No office rate
Choose 44156 for a continent, catheterizable ileostomy after total colectomy and proctectomy; 44155 describes the conventional ileostomy reconstruction.
On this page
CMS RVU26D · Effective 2026-10-01
44156 in Chico
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$2074.48
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Colorectal surgery
About 44156: Total colectomy with proctectomy and continent ileostomy
Reports open removal of the entire colon and rectum with creation of a continent ileostomy, typically for extensive colonic disease requiring this reconstruction.
A colorectal surgeon removes the entire colon and rectum through an abdominal operation and forms a continent ileostomy from the small bowel. The internal reservoir connects to a catheterizable abdominal stoma, allowing the patient to empty it by catheter rather than use a conventional external ileostomy appliance. This reconstruction may be performed for extensive disease such as ulcerative colitis or familial adenomatous polyposis when proctectomy and a continent diversion are planned.
Report this code when the operative record supports total colectomy, proctectomy, and creation of the continent ileostomy; a conventional end ileostomy or ileoanal reconstruction represents a different operation. The service has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 44156
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU36.48 · 57%
- Practice expense (office) RVU18.03 · 28%
- Malpractice RVU9.79 · 15%
14
Medicare services in 2024 · #6103 by national volume
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.
44156 compared with similar codes
Office rates for Chico, from the same CMS release.
No office rate
Both describe a continent ileostomy with total colectomy, but 44151 does not include proctectomy. The operative report must establish whether the rectum was removed.
No office rate
44157 describes ileoanal anastomosis after total colectomy and proctectomy. Use 44156 when the reconstruction is a continent ileostomy through an abdominal stoma.
No office rate
44158 includes an ileal reservoir for ileoanal reconstruction; 44156 creates a continent abdominal ileostomy rather than an ileoanal connection.
The same code, a different location
How does Chico compare?
44156 across payment areas
Same release and payment basis · bars start at $0
Chico · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Merced
California · 44156
Office
Unavailable
Facility
$2074.48
No comparable office rate is available.
Modesto
California · 44156
Office
Unavailable
Facility
$2074.48
No comparable office rate is available.
Napa
California · 44156
Office
Unavailable
Facility
$2255.07
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 44156
Office
Unavailable
Facility
$2168.12
No comparable office rate is available.
Redding
California · 44156
Office
Unavailable
Facility
$2074.48
No comparable office rate is available.
Rest Of California
California · 44156
Office
Unavailable
Facility
$2074.48
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 44156
Office
Unavailable
Facility
$2179.35
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 44156
Office
Unavailable
Facility
$2137.98
No comparable office rate is available.
Salinas
California · 44156
Office
Unavailable
Facility
$2129.48
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 44156
Office
Unavailable
Facility
$2152.50
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 44156
Office
Unavailable
Facility
$2333.44
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 44156
Office
Unavailable
Facility
$2322.32
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 44156
Office
Unavailable
Facility
$2396.16
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 44156
Office
Unavailable
Facility
$2350.71
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 44156
Office
Unavailable
Facility
$2100.37
No comparable office rate is available.
Santa Cruz-Watsonville
California · 44156
Office
Unavailable
Facility
$2151.02
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 44156
Office
Unavailable
Facility
$2130.04
No comparable office rate is available.
Santa Rosa-Petaluma
California · 44156
Office
Unavailable
Facility
$2169.81
No comparable office rate is available.
Stockton
California · 44156
Office
Unavailable
Facility
$2074.48
No comparable office rate is available.
Vallejo
California · 44156
Office
Unavailable
Facility
$2239.04
No comparable office rate is available.
Visalia
California · 44156
Office
Unavailable
Facility
$2074.48
No comparable office rate is available.
Yuba City
California · 44156
Office
Unavailable
Facility
$2074.48
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 44156
Office
Unavailable
Facility
$2357.62
No comparable office rate is available.
Miami
Florida · 44156
Office
Unavailable
Facility
$2672.34
No comparable office rate is available.
Chicago
Illinois · 44156
Office
Unavailable
Facility
$2582.68
No comparable office rate is available.
Manhattan
New York · 44156
Office
Unavailable
Facility
$2514.84
No comparable office rate is available.
Alaska*
Alaska · 44156
Office
Unavailable
Facility
$2649.23
No comparable office rate is available.
Alabama
Alabama · 44156
Office
Unavailable
Facility
$1930.48
No comparable office rate is available.
Arkansas
Arkansas · 44156
Office
Unavailable
Facility
$1904.17
No comparable office rate is available.
Arizona
Arizona · 44156
Office
Unavailable
Facility
$2081.92
No comparable office rate is available.
Colorado
Colorado · 44156
Office
Unavailable
Facility
$2129.23
No comparable office rate is available.
Connecticut
Connecticut · 44156
Office
Unavailable
Facility
$2287.09
No comparable office rate is available.
Delaware
Delaware · 44156
Office
Unavailable
Facility
$2113.52
No comparable office rate is available.
Fort Lauderdale
Florida · 44156
Office
Unavailable
Facility
$2419.72
No comparable office rate is available.
Rest Of Florida
Florida · 44156
Office
Unavailable
Facility
$2285.66
No comparable office rate is available.
Atlanta
Georgia · 44156
Office
Unavailable
Facility
$2226.69
No comparable office rate is available.
Rest Of Georgia
Georgia · 44156
Office
Unavailable
Facility
$2145.42
No comparable office rate is available.
Hawaii, Guam
Hawaii · 44156
Office
Unavailable
Facility
$2092.52
No comparable office rate is available.
Iowa
Iowa · 44156
Office
Unavailable
Facility
$1899.31
No comparable office rate is available.
Idaho
Idaho · 44156
Office
Unavailable
Facility
$1927.17
No comparable office rate is available.
East St. Louis
Illinois · 44156
Office
Unavailable
Facility
$2431.07
No comparable office rate is available.
Rest Of Illinois
Illinois · 44156
Office
Unavailable
Facility
$2279.38
No comparable office rate is available.
Suburban Chicago
Illinois · 44156
Office
Unavailable
Facility
$2424.91
No comparable office rate is available.
Indiana
Indiana · 44156
Office
Unavailable
Facility
$1935.64
No comparable office rate is available.
Kansas
Kansas · 44156
Office
Unavailable
Facility
$1927.68
No comparable office rate is available.
Kentucky
Kentucky · 44156
Office
Unavailable
Facility
$2053.04
No comparable office rate is available.
New Orleans
Louisiana · 44156
Office
Unavailable
Facility
$2156.62
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 44156
Office
Unavailable
Facility
$2064.69
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 44156
Office
Unavailable
Facility
$2278.50
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 44156
Office
Unavailable
Facility
$2132.71
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 44156
Office
Unavailable
Facility
$2288.63
No comparable office rate is available.
Rest Of Maryland
Maryland · 44156
Office
Unavailable
Facility
$2140.28
No comparable office rate is available.
Rest Of Maine
Maine · 44156
Office
Unavailable
Facility
$1975.90
No comparable office rate is available.
Southern Maine
Maine · 44156
Office
Unavailable
Facility
$2021.60
No comparable office rate is available.
Detroit
Michigan · 44156
Office
Unavailable
Facility
$2350.92
No comparable office rate is available.
Rest Of Michigan
Michigan · 44156
Office
Unavailable
Facility
$2137.47
No comparable office rate is available.
Minnesota
Minnesota · 44156
Office
Unavailable
Facility
$1934.94
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 44156
Office
Unavailable
Facility
$2103.42
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 44156
Office
Unavailable
Facility
$2119.43
No comparable office rate is available.
Rest Of Missouri
Missouri · 44156
Office
Unavailable
Facility
$2056.07
No comparable office rate is available.
Mississippi
Mississippi · 44156
Office
Unavailable
Facility
$1978.62
No comparable office rate is available.
Montana**
Montana · 44156
Office
Unavailable
Facility
$2147.02
No comparable office rate is available.
North Carolina
North Carolina · 44156
Office
Unavailable
Facility
$1989.28
No comparable office rate is available.
North Dakota**
North Dakota · 44156
Office
Unavailable
Facility
$1953.44
No comparable office rate is available.
Nebraska
Nebraska · 44156
Office
Unavailable
Facility
$1897.92
No comparable office rate is available.
New Hampshire
New Hampshire · 44156
Office
Unavailable
Facility
$2131.49
No comparable office rate is available.
Northern Nj
New Jersey · 44156
Office
Unavailable
Facility
$2343.03
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 44156
Office
Unavailable
Facility
$2283.54
No comparable office rate is available.
New Mexico
New Mexico · 44156
Office
Unavailable
Facility
$2163.42
No comparable office rate is available.
Nevada**
Nevada · 44156
Office
Unavailable
Facility
$2093.67
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 44156
Office
Unavailable
Facility
$2619.71
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 44156
Office
Unavailable
Facility
$2328.39
No comparable office rate is available.
Queens
New York · 44156
Office
Unavailable
Facility
$2479.80
No comparable office rate is available.
Rest Of New York
New York · 44156
Office
Unavailable
Facility
$2020.45
No comparable office rate is available.
Ohio
Ohio · 44156
Office
Unavailable
Facility
$2097.90
No comparable office rate is available.
Oklahoma
Oklahoma · 44156
Office
Unavailable
Facility
$2010.32
No comparable office rate is available.
Portland
Oregon · 44156
Office
Unavailable
Facility
$2150.31
No comparable office rate is available.
Rest Of Oregon
Oregon · 44156
Office
Unavailable
Facility
$2048.15
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 44156
Office
Unavailable
Facility
$2257.41
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 44156
Office
Unavailable
Facility
$2080.31
No comparable office rate is available.
Puerto Rico
Puerto Rico · 44156
Office
Unavailable
Facility
$2149.40
No comparable office rate is available.
Rhode Island
Rhode Island · 44156
Office
Unavailable
Facility
$2155.39
No comparable office rate is available.
South Carolina
South Carolina · 44156
Office
Unavailable
Facility
$2052.86
No comparable office rate is available.
South Dakota**
South Dakota · 44156
Office
Unavailable
Facility
$1930.55
No comparable office rate is available.
Tennessee
Tennessee · 44156
Office
Unavailable
Facility
$1941.48
No comparable office rate is available.
Austin
Texas · 44156
Office
Unavailable
Facility
$2147.77
No comparable office rate is available.
Beaumont
Texas · 44156
Office
Unavailable
Facility
$2070.26
No comparable office rate is available.
Brazoria
Texas · 44156
Office
Unavailable
Facility
$2080.07
No comparable office rate is available.
Dallas
Texas · 44156
Office
Unavailable
Facility
$2109.80
No comparable office rate is available.
Fort Worth
Texas · 44156
Office
Unavailable
Facility
$2108.03
No comparable office rate is available.
Galveston
Texas · 44156
Office
Unavailable
Facility
$2096.97
No comparable office rate is available.
Houston
Texas · 44156
Office
Unavailable
Facility
$2276.16
No comparable office rate is available.
Rest Of Texas
Texas · 44156
Office
Unavailable
Facility
$2085.25
No comparable office rate is available.
Utah
Utah · 44156
Office
Unavailable
Facility
$2078.19
No comparable office rate is available.
Virginia
Virginia · 44156
Office
Unavailable
Facility
$2041.30
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 44156
Office
Unavailable
Facility
$2149.40
No comparable office rate is available.
Vermont
Vermont · 44156
Office
Unavailable
Facility
$1980.12
No comparable office rate is available.
Rest Of Washington
Washington · 44156
Office
Unavailable
Facility
$2117.28
No comparable office rate is available.
Seattle (King Cnty)
Washington · 44156
Office
Unavailable
Facility
$2285.46
No comparable office rate is available.
Wisconsin
Wisconsin · 44156
Office
Unavailable
Facility
$1896.10
No comparable office rate is available.
West Virginia
West Virginia · 44156
Office
Unavailable
Facility
$2209.72
No comparable office rate is available.
Wyoming**
Wyoming · 44156
Office
Unavailable
Facility
$2062.66
No comparable office rate is available.
See how rates vary across the country
44156 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Chico is a Medicare payment area. Our Census mapping connects it to 30 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 44156 in Chico. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$2281.93
$2074.48 × 110% = $2281.93
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 44156 in Chico.
PPRRVU2026_Oct_nonQPP.csv
5,358
- Code
- 44156
- Physician work
- 36.48
- Practice expense
- 18.03
- Malpractice
- 9.79
GPCI2026.csv
9
- Locality
- Chico
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 36.48 | × 1.017 | 37.1002 |
| Practice expense | 18.03 | × 1.096 | 19.7609 |
| Malpractice | 9.79 | × 0.536 | 5.2474 |
| Total RVUs | 62.1085 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Chico$2074.48
Open 44156 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 36.48 | 1.017 |
| Practice expense | 18.03 | 1.096 |
| Malpractice | 9.79 | 0.536 |
(36.48 × 1.017 + 18.03 × 1.096 + 9.79 × 0.536) × $33.4009 = $2074.48
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
44156 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
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
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $2074.48 | RVU26D |
| 2026-07-01 | Not available in this setting | $2074.48 | RVU26C |
| 2026-04-01 | Not available in this setting | $2074.48 | RVU26B |
| 2026-01-01 | Not available in this setting | $2074.48 | RVU26A |
| 2025-10-01 | Not available in this setting | $2176.90 | RVU25D |
| 2025-07-01 | Not available in this setting | $2176.90 | RVU25C |
| 2025-04-01 | Not available in this setting | $2176.90 | RVU25B |
| 2025-01-01 | Not available in this setting | $2176.90 | RVU25A |
44156 billing questions
How does this differ from 44155?
Both include total colectomy and proctectomy. Code 44156 includes creation of a continent ileostomy; 44155 describes a conventional ileostomy.
When is 44151 a closer match?
44151 describes total colectomy with a continent ileostomy without proctectomy. Use 44156 when the rectum is also removed.
Does this code include the continent ileostomy?
Yes. Creation of the continent ileostomy is part of the operation represented by this code, alongside total colectomy and proctectomy.
How does 44156 differ from 44157 or 44158?
44157 and 44158 describe ileoanal reconstruction after proctectomy, with 44158 including creation of an ileal reservoir. Code 44156 instead creates a continent abdominal ileostomy.
What documentation supports reporting 44156?
The operative report should establish removal of the entire colon and rectum and formation of a continent, catheterizable ileostomy. It should distinguish this reconstruction from a conventional ileostomy or ileoanal connection.
How are other same-session procedures and surgical assistants handled?
Under the CMS multiple-procedure rule, the highest-valued procedure is paid in full and other procedures at 50%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,35544150,,Removal of colon,A,,29.43,15.59,NA,15.59,,6.79,51.81,51.81,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,35644151,,Removal of colon/ileostomy,A,,34.05,17.03,NA,17.03,,9.13,60.21,60.21,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,35744155,,Removal of colon/ileostomy,A,,33.56,16.46,NA,16.46,,7.47,57.49,57.49,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,35844156,,Removal of colon/ileostomy,A,,36.48,18.03,NA,18.03,,9.79,64.30,64.30,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,35944157,,Colectomy w/ileoanal anast,A,,34.81,17.01,NA,17.01,,9.32,61.14,61.14,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,36044158,,Colectomy w/neo-rectum pouch,A,,35.78,17.25,NA,17.25,,9.58,62.61,62.61,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,36144160,,Removal of colon,A,,20.37,9.38,NA,9.38,,4.90,34.65,34.65,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515
801112,CA,54,BAKERSFIELD,1.019,1.096,0.609
901112,CA,55,CHICO,1.017,1.096,0.536
1001182,CA,71,EL CENTRO,1.017,1.096,0.541
1101112,CA,56,FRESNO,1.017,1.096,0.536
1201112,CA,57,HANFORD-CORCORAN,1.017,1.096,0.536