive Services criteria + RM Criteria – ADL 7-15	528.34	0.0%	528.34
9	RLX - Extensive Services criteria + RL Criteria – ADL 7-18	505.72	0.0%	505.72
10	RUC – Special Rehab Ultra High – ADL 16-18	584.37	0.0%	584.37
11	RUB – Special Rehab Ultra High – ADL 9-15	584.37	0.0%	584.37
12	RUA – Special Rehab Ultra High – ADL 1-8	488.62	0.0%	488.62
13	RVC Special Rehab Very High – ADL 16-18	501.32	0.0%	501.32
14	RVB – Special Rehab Very High – ADL 9-15	434.13	0.0%	434.13
15	RVA – Special Rehab Very High – ADL 1-8	432.45	0.0%	432.45
16	RHC – Special Rehab High – ADL 13-18	436.84	0.0%	436.84
17	RHB – Special Rehab High – ADL 8-12	393.16	0.0%	393.16
18	RHA – Special Rehab High – ADL 1-7	346.13	0.0%	346.13
19	RMC – Special Rehab Medium – ADL 15-18	383.76	0.0%	383.76
20	RMB – Special Rehab Medium – ADL 8-14	360.25	0.0%	360.25
21	RMA – Special Rehab Medium – ADL 4-7	296.41	0.0%	296.41
22	RLB Special Rehab Low – ADL 14-18	373.11	0.0%	373.11
23	RLA – Special Rehab Low – ADL 1-13	240.41	0.0%	240.41
24	ES3 – Extensive Services – ADL 2-16	703.74	0.0%	703.74
25	ES2 – Extensive Services – ADL 2-16	550.87	0.0%	550.87
26	ES1 – Extensive Services – ADL 2-16	492.09	0.0%	492.09
27	HE2 – Special Care High – ADL 15-16	475.29	0.0%	475.29
28	HE1 – Special Care High – ADL 15-16	394.67	0.0%	394.67
29	HD2 – Special Care High – ADL 11-14	445.06	0.0%	445.06
30	HD1 – Special Care High – ADL 11-14	371.14	0.0%	371.14
31	HC2 – Special Care High – ADL 6-10	419.86	0.0%	419.86
32	HC1 – Special Care High – ADL 6-10	350.99	0.0%	350.99
33	HB2 – Special Care High – ADL 2-5	414.82	0.0%	414.82
34	HB1 – Special Care High – ADL 2-5	347.63	0.0%	347.63
35	LE2 – Special Care Low - ADL 15-16	431.61	0.0%	431.61
36	LE1 – Special Care Low – ADL 15-16	361.07	0.0%	361.07
37	LD2 – Special Care Low – ADL 11-14	414.82	0.0%	414.82
38	LD1 – Special Care Low – ADL 11-14	347.63	0.0%	347.63
39	LC2 – Special Care Low – ADL 6-10	364.43	0.0%	364.43
40	LC1 – Special Care Low – ADL 6-10	307.32	0.0%	307.32
41	LB2 – Special Care Low – ADL 2-5	345.95	0.0%	345.95
42	LB1 – Special Care Low – ADL 2-5	293.88	0.0%	293.88
43	CE2 – Clinically Complex – ADL 15-16	384.58	0.0%	384.58
44	CE1 – Clinically Complex – ADL 15-16	354.35	0.0%	354.35
45	CD2 – Clinically Complex – ADL 11-14	364.43	0.0%	364.43
46	CD1 – Clinically Complex – ADL 11-14	334.20	0.0%	334.20
47	CC2 – Clinically Complex – ADL 6-10	319.08	0.0%	319.08
48	CC1 – Clinically Complex – ADL 6-10	295.56	0.0%	295.56
49	CB2 – Clinically Complex – ADL 2-5	295.56	0.0%	295.56
50	CB1 – Clinically Complex – ADL 2-5	273.72	0.0%	273.72
51	CA2 – Clinically Complex – ADL 0-1	250.21	0.0%	250.21
52	CA1 – Clinically Complex – ADL 0-1	233.41	0.0%	233.41
53	BB2 – Behavior Symptoms – ADL 2-5	265.33	0.0%	265.33
54	BB1 – Behavior Symptoms – ADL 2-5	253.57	0.0%	253.57
55	BA2 – Behavior Symptoms – ADL 0-1	219.97	0.0%	219.97
56	BA1 – Behavior Symptoms – ADL 0-1	209.89	0.0%	209.89
57	PE2 – Physical Function Reduced – ADL 15-16	354.35	0.0%	354.35
58	PE1 – Physical Function Reduced – ADL 15-16	337.56	0.0%	337.56
59	PD2 – Physical Function Reduced – ADL 11-14	334.20	0.0%	334.20
60	PD1 – Physical Function Reduced – ADL 11-14	317.39	0.0%	317.39
61	PC2 – Physical Function Reduced – ADL 6-10	287.16	0.0%	287.16
62	PC1 – Physical Function Reduced – ADL 6-10	273.72	0.0%	273.72
63	PB2 – Physical Function Reduced – ADL 2-5	243.49	0.0%	243.49
64	PB1 – Physical Function Reduced – ADL 2-5	233.41	0.0%	233.41
65	PA2 – Physical Function Reduced – ADL 0-1	201.49	0.0%	201.49
66	PA1 – Physical Function Reduced – ADL 0-1	193.10	0.0%	193.10

Sheet2

LINE ITEM

RUGS IV CATEGORY DESCRIPTION

Boone, WV

Cabell, WV

Jackson, WV

(rural)

Jackson, WV

(urban)

Kanawha, WV

Lincoln, WV

Logan, WV

Mason, WV

Mingo, WV

Putman, WV

Wayne, WV

Boyd, KY

Carter, KY

(rural)

Carter, KY

(urban)

Elliott, KY

Floyd, KY

Greenup, KY

Johnson, KY

Knott, KY

Lawrence, KY

Lewis, KY

Magoffin, KY

Martin, KY

Pike, KY

Gallia, OH

Lawrence, OH

1	RUX – Extensive Services criteria + RU Criteria – ADL 16-18	778.43	795.35	730.60	778.43	778.43	778.43	730.60	730.60	730.60	795.35	795.35	795.35	780.95	795.35	780.95	780.95	795.35	780.95	780.95	780.95	780.95	780.95	780.95	780.95	788.90	795.35
2	RUL – Extensive Services criteria + RU Criteria – ADL 7-15	761.47	778.02	715.72	761.47	761.47	761.47	715.72	715.72	715.72	778.02	778.02	778.02	765.05	778.02	765.05	765.05	778.02	765.05	765.05	765.05	765.05	765.05	765.05	765.05	772.84	778.02
3	RVX – Extensive Services criteria + RV Criteria – ADL 16-18	692.87	707.94	641.93	692.87	692.87	692.87	641.93	641.93	641.93	707.94	707.94	707.94	686.17	707.94	686.17	686.17	707.94	686.17	686.17	686.17	686.17	686.17	686.17	686.17	693.16	707.94
4	RVL - Extensive Services criteria + RV Criteria – ADL 7-15	621.62	635.14	579.48	621.62	621.62	621.62	579.48	579.48	579.48	635.14	635.14	635.14	619.42	635.14	619.42	619.42	635.14	619.42	619.42	619.42	619.42	619.42	619.42	619.42	625.73	635.14
5	RHX - Extensive Services criteria + Rehab High Criteria – ADL 13-18	627.74	641.39	574.89	627.74	627.74	627.74	574.89	574.89	574.89	641.39	641.39	641.39	614.51	641.39	614.51	614.51	641.39	614.51	614.51	614.51	614.51	614.51	614.51	614.51	620.76	641.39
6	RHL- Extensive Services criteria + Rehab High Criteria – ADL 7-12	559.90	572.07	515.42	559.90	559.90	559.90	515.42	515.42	515.42	572.07	572.07	572.07	550.94	572.07	550.94	550.94	572.07	550.94	550.94	550.94	550.94	550.94	550.94	550.94	556.55	572.07
7	RMX - Extensive Services criteria + RM Criteria – ADL 15-18	575.85	588.37	522.44	575.85	575.85	575.85	522.44	522.44	522.44	588.37	588.37	588.37	558.44	588.37	558.44	558.44	588.37	558.44	558.44	558.44	558.44	558.44	558.44	558.44	564.13	588.37
8	RML - Extensive Services criteria + RM Criteria – ADL 7-15	528.34	539.83	480.81	528.34	528.34	528.34	480.81	480.81	480.81	539.83	539.83	539.83	513.94	539.83	513.94	513.94	539.83	513.94	513.94	513.94	513.94	513.94	513.94	513.94	519.18	539.83
9	RLX - Extensive Services criteria + RL Criteria – ADL 7-18	505.72	516.71	454.73	505.72	505.72	505.72	454.73	454.73	454.73	516.71	516.71	516.71	486.07	516.71	486.07	486.07	516.71	486.07	486.07	486.07	486.07	486.07	486.07	486.07	491.02	516.71
10	RUC – Special Rehab Ultra High – ADL 16-18	584.37	597.07	560.04	584.37	584.37	584.37	560.04	560.04	560.04	597.07	597.07	597.07	598.63	597.07	598.63	598.63	597.07	598.63	598.63	598.63	598.63	598.63	598.63	598.63	604.73	597.07
11	RUB – Special Rehab Ultra High – ADL 9-15	584.37	597.07	560.04	584.37	584.37	584.37	560.04	560.04	560.04	597.07	597.07	597.07	598.63	597.07	598.63	598.63	597.07	598.63	598.63	598.63	598.63	598.63	598.63	598.63	604.73	597.07
12	RUA – Special Rehab Ultra High – ADL 1-8	488.62	499.25	475.41	488.62	488.62	488.62	475.41	475.41	475.41	499.25	499.25	499.25	508.17	499.25	508.17	508.17	499.25	508.17	508.17	508.17	508.17	508.17	508.17	508.17	513.35	499.25
13	RVC Special Rehab Very High – ADL 16-18	501.32	512.22	473.71	501.32	501.32	501.32	473.71	473.71	473.71	512.22	512.22	512.22	506.36	512.22	506.36	506.36	512.22	506.36	506.36	506.36	506.36	506.36	506.36	506.36	511.51	512.22
14	RVB – Special Rehab Very High – ADL 9-15	434.13	443.57	414.83	434.13	434.13	434.13	414.83	414.83	414.83	443.57	443.57	443.57	443.42	443.57	443.42	443.42	443.57	443.42	443.42	443.42	443.42	443.42	443.42	443.42	447.93	443.57
15	RVA – Special Rehab Very High – ADL 1-8	432.45	441.85	413.35	432.45	432.45	432.45	413.35	413.35	413.35	441.85	441.85	441.85	441.84	441.85	441.84	441.84	441.85	441.84	441.84	441.84	441.84	441.84	441.84	441.84	446.34	441.85
16	RHC – Special Rehab High – ADL 13-18	436.84	446.33	407.32	436.84	436.84	436.84	407.32	407.32	407.32	446.33	446.33	446.33	435.39	446.33	435.39	435.39	446.33	435.39	435.39	435.39	435.39	435.39	435.39	435.39	439.83	446.33
17	RHB – Special Rehab High – ADL 8-12	393.16	401.71	369.04	393.16	393.16	393.16	369.04	369.04	369.04	401.71	401.71	401.71	394.48	401.71	394.48	394.48	401.71	394.48	394.48	394.48	394.48	394.48	394.48	394.48	398.49	401.71
18	RHA – Special Rehab High – ADL 1-7	346.13	353.65	327.83	346.13	346.13	346.13	327.83	327.83	327.83	353.65	353.65	353.65	350.42	353.65	350.42	350.42	353.65	350.42	350.42	350.42	350.42	350.42	350.42	350.42	353.99	353.65
19	RMC – Special Rehab Medium – ADL 15-18	383.76	392.11	353.92	383.76	383.76	383.76	353.92	353.92	353.92	392.11	392.11	392.11	378.31	392.11	378.31	378.31	392.11	378.31	378.31	378.31	378.31	378.31	378.31	378.31	382.16	392.11
20	RMB – Special Rehab Medium – ADL 8-14	360.25	368.08	333.31	360.25	360.25	360.25	333.31	333.31	333.31	368.08	368.08	368.08	356.28	368.08	356.28	356.28	368.08	356.28	356.28	356.28	356.28	356.28	356.28	356.28	359.91	368.08
21	RMA – Special Rehab Medium – ADL 4-7	296.41	302.86	277.37	296.41	296.41	296.41	277.37	277.37	277.37	302.86	302.86	302.86	296.49	302.86	296.49	296.49	302.86	296.49	296.49	296.49	296.49	296.49	296.49	296.49	299.51	302.86
22	RLB Special Rehab Low – ADL 14-18	373.11	381.23	338.06	373.11	373.11	373.11	338.06	338.06	338.06	381.23	381.23	381.23	361.36	381.23	361.36	361.36	381.23	361.36	361.36	361.36	361.36	361.36	361.36	361.36	365.04	381.23
23	RLA – Special Rehab Low – ADL 1-13	240.41	245.64	222.09	240.41	240.41	240.41	222.09	222.09	222.09	245.64	245.64	245.64	237.40	245.64	237.40	237.40	245.64	237.40	237.40	237.40	237.40	237.40	237.40	237.40	239.82	245.64
24	ES3 – Extensive Services – ADL 2-16	703.74	719.04	623.45	703.74	703.74	703.74	623.45	623.45	623.45	719.04	719.04	719.04	666.42	719.04	666.42	666.42	719.04	666.42	666.42	666.42	666.42	666.42	666.42	666.42	673.21	719.04
25	ES2 – Extensive Services – ADL 2-16	550.87	562.85	489.49	550.87	550.87	550.87	489.49	489.49	489.49	562.85	562.85	562.85	523.22	562.85	523.22	523.22	562.85	523.22	523.22	523.22	523.22	523.22	523.22	523.22	528.55	562.85
26	ES1 – Extensive Services – ADL 2-16	492.09	502.79	437.96	492.09	492.09	492.09	437.96	437.96	437.96	502.79	502.79	502.79	468.15	502.79	468.15	468.15	502.79	468.15	468.15	468.15	468.15	468.15	468.15	468.15	472.91	502.79
27	HE2 – Special Care High – ADL 15-16	475.29	485.63	423.24	475.29	475.29	475.29	423.24	423.24	423.24	485.63	485.63	485.63	452.40	485.63	452.40	452.40	485.63	452.40	452.40	452.40	452.40	452.40	452.40	452.40	457.01	485.63
28	HE1 – Special Care High – ADL 15-16	394.67	403.25	352.58	394.67	394.67	394.67	352.58	352.58	352.58	403.25	403.25	403.25	376.88	403.25	376.88	376.88	403.25	376.88	376.88	376.88	376.88	376.88	376.88	376.88	380.71	403.25
29	HD2 – Special Care High – ADL 11-14	445.06	454.73	396.74	445.06	445.06	445.06	396.74	396.74	396.74	454.73	454.73	454.73	424.08	454.73	424.08	424.08	454.73	424.08	424.08	424.08	424.08	424.08	424.08	424.08	428.40	454.73
30	HD1 – Special Care High – ADL 11-14	371.14	379.21	331.96	371.14	371.14	371.14	331.96	331.96	331.96	379.21	379.21	379.21	354.84	379.21	354.84	354.84	379.21	354.84	354.84	354.84	354.84	354.84	354.84	354.84	358.46	379.21
31	HC2 – Special Care High – ADL 6-10	419.86	428.99	374.66	419.86	419.86	419.86	374.66	374.66	374.66	428.99	428.99	428.99	400.48	428.99	400.48	400.48	428.99	400.48	400.48	400.48	400.48	400.48	400.48	400.48	404.56	428.99
32	HC1 – Special Care High – ADL 6-10	350.99	358.62	314.30	350.99	350.99	350.99	314.30	314.30	314.30	358.62	358.62	358.62	335.96	358.62	335.96	335.96	358.62	335.96	335.96	335.96	335.96	335.96	335.96	335.96	339.38	358.62
33	HB2 – Special Care High – ADL 2-5	414.82	423.84	370.24	414.82	414.82	414.82	370.24	370.24	370.24	423.84	423.84	423.84	395.76	423.84	395.76	395.76	423.84	395.76	395.76	395.76	395.76	395.76	395.76	395.76	399.79	423.84
34	HB1 – Special Care High – ADL 2-5	347.63	355.19	311.36	347.63	347.63	347.63	311.36	311.36	311.36	355.19	355.19	355.19	332.82	355.19	332.82	332.82	355.19	332.82	332.82	332.82	332.82	332.82	332.82	332.82	336.21	355.19
35	LE2 – Special Care Low - ADL 15-16	431.61	441.00	384.97	431.61	431.61	431.61	384.97	384.97	384.97	441.00	441.00	441.00	411.50	441.00	411.50	411.50	441.00	411.50	411.50	411.50	411.50	411.50	411.50	411.50	415.69	441.00
36	LE1 – Special Care Low – ADL 15-16	361.07	368.92	323.13	361.07	361.07	361.07	323.13	323.13	323.13	368.92	368.92	368.92	345.40	368.92	345.40	345.40	368.92	345.40	345.40	345.40	345.40	345.40	345.40	345.40	348.92	368.92
37	LD2 – Special Care Low – ADL 11-14	414.82	423.84	370.24	414.82	414.82	414.82	370.24	370.24	370.24	423.84	423.84	423.84	395.76	423.84	395.76	395.76	423.84	395.76	395.76	395.76	395.76	395.76	395.76	395.76	399.79	423.84
38	LD1 – Special Care Low – ADL 11-14	347.63	355.19	311.36	347.63	347.63	347.63	311.36	311.36	311.36	355.19	355.19	355.19	332.82	355.19	332.82	332.82	355.19	332.82	332.82	332.82	332.82	332.82	332.82	332.82	336.21	355.19
39	LC2 – Special Care Low – ADL 6-10	364.43	372.36	326.08	364.43	364.43	364.43	326.08	326.08	326.08	372.36	372.36	372.36	348.55	372.36	348.55	348.55	372.36	348.55	348.55	348.55	348.55	348.55	348.55	348.55	352.10	372.36
40	LC1 – Special Care Low – ADL 6-10	307.32	314.00	276.02	307.32	307.32	307.32	276.02	276.02	276.02	314.00	314.00	314.00	295.05	314.00	295.05	295.05	314.00	295.05	295.05	295.05	295.05	295.05	295.05	295.05	298.05	314.00
41	LB2 – Special Care Low – ADL 2-5	345.95	353.48	309.88	345.95	345.95	345.95	309.88	309.88	309.88	353.48	353.48	353.48	331.24	353.48	331.24	331.24	353.48	331.24	331.24	331.24	331.24	331.24	331.24	331.24	334.61	353.48
42	LB1 – Special Care Low – ADL 2-5	293.88	300.27	264.25	293.88	293.88	293.88	264.25	264.25	264.25	300.27	300.27	300.27	282.46	300.27	282.46	282.46	300.27	282.46	282.46	282.46	282.46	282.46	282.46	282.46	285.34	300.27
43	CE2 – Clinically Complex – ADL 15-16	384.58	392.95	343.74	384.58	384.58	384.58	343.74	343.74	343.74	392.95	392.95	392.95	367.43	392.95	367.43	367.43	392.95	367.43	367.43	367.43	367.43	367.43	367.43	367.43	371.18	392.95
44	CE1 – Clinically Complex – ADL 15-16	354.35	362.05	317.25	354.35	354.35	354.35	317.25	317.25	317.25	362.05	362.05	362.05	339.11	362.05	339.11	339.11	362.05	339.11	339.11	339.11	339.11	339.11	339.11	339.11	342.56	362.05
45	CD2 – Clinically Complex – ADL 11-14	364.43	372.36	326.08	364.43	364.43	364.43	326.08	326.08	326.08	372.36	372.36	372.36	348.55	372.36	348.55	348.55	372.36	348.55	348.55	348.55	348.55	348.55	348.55	348.55	352.10	372.36
46	CD1 – Clinically Complex – ADL 11-14	334.20	341.46	299.58	334.20	334.20	334.20	299.58	299.58	299.58	341.46	341.46	341.46	320.23	341.46	320.23	320.23	341.46	320.23	320.23	320.23	320.23	320.23	320.23	320.23	323.49	341.46
47	CC2 – Clinically Complex – ADL 6-10	319.08	326.02	286.33	319.08	319.08	319.08	286.33	286.33	286.33	326.02	326.02	326.02	306.07	326.02	306.07	306.07	326.02	306.07	306.07	306.07	306.07	306.07	306.07	306.07	309.18	326.02
48	CC1 – Clinically Complex – ADL 6-10	295.56	301.99	265.72	295.56	295.56	295.56	265.72	265.72	265.72	301.99	301.99	301.99	284.03	301.99	284.03	284.03	301.99	284.03	284.03	284.03	284.03	284.03	284.03	284.03	286.93	301.99
49	CB2 – Clinically Complex – ADL 2-5	295.56	301.99	265.72	295.56	295.56	295.56	265.72	265.72	265.72	301.99	301.99	301.99	284.03	301.99	284.03	284.03	301.99	284.03	284.03	284.03	284.03	284.03	284.03	284.03	286.93	301.99
50	CB1 – Clinically Complex – ADL 2-5	273.72	279.68	246.59	273.72	273.72	273.72	246.59	246.59	246.59	279.68	279.68	279.68	263.58	279.68	263.58	263.58	279.68	263.58	263.58	263.58	263.58	263.58	263.58	263.58	266.27	279.68
51	CA2 – Clinically Complex – ADL 0-1	250.21	255.65	225.98	250.21	250.21	250.21	225.98	225.98	225.98	255.65	255.65	255.65	241.55	255.65	241.55	241.55	255.65	241.55	241.55	241.55	241.55	241.55	241.55	241.55	244.01	255.65
52	CA1 – Clinically Complex – ADL 0-1	233.41	238.48	211.26	233.41	233.41	233.41	211.26	211.26	211.26	238.48	238.48	238.48	225.82	238.48	225.82	225.82	238.48	225.82	225.82	225.82	225.82	225.82	225.82	225.82	228.12	238.48
53	BB2 – Behavior Symptoms – ADL 2-5	265.33	271.10	239.22	265.33	265.33	265.33	239.22	239.22	239.22	271.10	271.10	271.10	255.71	271.10	255.71	255.71	271.10	255.71	255.71	255.71	255.71	255.71	255.71	255.71	258.31	271.10
54	BB1 – Behavior Symptoms – ADL 2-5	253.57	259.08	228.92	253.57	253.57	253.57	228.92	228.92	228.92	259.08	259.08	259.08	244.70	259.08	244.70	244.70	259.08	244.70	244.70	244.70	244.70	244.70	244.70	244.70	247.19	259.08
55	BA2 – Behavior Symptoms – ADL 0-1	219.97	224.76	199.48	219.97	219.97	219.97	199.48	199.48	199.48	224.76	224.76	224.76	213.23	224.76	213.23	213.23	224.76	213.23	213.23	213.23	213.23	213.23	213.23	213.23	215.40	224.76
56	BA1 – Behavior Symptoms – ADL 0-1	209.89	214.46	190.65	209.89	209.89	209.89	190.65	190.65	190.65	214.46	214.46	214.46	203.78	214.46	203.78	203.78	214.46	203.78	203.78	203.78	203.78	203.78	203.78	203.78	205.86	214.46
57	PE2 – Physical Function Reduced – ADL 15-16	354.35	362.05	317.25	354.35	354.35	354.35	317.25	317.25	317.25	362.05	362.05	362.05	339.11	362.05	339.11	339.11	362.05	339.11	339.11	339.11	339.11	339.11	339.11	339.11	342.56	362.05
58	PE1 – Physical Function Reduced – ADL 15-16	337.56	344.90	302.53	337.56	337.56	337.56	302.53	302.53	302.53	344.90	344.90	344.90	323.38	344.90	323.38	323.38	344.90	323.38	323.38	323.38	323.38	323.38	323.38	323.38	326.67	344.90
59	PD2 – Physical Function Reduced – ADL 11-14	334.20	341.46	299.58	334.20	334.20	334.20	299.58	299.58	299.58	341.46	341.46	341.46	320.23	341.46	320.23	320.23	341.46	320.23	320.23	320.23	320.23	320.23	320.23	320.23	323.49	341.46
60	PD1 – Physical Function Reduced – ADL 11-14	317.39	324.29	284.86	317.39	317.39	317.39	284.86	284.86	284.86	324.29	324.29	324.29	304.50	324.29	304.50	304.50	324.29	304.50	304.50	304.50	304.50	304.50	304.50	304.50	307.60	324.29
61	PC2 – Physical Function Reduced – ADL 6-10	287.16	293.40	258.36	287.16	287.16	287.16	258.36	258.36	258.36	293.40	293.40	293.40	276.16	293.40	276.16	276.16	293.40	276.16	276.16	276.16	276.16	276.16	276.16	276.16	278.98	293.40
62	PC1 – Physical Function Reduced – ADL 6-10	273.72	279.68	246.59	273.72	273.72	273.72	246.59	246.59	246.59	279.68	279.68	279.68	263.58	279.68	263.58	263.58	279.68	263.58	263.58	263.58	263.58	263.58	263.58	263.58	266.27	279.68
63	PB2 – Physical Function Reduced – ADL 2-5	243.49	248.78	220.09	243.49	243.49	243.49	220.09	220.09	220.09	248.78	248.78	248.78	235.26	248.78	235.26	235.26	248.78	235.26	235.26	235.26	235.26	235.26	235.26	235.26	237.65	248.78
64	PB1 – Physical Function Reduced – ADL 2-5	233.41	238.48	211.26	233.41	233.41	233.41	211.26	211.26	211.26	238.48	238.48	238.48	225.82	238.48	225.82	225.82	238.48	225.82	225.82	225.82	225.82	225.82	225.82	225.82	228.12	238.48
65	PA2 – Physical Function Reduced – ADL 0-1	201.49	205.88	183.28	201.49	201.49	201.49	183.28	183.28	183.28	205.88	205.88	205.88	195.91	205.88	195.91	195.91	205.88	195.91	195.91	195.91	195.91	195.91	195.91	195.91	197.91	205.88
66	PA1 – Physical Function Reduced – ADL 0-1	193.10	197.30	175.92	193.10	193.10	193.10	175.92	175.92	175.92	197.30	197.30	197.30	188.04	197.30	188.04	188.04	197.30	188.04	188.04	188.04	188.04	188.04	188.04	188.04	189.96	197.30

File details come from the government source that posted it. Updated Mar 11, 2022.