{"asof":"Medicare DY2024 · POS Q2 2026 · Care Compare 2026 release","national":{"knee":{"cpt":"27447","asc":9048.37,"hopd":11939.76,"apc":"5115","dev":5593.78,"devpct":0.4685,"drg":"470"},"hip":{"cpt":"27130","asc":9237.69,"hopd":11939.76,"apc":"5115","dev":6009.28,"devpct":0.5033,"drg":"470"},"shoulder":{"cpt":"23472","asc":13991.83,"hopd":17040.84,"apc":"5116","dev":10348.9,"devpct":0.6073,"drg":"483"}},"con":{"_source":"Verified 2026-09-26, state by state, against state statutes and health department CON program pages (e.g., Maine 22 MRSA 328, Missouri RSMo 197.366, Oregon ORS 442.315, WV Code 16-2D-8, DC Code 44-406), state legislature bill records, NCSL and Mercatus CON summaries, and recent law-firm alerts (Holland & Knight Oct 2025, Nixon Peabody Jun 2026, Pullman & Comley 2026) plus HFMA's May 2026 CON legislation roundup. Tier 'asc' = CON review applies to establishing a new ASC (some only above a capital threshold, noted per state); 'limited' = CON exists but does not cover new ASCs (or applies only in some counties); 'none' = no CON program. Status is as of September 2026; pending bills are noted but not applied.","states":{"CA":{"tier":"none","note":"No certificate of need program; the state repealed its CON law in 1987.","source":"https://en.wikipedia.org/wiki/Certificate_of_need"},"CO":{"tier":"none","note":"No certificate of need program; the state repealed its CON law in 1987.","source":"https://en.wikipedia.org/wiki/Certificate_of_need"},"ID":{"tier":"none","note":"No certificate of need program; the state repealed its CON law in 1983.","source":"https://en.wikipedia.org/wiki/Certificate_of_need"},"KS":{"tier":"none","note":"No certificate of need program; the state repealed its CON law in 1985.","source":"https://en.wikipedia.org/wiki/Certificate_of_need"},"ND":{"tier":"none","note":"No certificate of need program; the state repealed its CON law in 1995.","source":"https://en.wikipedia.org/wiki/Certificate_of_need"},"NH":{"tier":"none","note":"No certificate of need program; the state repealed its CON law in 2016.","source":"https://en.wikipedia.org/wiki/Certificate_of_need"},"NM":{"tier":"none","note":"No certificate of need program; the state repealed its CON law in 1983.","source":"https://en.wikipedia.org/wiki/Certificate_of_need"},"PA":{"tier":"none","note":"No certificate of need program; the state repealed its CON law in 1996.","source":"https://en.wikipedia.org/wiki/Certificate_of_need"},"SD":{"tier":"none","note":"No certificate of need program; the state repealed its CON law in 1988.","source":"https://en.wikipedia.org/wiki/Certificate_of_need"},"TX":{"tier":"none","note":"No certificate of need program; the state repealed its CON law in 1985.","source":"https://en.wikipedia.org/wiki/Certificate_of_need"},"UT":{"tier":"none","note":"No certificate of need program; the state repealed its CON law in 1984.","source":"https://en.wikipedia.org/wiki/Certificate_of_need"},"WY":{"tier":"none","note":"No certificate of need program; the state repealed its CON law in 1985.","source":"https://en.wikipedia.org/wiki/Certificate_of_need"},"AR":{"tier":"limited","note":"Permit of Approval covers nursing homes, assisted living, home health, hospice, and ICF/IID; ASCs and hospitals are not covered.","source":"https://healthy.arkansas.gov/boards-commissions/commissions/arkansas-health-services-permit-agency/permit-of-approval-process/"},"AZ":{"tier":"limited","note":"No facility CON; only a certificate of necessity for ground ambulance services remains.","source":"https://www.azdhs.gov/documents/preparedness/emergency-medical-services-trauma-system/ambulance/ground/CONGeneralInformation.pdf"},"FL":{"tier":"limited","note":"CON covers only nursing homes, hospices, and ICF/DD; hospital CON was repealed in 2019 and outpatient services including ASCs are not regulated; a 2026 bill to repeal the rest died in the Senate.","source":"https://ahca.myflorida.com/health-quality-assurance/bureau-of-health-facility-regulation/certificate-of-need-and-commercial-managed-care-unit/certificate-of-need-con-program-overview.html"},"IN":{"tier":"limited","note":"CON applies only to comprehensive care facilities (nursing homes), in effect since 2019.","source":"https://www.in.gov/health/ltc/certificate-of-need/"},"LA":{"tier":"limited","note":"Facility Need Review covers nursing facilities, ICF/DD, hospice, home and community-based, adult day health, and behavioral health providers, not ASCs.","source":"https://ldh.la.gov/health-standards-section/facility-need-review"},"MN":{"tier":"limited","note":"No CON program; a legislative moratorium limits new hospital beds (with public interest review) and nursing home beds, and does not reach ASCs.","source":"https://www.health.state.mn.us/data/economics/moratorium/index.html"},"MO":{"tier":"limited","note":"CON covers long-term care facilities and beds, new hospital construction, and major capital or equipment spending; freestanding ASCs are not covered (ASC review repealed in the early 2000s).","source":"https://revisor.mo.gov/main/OneSection.aspx?section=197.366"},"MT":{"tier":"limited","note":"A 2021 law (HB 231) repealed CON for everything except long-term care beds and swing beds.","source":"https://dphhs.mt.gov/oig/licensure/healthcarefacilitylicensure/certificateofneed/"},"NE":{"tier":"limited","note":"CON covers only new long-term care beds and rehabilitation beds; a 2026 law (LB 437) extended how long an approval stays valid.","source":"https://update.legislature.ne.gov/?p=39660"},"NJ":{"tier":"limited","note":"CON still covers hospitals, long-term care, and some specialty services, but ambulatory care facilities including ASCs have been exempt since the 1998 reform.","source":"https://law.justia.com/codes/new-jersey/title-26/section-26-2h-7a/"},"NV":{"tier":"limited","note":"CON applies only to new health facility construction over $2 million, including ASCs, in counties under 100,000 people or small towns; Clark and Washoe counties are exempt.","source":"https://rpcconsulting.com/certificate-of-need/nevada/"},"OH":{"tier":"limited","note":"CON applies only to long-term care beds and facilities.","source":"https://odh.ohio.gov/know-our-programs/certificate-of-need/certificate-of-need"},"OK":{"tier":"limited","note":"CON covers long-term care facilities and psychiatric and chemical dependency beds; hospitals and ASCs are not covered.","source":"https://rpcconsulting.com/certificate-of-need/oklahoma/"},"OR":{"tier":"limited","note":"CON is required only for new hospitals and new skilled nursing or intermediate care facilities and services; freestanding ASCs are not listed.","source":"https://oregon.public.law/statutes/ors_442.315"},"RI":{"tier":"limited","note":"The FY2027 budget, signed June 12, 2026, removed ASCs (surgicenters and multi-practice ambulatory surgery centers) from CON; hospitals, nursing facilities, and hospice remain covered.","source":"https://www.nixonpeabody.com/insights/alerts/2026/06/26/rhode-island-updates-certificate-of-need-rules"},"SC":{"tier":"limited","note":"A 2023 law (S.164) removed ASCs and most facilities from CON immediately; hospital CON ends January 1, 2027 and nursing homes stay covered.","source":"https://www.maynardnexsen.com/publication-ambulatory-surgery-centers-sc-regulatory-updates-and-other-considerations"},"WI":{"tier":"limited","note":"No general CON; state approval is required only for nursing home and ICF/IID bed capacity.","source":"https://docs.legis.wisconsin.gov/statutes/statutes/150.pdf"},"AK":{"tier":"asc","note":"CON covers health care facilities including ambulatory surgical facilities above a capital expenditure threshold (about $1.5 million).","source":"https://health.alaska.gov/media/emnn4xnz/certificate-of-need-statutes.pdf"},"AL":{"tier":"asc","note":"CON is required to establish a new ASC or hospital, reviewed by the SHPDA CON Review Board.","source":"http://shpda.alabama.gov/documents/conforms/Rules%20and%20Regs%20with%20Appendices%2012.15.2025.pdf"},"CT":{"tier":"asc","note":"CON is required to establish an outpatient surgical facility; a 2026 overhaul (PA 26-68) moves review to a new CON panel starting July 1, 2027.","source":"https://www.pullcom.com/connecticut-health-law-blog/connecticut-con-law-overhaul-top-10-changes-health-care-providers-must-know"},"DC":{"tier":"asc","note":"CON is required for new institutional health services and health care facilities, which include ambulatory surgical facilities.","source":"https://code.dccouncil.gov/us/dc/council/code/sections/44-406"},"DE":{"tier":"asc","note":"A Certificate of Public Review is required to build or establish a health care facility, which includes freestanding surgical centers; a 2026 law eased equipment review only.","source":"https://dhss.delaware.gov/dhcc/hrb/cprpinfo/"},"GA":{"tier":"asc","note":"CON covers ASCs and hospitals; a 2024 law (HB 1339) widened exemptions for physician-owned single-specialty and some joint-venture ASCs, but multispecialty ASCs still need CON.","source":"https://natlawreview.com/article/modifications-georgia-certificate-need-statute"},"HI":{"tier":"asc","note":"CON covers new health care facilities and services including ASCs; 2026 exemption proposals did not remove ASCs.","source":"https://health.hawaii.gov/shpda/certificate-of-need/"},"IA":{"tier":"asc","note":"CON covers new institutional health services including ASCs; a 2024 law exempted cosmetic and plastic surgery at ASCs and a 2026 law (HF 2635) raised thresholds.","source":"https://www.legis.iowa.gov/docs/publications/LGR/91/attachments/HF2635.html"},"IL":{"tier":"asc","note":"A Health Facilities and Services Review Board permit is required to establish an ambulatory surgical treatment center.","source":"https://hfsrb.illinois.gov/con-program.html"},"KY":{"tier":"asc","note":"CON is required to establish an ambulatory surgical center, with a nonsubstantive review path for some physician-office ASCs.","source":"https://apps.legislature.ky.gov/law/kar/titles/900/006/075/"},"MA":{"tier":"asc","note":"A Determination of Need is required to establish a freestanding ambulatory surgery center, with limited exceptions.","source":"https://www.sec.state.ma.us/reg_pub/pdf/911/e105100.pdf"},"MD":{"tier":"asc","note":"CON is required for ambulatory surgical facilities with three or more operating rooms; smaller centers receive a coverage determination instead.","source":"https://mhcc.maryland.gov/healthcare-communities/state-health-planning-and-certificate-need-con/ambulatory-surgery"},"ME":{"tier":"asc","note":"CON covers new health care facilities including ambulatory surgical facilities above a capital cost threshold, which a 2026 law (LD 1890) raised and indexed to inflation.","source":"https://legislature.maine.gov/statutes/22/title22sec328.html"},"MI":{"tier":"asc","note":"CON is required to initiate surgical services, including freestanding surgical outpatient facilities; a 2026 law exempted outpatient imaging only.","source":"https://www.michigan.gov/lara/bureau-list/bchs/providers/fsof"},"MS":{"tier":"asc","note":"CON is required to establish an ambulatory surgical facility or begin new ambulatory surgery services.","source":"https://www.law.cornell.edu/regulations/mississippi/15-Miss-Code-R-SS-8-90-07-701-02"},"NC":{"tier":"asc","note":"CON covers ASCs statewide except qualified urban ASCs in large counties exempt since November 2025 under the 2023 law (HB 76); a 2026 full ASC repeal bill (S 1040) has not passed.","source":"https://ncleg.gov/BillLookUp/2025/S1040"},"NY":{"tier":"asc","note":"Article 28 CON approval from the Department of Health and PHHPC is required to establish an ambulatory surgery center.","source":"https://www.health.ny.gov/facilities/cons/more_information/"},"TN":{"tier":"asc","note":"CON still applies to new ASCs until December 1, 2027 under a 2024 law; a 2026 law phases out hospital CON by 2030.","source":"https://ascnews.com/2026/04/tennessee-lawmakers-continue-to-rewrite-states-certificate-of-need-framework/"},"VA":{"tier":"asc","note":"A Certificate of Public Need is required to establish a medical care facility, including outpatient surgical hospitals and ASCs.","source":"https://www.cblaw.com/virginia-certificate-of-public-need-overview"},"VT":{"tier":"asc","note":"CON covers ASCs, but a 2025 law (Act 15) set a $10 million capital threshold for ASC projects that had previously been reviewed at any cost.","source":"https://legislature.vermont.gov/Documents/2026/Docs/ACTS/ACT015/ACT015%20As%20Enacted.pdf"},"WA":{"tier":"asc","note":"CON is required to establish an ambulatory surgical facility, reviewed under WAC 246-310-270.","source":"https://app.leg.wa.gov/wac/default.aspx?cite=246-310-270"},"WV":{"tier":"asc","note":"CON is required to establish an ambulatory surgical center; a 2023 law removed CON for most hospital-campus services, and a 2026 full repeal bill stalled in committee.","source":"https://code.wvlegislature.gov/16-2D-8/"}}},"hospitals":[{"id":"010001","n":"Southeast Health Medical Center","c":"Dothan","s":"AL","z":"36301","f":[26,15790,84395],"o5":[42,10806,74805],"o6":[12,14755,120095],"cq":[3.8,0],"rq":[6.4,0],"star":4,"own":"Government","t":"Acute","beds":420,"ru":"U","la":31.1405,"lo":-85.4091,"a10":5,"a25":5,"o10":2,"o25":2,"near":0,"cbsa":"20020","fips":"01069","wi":0.8573,"hr":{"knee":10917,"hip":10917,"shoulder":15582}},{"id":"010005","n":"Marshall Medical Centers South Campus","c":"Boaz","s":"AL","z":"35957","f":[31,14010,31769],"o5":[86,10900,26804],"o6":[23,14225,42382],"cq":[5,0],"rq":[6,0],"star":3,"own":"Government","t":"Acute","beds":240,"ru":"R","la":34.1962,"lo":-86.1969,"a10":0,"a25":2,"o10":0,"o25":1,"near":18.2,"cbsa":"01","fips":"01095","wi":0.7894,"hr":{"knee":10431,"hip":10431,"shoulder":14888}},{"id":"010006","n":"North Alabama Medical Center","c":"Florence","s":"AL","z":"35630","k":[19,13112,75607],"f":[32,14198,64985],"o5":[140,10657,56626],"o6":[21,14587,63533],"cq":[4.8,0],"rq":[5.1,0],"star":2,"own":"For-profit","t":"Acute","beds":338,"ru":"U","la":34.8252,"lo":-87.6598,"a10":3,"a25":4,"o10":1,"o25":1,"near":0,"cbsa":"22520","fips":"01077","wi":0.798,"hr":{"knee":10493,"hip":10493,"shoulder":14975}},{"id":"010011","n":"St Vincent's East","c":"Birmingham","s":"AL","z":"35235","f9":[11,20380,73099],"f":[18,15433,56817],"o5":[32,10684,48783],"star":3,"own":"Nonprofit","t":"Acute","beds":362,"ru":"U","la":33.6153,"lo":-86.6454,"a10":1,"a25":14,"o10":1,"o25":6,"near":0,"cbsa":"13820","fips":"01073","wi":0.8173,"hr":{"knee":10631,"hip":10631,"shoulder":15173}},{"id":"010012","n":"Dekalb Regional Medical Center","c":"Fort 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Hospital","c":"Sheffield","s":"AL","z":"35660","f":[17,13745,36575],"o5":[91,10568,25913],"cq":[5.6,0],"rq":[7.3,0],"star":2,"own":"Government","t":"Acute","beds":185,"ru":"U","la":34.7584,"lo":-87.6965,"a10":4,"a25":4,"o10":1,"o25":1,"near":5.1,"cbsa":"22520","fips":"01033","wi":0.7894,"hr":{"knee":10431,"hip":10431,"shoulder":14888}},{"id":"010023","n":"Baptist Medical Center South","c":"Montgomery","s":"AL","z":"36116","k":[32,14717,44749],"f9":[11,21806,65120],"f":[33,16740,39615],"o5":[260,10259,36012],"o6":[35,14816,45780],"cq":[4.3,0],"rq":[5.3,0],"star":2,"own":"Government","t":"Acute","beds":432,"ru":"U","la":32.2716,"lo":-86.2193,"a10":4,"a25":4,"o10":2,"o25":2,"near":6.1,"cbsa":"33860","fips":"01101","wi":0.8259,"hr":{"knee":10693,"hip":10693,"shoulder":15261}},{"id":"010024","n":"Jackson Hospital & Clinic Inc","c":"Montgomery","s":"AL","z":"36106","f":[18,13900,63282],"o5":[83,10379,48438],"star":2,"own":"Nonprofit","t":"Acute","beds":344,"ru":"U","la":32.3534,"lo":-86.257,"a10":4,"a25":4,"o10":2,"o25":2,"near":0,"cbsa":"33860","fips":"01101","wi":0.8072,"hr":{"knee":10559,"hip":10559,"shoulder":15070}},{"id":"010029","n":"East Alabama Medical Center","c":"Opelika","s":"AL","z":"36801","k":[160,15074,30586],"f":[35,15078,40633],"o5":[45,10963,24862],"o6":[22,15185,22212],"cq":[3.1,0],"rq":[5.3,0],"star":3,"own":"Government","t":"Acute","beds":429,"ru":"U","la":32.7025,"lo":-85.3855,"a10":0,"a25":12,"o10":0,"o25":2,"near":11.9,"cbsa":"12220","fips":"01081","wi":0.8334,"hr":{"knee":10746,"hip":10746,"shoulder":15337}},{"id":"010033","n":"University Of Alabama Hospital","c":"Birmingham","s":"AL","z":"35233","k":[24,27608,103696],"sh":[21,21349,99494],"f9":[16,70573,152357],"f":[27,26477,121074],"o5":[167,10975,67902],"o6":[50,14971,94641],"cq":[7.1,-1],"rq":[8.1,-1],"star":2,"own":"Government","t":"Acute","beds":1157,"ru":"U","la":33.5092,"lo":-86.8014,"a10":11,"a25":15,"o10":4,"o25":7,"near":0,"cbsa":"13820","fips":"01073","wi":0.8173,"hr":{"knee":10631,"hip":10631,"shoulder":15173}},{"id":"010035","n":"Cullman Regional Medical Center","c":"Cullman","s":"AL","z":"35058","f":[23,16431,64784],"o5":[70,11579,61926],"cq":[5.1,0],"star":2,"own":"Government","t":"Acute","beds":115,"ru":"R","la":34.2368,"lo":-86.7302,"a10":1,"a25":2,"o10":1,"o25":1,"near":6.1,"cbsa":"01","fips":"01043","wi":0.8908,"hr":{"knee":11157,"hip":11157,"shoulder":15924}},{"id":"010036","n":"Andalusia 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