CPT code 44389: Colonoscopy, through stoma, with biopsy2026 Medicare rate & RVUs in Santa Rosa, CA
Reports examination of the colon through a stoma when the endoscopist takes one or more tissue samples during the procedure.
In Santa Rosa, CA, Medicare pays $533.23 for 44389 in the office and $159.99 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 44389 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 44389 covers
Code 44389 describes endoscopic examination of the colon through an existing stoma, with tissue sampling during the procedure. A gastroenterologist or colorectal surgeon may use it to evaluate abnormal mucosa, a suspected neoplasm, or another finding in a patient with a colostomy. The access route is the stoma; a colonoscopy performed through the anus belongs to a different code family.
Report the service when the procedure note documents access through the stoma, the examination performed, and the biopsy site or sites. The code includes the colonoscopy and biopsy, whether one or multiple samples are taken; do not count biopsy sites as separate units. If the endoscopist removes a lesion or treats bleeding, select the code describing that intervention. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. CMS endoscopy-family pricing applies when related endoscopies are performed together. Modifier 50 is inappropriate for this single examination. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Santa Rosa, CA compares for 44389
Across 109 of 109 payment localities, the office rate for 44389 runs from $402.32 in Arkansas to $615.14 in San Benito County, CA. Santa Rosa, CA pays $533.23. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Santa Rosa, CA · this page$533.23
- Bakersfield, CA · California$487.45−$45.78
- Chico, CA · California$486.28−$46.95
- El Centro, CA · California$486.35−$46.88
- Fresno, CA · California$486.28−$46.95
- Hanford, CA · California$486.28−$46.95
- Los Angeles, CA · California$520.45−$12.78
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Madera, CACalifornia | $486.28 | $153.15 |
| Merced, CACalifornia | $486.28 | $153.15 |
| Modesto, CACalifornia | $486.28 | $153.15 |
| Napa, CACalifornia | $567.24 | $166.64 |
| Oxnard, CACalifornia | $518.28 | $159.02 |
| Redding, CACalifornia | $486.28 | $153.15 |
| Rest of CaliforniaCalifornia | $486.28 | $153.15 |
| Riverside, CACalifornia | $490.62 | $157.49 |
| Sacramento, CACalifornia | $511.33 | $157.84 |
| Salinas, CACalifornia | $509.46 | $157.18 |
| San Diego, CACalifornia | $522.24 | $158.72 |
| Marin County, CACalifornia | $601.57 | $173.00 |
| San Francisco, CACalifornia | $601.11 | $172.55 |
| San Benito County, CACalifornia | $615.14 | $176.85 |
| Santa Clara County, CACalifornia | $613.28 | $174.99 |
| San Luis Obispo, CACalifornia | $501.16 | $154.96 |
| Santa Cruz, CACalifornia | $527.85 | $158.56 |
| Santa Maria, CACalifornia | $511.58 | $157.18 |
| Stockton, CACalifornia | $486.28 | $153.15 |
| Vallejo, CACalifornia | $566.59 | $165.99 |
| Visalia, CACalifornia | $486.28 | $153.15 |
| Yuba City, CACalifornia | $486.28 | $153.15 |
| Washington, DC areaDistrict of Columbia | $526.00 | $167.95 |
| Miami, FLFlorida | $492.21 | $175.80 |
| Chicago, ILIllinois | $477.31 | $171.84 |
| Manhattan, NYNew York | $527.76 | $174.58 |
| AlaskaAlaska | $523.19 | $199.48 |
| AlabamaAlabama | $408.54 | $142.59 |
| ArkansasArkansas | $402.32 | $141.23 |
| ArizonaArizona | $444.94 | $150.42 |
| ColoradoColorado | $477.99 | $154.59 |
| ConnecticutConnecticut | $489.01 | $161.65 |
| DelawareDelaware | $452.58 | $152.28 |
| Fort Lauderdale, FLFlorida | $472.89 | $164.99 |
| Rest of FloridaFlorida | $449.09 | $158.51 |
| Atlanta, GAGeorgia | $466.11 | $157.30 |
| Rest of GeorgiaGeorgia | $422.79 | $151.66 |
| Hawaii, Guam, HIHawaii | $499.37 | $153.79 |
| IowaIowa | $420.12 | $142.01 |
| IdahoIdaho | $422.87 | $143.24 |
| East St. Louis, ILIllinois | $443.46 | $163.82 |
| Rest of IllinoisIllinois | $435.01 | $157.50 |
| Suburban Chicago, ILIllinois | $477.94 | $165.78 |
| IndianaIndiana | $425.46 | $143.70 |
| KansasKansas | $417.75 | $142.98 |
| KentuckyKentucky | $418.05 | $147.84 |
| New Orleans, LALouisiana | $438.99 | $152.98 |
| Rest of LouisianaLouisiana | $417.24 | $148.24 |
| Metropolitan Boston, MAMassachusetts | $527.28 | $164.37 |
| Rest of MassachusettsMassachusetts | $474.79 | $154.73 |
| Baltimore area, MDMaryland | $487.59 | $161.45 |
| Rest of MarylandMaryland | $461.63 | $154.04 |
| Rest of MaineMaine | $424.86 | $145.23 |
| Southern Maine, MEMaine | $449.55 | $148.34 |
| Detroit, MIMichigan | $454.65 | $161.34 |
| Rest of MichiganMichigan | $429.21 | $151.71 |
| MinnesotaMinnesota | $458.22 | $145.46 |
| Metropolitan Kansas City, MOMissouri | $436.18 | $150.77 |
| Metropolitan St. Louis, MOMissouri | $441.01 | $151.65 |
| Rest of MissouriMissouri | $409.49 | $147.49 |
| MississippiMississippi | $406.01 | $144.31 |
| MontanaMontana | $457.57 | $153.62 |
| North CarolinaNorth Carolina | $429.59 | $146.00 |
| North DakotaNorth Dakota | $449.66 | $145.71 |
| NebraskaNebraska | $422.64 | $142.09 |
| New HampshireNew Hampshire | $470.11 | $153.70 |
| Northern New JerseyNew Jersey | $520.05 | $167.47 |
| Rest of New JerseyNew Jersey | $494.65 | $162.74 |
| New MexicoNew Mexico | $431.56 | $152.84 |
| NevadaNevada | $455.71 | $151.46 |
| NYC suburbs and Long Island, NYNew York | $540.73 | $179.33 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $497.69 | $164.87 |
| Queens, NYNew York | $532.76 | $173.49 |
| Rest of New YorkNew York | $436.32 | $147.57 |
| OhioOhio | $427.59 | $150.09 |
| OklahomaOklahoma | $417.59 | $146.16 |
| Portland, OROregon | $494.15 | $156.47 |
| Rest of OregonOregon | $452.24 | $149.51 |
| Metropolitan Philadelphia, PAPennsylvania | $476.13 | $159.72 |
| Rest of PennsylvaniaPennsylvania | $428.48 | $149.46 |
| Puerto RicoPuerto Rico | $461.20 | $153.91 |
| Rhode IslandRhode Island | $469.43 | $155.46 |
| South CarolinaSouth Carolina | $429.29 | $148.44 |
| South DakotaSouth Dakota | $448.72 | $144.77 |
| TennesseeTennessee | $419.92 | $143.63 |
| Austin, TXTexas | $476.34 | $154.76 |
| Beaumont, TXTexas | $425.50 | $148.91 |
| Brazoria, TXTexas | $452.32 | $151.11 |
| Dallas, TXTexas | $455.19 | $152.46 |
| Fort Worth, TXTexas | $451.91 | $152.22 |
| Galveston, TXTexas | $453.66 | $151.84 |
| Houston, TXTexas | $460.98 | $159.16 |
| Rest of TexasTexas | $438.65 | $150.20 |
| UtahUtah | $435.47 | $149.76 |
| VirginiaVirginia | $447.78 | $149.00 |
| Virgin Islands, VIUnited States Virgin Islands | $461.20 | $153.91 |
| VermontVermont | $447.53 | $146.62 |
| Rest of WashingtonWashington | $474.02 | $153.96 |
| King County, WAWashington | $538.61 | $165.66 |
| WisconsinWisconsin | $433.81 | $142.63 |
| West VirginiaWest Virginia | $418.02 | $153.89 |
| WyomingWyoming | $454.12 | $150.17 |
44389 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$402.32
$550.71
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $523.19 | 1 |
| AL | $408.54 | 1 |
| AR | $402.32 | 1 |
| AZ | $444.94 | 1 |
| CA | $486.28–$615.14 | 29 |
| CO | $477.99 | 1 |
| CT | $489.01 | 1 |
| DC | $526.00 | 1 |
| DE | $452.58 | 1 |
| FL | $449.09–$492.21 | 3 |
| GA | $422.79–$466.11 | 2 |
| GU | $499.37 | 1 |
| HI | $499.37 | 1 |
| IA | $420.12 | 1 |
| ID | $422.87 | 1 |
| IL | $435.01–$477.94 | 4 |
| IN | $425.46 | 1 |
| KS | $417.75 | 1 |
| KY | $418.05 | 1 |
| LA | $417.24–$438.99 | 2 |
| MA | $474.79–$527.28 | 2 |
| MD | $461.63–$526.00 | 3 |
| ME | $424.86–$449.55 | 2 |
| MI | $429.21–$454.65 | 2 |
| MN | $458.22 | 1 |
| MO | $409.49–$441.01 | 3 |
| MS | $406.01 | 1 |
| MT | $457.57 | 1 |
| NC | $429.59 | 1 |
| ND | $449.66 | 1 |
| NE | $422.64 | 1 |
| NH | $470.11 | 1 |
| NJ | $494.65–$520.05 | 2 |
| NM | $431.56 | 1 |
| NV | $455.71 | 1 |
| NY | $436.32–$540.73 | 5 |
| OH | $427.59 | 1 |
| OK | $417.59 | 1 |
| OR | $452.24–$494.15 | 2 |
| PA | $428.48–$476.13 | 2 |
| PR | $461.20 | 1 |
| RI | $469.43 | 1 |
| SC | $429.29 | 1 |
| SD | $448.72 | 1 |
| TN | $419.92 | 1 |
| TX | $425.50–$476.34 | 8 |
| UT | $435.47 | 1 |
| VA | $447.78–$526.00 | 2 |
| VI | $461.20 | 1 |
| VT | $447.53 | 1 |
| WA | $474.02–$538.61 | 2 |
| WI | $433.81 | 1 |
| WV | $418.02 | 1 |
| WY | $454.12 | 1 |
How the 44389 rate is calculated
Each of 44389’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 44389
RVUs × geographic indexes × conversion factor
Work2.94
2.94 RVUs× 1.000 GPCI
Practice expense10.36
10.36 RVUs× 1.000 GPCI
Malpractice0.40
0.40 RVUs× 1.000 GPCI
Adjusted RVUs
13.7000
Conversion factor
$33.4009
Medicare rate
$457.59
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Santa Rosa, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,411
- Code
- 44389
- Physician work
- 2.94
- Practice expense
- 10.36
- Malpractice
- 0.40
GPCI2026.csv
31
- Locality
- Santa Rosa, CA
- Physician work
- 1.030
- Practice expense
- 1.228
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.94 | × 1.030 | 3.0282 |
| Practice expense | 10.36 | × 1.228 | 12.7221 |
| Malpractice | 0.40 | × 0.536 | 0.2144 |
| Total RVUs | 15.9647 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Santa Rosa, CA$533.23
Office: (2.94 × 1.03 + 10.36 × 1.228 + 0.4 × 0.536) × $33.4009 = $533.23
Facility: (2.94 × 1.03 + 1.26 × 1.228 + 0.4 × 0.536) × $33.4009 = $159.99
Payment rules and modifiers for 44389
The CMS indicators that decide how 44389 is paid alongside other services.
CMS payment indicators · 44389
Colonoscopy, through stoma, with biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
44389 without 51 · national office
$457.59
Colonoscopy, through stoma, with biopsy
44389-51 · Second procedure: 50%
$228.80
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 44389 has changed in Santa Rosa, CA
44389 · Office / nonfacility
$533.23
Effective 2026-10-01
The base rate is $78.20 higher than on 2025-10-01, moving from $455.03 to $533.23 (17.2%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$455.03changed to$533.23
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 3.02 changed to 2.94
- Practice expense RVU 8.71 changed to 10.36
- Malpractice RVU 0.42 changed to 0.40
- Work GPCI 1.027 changed to 1.030
- Practice expense GPCI 1.232 changed to 1.228
- Malpractice GPCI 0.560 changed to 0.536
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$476.10changed to$455.03
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 8.91 changed to 8.71
- Malpractice RVU 0.40 changed to 0.42
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$468.33changed to$476.10
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$480.35changed to$468.33
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 8.97 changed to 8.91
- Malpractice RVU 0.41 changed to 0.40
- Work GPCI 1.036 changed to 1.027
- Practice expense GPCI 1.205 changed to 1.232
- Malpractice GPCI 0.579 changed to 0.560
January 1, 2023
RVU23A
$492.82changed to$480.35
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 9.22 changed to 8.97
- Malpractice RVU 0.39 changed to 0.41
- Work GPCI 1.045 changed to 1.036
- Practice expense GPCI 1.177 changed to 1.205
- Malpractice GPCI 0.597 changed to 0.579
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$486.95changed to$492.82
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 9.13 changed to 9.22
- Malpractice RVU 0.38 changed to 0.39
- Work GPCI 1.042 changed to 1.045
- Practice expense GPCI 1.159 changed to 1.177
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$452.25changed to$486.95
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 8.03 changed to 9.13
- Malpractice RVU 0.39 changed to 0.38
- Work GPCI 1.038 changed to 1.042
- Practice expense GPCI 1.142 changed to 1.159
- Malpractice GPCI 0.580 changed to 0.597
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$430.88changed to$452.25
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 7.63 changed to 8.03
- Malpractice RVU 0.43 changed to 0.39
- Work GPCI 1.024 changed to 1.038
- Practice expense GPCI 1.130 changed to 1.142
- Malpractice GPCI 0.562 changed to 0.580
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$414.89changed to$430.88
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 7.37 changed to 7.63
- Malpractice RVU 0.44 changed to 0.43
- Work GPCI 1.023 changed to 1.024
- Practice expense GPCI 1.111 changed to 1.130
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$406.97changed to$414.89
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 7.30 changed to 7.37
- Work GPCI 1.024 changed to 1.023
- Practice expense GPCI 1.093 changed to 1.111
- Malpractice GPCI 0.610 changed to 0.562
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$406.97
Held through RVU17B, RVU17C, RVU17D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $533.23 | $159.99 | RVU26D |
| 2026-07-01 | $533.23 | $159.99 | RVU26C |
| 2026-04-01 | $533.23 | $159.99 | RVU26B |
| 2026-01-01 | $533.23 | $159.99 | RVU26A |
| 2025-10-01 | $455.03 | $174.08 | RVU25D |
| 2025-07-01 | $455.03 | $174.08 | RVU25C |
| 2025-04-01 | $455.03 | $174.08 | RVU25B |
| 2025-01-01 | $455.03 | $174.08 | RVU25A |
| 2024-10-01 | $476.10 | $178.37 | RVU24D |
| 2024-07-01 | $476.10 | $178.37 | RVU24C |
| 2024-04-01 | $476.10 | $178.37 | RVU24B |
| 2024-03-09 | $476.10 | $178.37 | RVU24AR |
| 2024-01-01 | $468.33 | $175.45 | RVU24A |
| 2023-10-01 | $480.35 | $180.22 | RVU23D |
| 2023-07-01 | $480.35 | $180.22 | RVU23C |
| 2023-04-01 | $480.35 | $180.22 | RVU23B |
| 2023-01-01 | $480.35 | $180.22 | RVU23A |
| 2022-10-01 | $492.82 | $183.26 | RVU22D |
| 2022-07-01 | $492.82 | $183.26 | RVU22C |
| 2022-04-01 | $492.82 | $183.26 | RVU22B |
| 2022-01-01 | $492.82 | $183.26 | RVU22A |
| 2021-10-01 | $486.95 | $182.83 | RVU21D |
| 2021-07-01 | $486.95 | $182.83 | RVU21C |
| 2021-04-01 | $486.95 | $182.83 | RVU21B |
| 2021-01-01 | $486.95 | $182.83 | RVU21A |
| 2020-10-01 | $452.25 | $185.59 | RVU20D |
| 2020-07-01 | $452.25 | $185.59 | RVU20C |
| 2020-04-01 | $452.25 | $185.59 | RVU20B |
| 2020-01-01 | $452.25 | $185.59 | RVU20A |
| 2019-10-01 | $430.88 | $184.10 | RVU19D |
| 2019-07-01 | $430.88 | $184.10 | RVU19C |
| 2019-04-01 | $430.88 | $184.10 | RVU19B |
| 2019-01-01 | $430.88 | $184.10 | RVU19A |
| 2018-10-01 | $414.89 | $184.11 | RVU18D |
| 2018-07-01 | $414.89 | $184.11 | RVU18C |
| 2018-04-01 | $414.89 | $184.11 | RVU18B |
| 2018-01-01 | $414.89 | $184.11 | RVU18AR1 |
| 2017-10-01 | $406.97 | $182.99 | RVU17D |
| 2017-07-01 | $406.97 | $182.99 | RVU17C |
| 2017-04-01 | $406.97 | $182.99 | RVU17B |
| 2017-01-01 | $406.97 | $182.99 | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Santa Rosa, CA rate applies
Santa Rosa, CA is a Medicare payment area, not a city. Our Census mapping connects it to 38 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Petaluma
- Santa Rosa
- Bloomfield
- Bodega
- Bodega Bay
- Boyes Hot Springs
- Carmet
- Cazadero
44389 billing questions
How does 44389 differ from 45380?
Code 44389 is for colonoscopy performed through a stoma. Code 45380 describes colonoscopy with biopsy through the usual anal route.
Do multiple biopsy sites create multiple units?
No. The code covers the examination with one or more biopsies; the number of sites or specimens does not create additional units.
Can the diagnostic stoma colonoscopy be billed separately?
The examination is included in 44389 when biopsy is performed during it. Do not separately report a diagnostic colonoscopy for that same examination.
Which code should be used if a lesion is removed?
Use the stoma-colonoscopy code that describes the removal technique, such as 44392 or 44394, rather than coding biopsy alone for the removal.
Can modifier 50 or an assistant-at-surgery claim be reported?
Modifier 50 is inappropriate for this single stoma examination. Medicare does not pay an assistant at surgery for 44389.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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