Raw Average Raw Cost. Cost

Transcription

1 Average StDev Claims with s Capped at old Average Stable Weight 001 Craniotomy Age >17 W CC ,256 13,023 26,840 12, NJ_MK , Craniotomy Age >17 W/O CC ,657 9,681 19,311 8, NJ_MK , Carpal Tunnel Release NY_AP , Periph & Cranial Nerve & Other Nerv Syst Proc W CC 13-29,773 21,377 28,050 16, NJ_Mix , Periph & Cranial Nerve & Other Nerv Syst Proc W/O CC 3-20,786 8,272 20,786 8, NY_AP , Spinal Disorders & Injuries 4-3,129 1,747 3,129 1, NY_AP , Nervous System Neoplasms W CC ,559 7,239 9,068 5, NJ_MK , Nervous System Neoplasms W/O CC ,442 8,335 9,332 8, NY_AP , Degenerative Nervous System Disorders 53-12,369 12,646 11,726 10, NJ_MK , Multiple Sclerosis & Cerebellar Ataxia 42-8,304 7,886 7,722 5, NJ_MK , Stroke W Infarct ,833 10,579 12,207 8, NJ_MK , Nonspecific CVa & Precerebral Occlusion W/O Infarct 3-6,837 4,161 6,837 4, NY_AP , Nonspecific Cerebrovascular Disorders W CC 15-8,807 6,381 8,507 5, NJ_Mix , Nonspecific Cerebrovascular Disorders W/O CC 5-7,612 5,599 7,612 5, NY_AP , Cranial & Peripheral Nerve Disorders W CC 59-8,796 5,539 8,552 4, NJ_MK , Cranial & Peripheral Nerve Disorders W/O CC ,121 8,431 7,364 6, NJ_Mix , Viral Meningitis 28-3,927 1,495 3,843 1, NJ_MK , Hypertensive Encephalopathy 2-6,367 1,062 6,367 1, NJ_Mix , Nontraumatic Stupor & Coma 3 1 4,154 3,324 4,154 3, NY_AP , Other Disorders of Nervous System W CC ,513 4,229 6,404 3, NJ_MK , Other Disorders of Nervous System W/O CC 22-8,183 9,557 7,411 6, NJ_Mix , Retinal Procedures NY_AP , Orbital Procedures 2-11,336 1,461 11,336 1, NJ_Mix , Primary Iris Procedures NY_AP , Lens Procedures With or Without Vitrectomy NY_AP , Extraocular Procedures Except Orbit Age >17 1-8,454-8, NJ_Mix , Extraocular Procedures Except Orbit Age < NY_AP , Intraocular Procedures Except Retina, Iris & Lens NY_AP , Hyphema 1-10,482-10, NY_AP , Acute Major Eye Infections 15-4,664 2,053 4,664 2, NJ_MK , Neurological Eye Disorders 4-7,016 2,944 7,016 2, NJ_Mix , Other Disorders of the Eye Age >17 W CC 7-7,244 3,644 7,244 3, NJ_Mix , Other Disorders of the Eye Age >17 W/O CC 6-3,848 2,578 3,848 2, NJ_Mix , Other Disorders of the Eye Age < , , NJ_MK , Major Head & Neck Procedures Except for Malignancy NY_AP , Sialoadenectomy 1-6,132-6, NJ_Mix , Salivary Gland Procedures Except Sialoadenectomy NY_AP , Cleft Lip & Palate Repair 6-6,695 2,146 6,695 2, NJ_MK , Sinus & Mastoid Procedures Age > NY_AP , Sinus & Mastoid Procedures Age < ,534-13, NY_AP , Miscellaneous Ear, Nose, Mouth & Throat Procedures 2-5, , NY_AP , Rhinoplasty NY_AP , T&A Proc, Except Tonsillectomy &/or Adenoidect Only, Age >17 5-6,955 5,394 6,955 5, NJ_Mix , T&A Proc, Except Tonsillectomy &/or Adenoidect Only, Age <18 4-6,731 2,000 6,731 2, NY_AP , Tonsillectomy &/or Adenoidectomy Only, Age > ,445-10, NY_AP , Tonsillectomy &/or Adenoidectomy Only, Age <18 4-4, , NY_AP , Myringotomy W Tube Insertion Age >17 1-7,417-7, NY_AP , Myringotomy W Tube Insertion Age <18 1-3,235-3, NY_AP , Other Ear, Nose, Mouth & Throat O.R. Procedures 4-10,789 10,052 10,789 10, NY_AP , Ear, Nose, Mouth & Throat Malignancy 13-10,241 5,685 10,034 5, NY_AP , Dysequilibrium 17-4,172 1,957 4,131 1, NJ_MK , Epistaxis 7-3,985 2,253 3,985 2, NJ_Mix , Epiglottitis NY_AP , Otitis Media & URI Age >17 W CC 21-6,482 5,613 6,113 4, NJ_Mix , Otitis Media & URI Age >17 W/O CC 23-2,836 1,606 2,799 1, NJ_MK ,000

2 Average StDev Claims with s Capped at old Average Stable Weight 070 Otitis Media & URI Age < ,935 1,956 2,808 1, NJ_MK , Laryngotracheitis ,487 2,100 2,268 1, NJ_Mix , Nasal Trauma & Deformity 1-7,509-7, NJ_Mix , Other Ear, Nose, Mouth & Throat Diagnoses Age >17 8-7,300 4,380 7,300 4, NJ_Mix , Other Ear, Nose, Mouth & Throat Diagnoses Age < ,971 2,014 3,913 1, NJ_MK , Major Chest Procedures 34-20,041 20,868 18,224 13, NJ_MK , Other Resp System O.R. Procedures W CC ,791 8,829 18,791 8, NJ_MK , Other Resp System O.R. Procedures W/O CC 5-11,148 6,216 11,148 6, NJ_Mix , Pulmonary Embolism ,402 5,676 9,170 5, NJ_MK , Respiratory Infections & Inflammations Exc Simple Pneumonia Age > ,342 7,745 9,824 6, NJ_MK , Respiratory Infections & Inflammations Exc Simple Pneumonia Age > ,031 5,101 6,801 4, NJ_Mix , Respiratory Neoplasms 68-11,046 7,902 10,617 6, NJ_MK , Major Chest Trauma W CC 1-2,577-2, NY_AP , Major Chest Trauma W/O CC 1-1,343-1, NY_AP , Pleural Effusion W CC ,614 4,151 6,426 3, NJ_Mix , Pleural Effusion W/O CC NY_AP , Pulmonary Edema & Respiratory Failure ,166 14,031 10,957 8, NJ_MK , Chronic Obstructive Pulmonary Disease ,610 4,814 6,290 3, NJ_MK , Simple Pneumonia & Pleurisy Age >17 W CC ,839 5,072 7,570 4, NJ_MK , Simple Pneumonia & Pleurisy Age >17 W/O CC 110-7,029 6,559 6,631 4, NJ_MK , Interstitial Lung Disease W CC 11-10,788 8,174 10,745 8, NY_AP , Interstitial Lung Disease W/O CC 2-4, , NY_AP , Pneumothorax W CC 10-7,364 2,353 7,298 2, NJ_MK , Pneumothorax W/O CC 5-4,769 1,596 4,769 1, NJ_Mix , Bronchitis & Asthma Age >17 W CC 107-6,103 3,960 5,892 3, NJ_MK , Bronchitis & Asthma Age >17 W/O CC 103-4,347 2,522 4,213 2, NJ_MK , Respiratory Signs & Symptoms W CC ,372 4,561 6,117 3, NJ_MK , Respiratory Signs & Symptoms W/O CC 31-3,679 2,687 3,574 2, NJ_MK , Other Respiratory System Diagnoses W CC 14-6,848 6,141 6,547 5, NJ_Mix , Other Respiratory System Diagnoses W/O CC ,453 3,763 3,037 2, NJ_Mix , Heart Transplant or Implant of Heart Assist System 3-240, , , , NY_AP , Cardiac Valve & Other Major Cardiothoracic Proc W Cardiac Cath 5-67,482 39,092 67,482 39, NJ_Mix , Cardiac Valve & Other Major Cardiothoracic Proc W/O Cardiac Cath 14-45,528 16,468 45,206 15, NJ_MK , Coronary Bypass W PTCA 3-44,367 8,579 44,367 8, NJ_Mix , Coronary Bypass W/O PTCA W Cardiac Cath 24-38,531 11,506 38,531 11, NJ_MK , Other Cardiothoracic Proc W/O PDX Congenital Anomaly 3-42,007 5,862 42,007 5, NJ_Mix , Coronary Bypass W/O PTCA W/O Cardiac Cath 18-30,425 11,563 30,220 11, NJ_MK , Major Cardiovascular Procedures W CC 13-28,756 16,016 28,756 16, NJ_Mix , Major Cardiovascular Procedures W/O CC ,913 13,676 16,913 13, NJ_Mix , Percutaneous Cardiovascular Proc W/O AMI, Heart Failure or Shock ,324 6,594 14,155 6, NJ_MK , Amputation for Circ System Disord Except Upper Limb & Toe 12-27,792 19,415 26,678 16, NJ_Mix , Upper Limb & Toe Amputation for Circ System Disorders 4-16,378 6,482 16,378 6, NJ_Mix , Prm Card Pacem Impl W AMI/HF/Shock or AICD Lead or Gnrtr Proc 3-27,482 9,589 27,482 9, NY_AP , Other Permanent Cardiac Pacemaker Implant 26-21,077 5,879 21,077 5, NJ_MK , Cardiac Pacemaker Revision Except Device Replacement 5-6,035 1,908 6,035 1, T-Test - NJ_MK , Cardiac Pacemaker Device Replacement 2-7, , NY_AP , Vein Ligation & Stripping 1-7,265-7, NY_AP , Other Circulatory System O.R. Procedures 6-11,712 2,764 11,712 2, NJ_MK , Circulatory Disorders W AMI & Major Comp, Discharged Alive ,715 15,614 16,485 11, NJ_MK , Circulatory Disorders W AMI W/O Major Comp, Discharged Alive ,174 9,554 11,354 6, NJ_MK , Circulatory Disorders W AMI, Expired 12-33,844 32,402 33,301 31, NY_AP , Circulatory Disord Except AMI, W Card Cath & Complex Diag ,681 6,878 10,214 5, NJ_MK , Circulatory Disord Except AMI, W Card Cath W/O Complex Diag ,800 6,409 9,377 4, NJ_MK , Acute & Subacute Endocarditis ,854 9,130 14,854 9, NJ_Mix , Heart Failure & Shock ,546 8,507 8,135 5, NJ_MK ,219

3 Average StDev Claims with s Capped at old Average Stable Weight 128 Deep Vein Thrombophlebitis 4-5,706 2,395 5,706 2, NY_AP , Cardiac Arrest, Unexplained NY_AP , Peripheral Vascular Disorders W CC 99-8,043 7,015 7,547 4, NJ_MK , Peripheral Vascular Disorders W/O CC ,565 2,715 4,482 2, NJ_MK , Atherosclerosis W CC ,566 3,809 6,447 3, NJ_MK , Atherosclerosis W/O CC ,525 2,470 4,525 2, NJ_MK , Hypertension 58-5,635 3,475 5,477 3, NJ_MK , Cardiac Congenital & Valvular Disorders Age >17 W CC 2-4, , NY_AP , Cardiac Congenital & Valvular Disorders Age >17 W/O CC 1-1,632-1, NY_AP , Cardiac Congenital & Valvular Disorders Age < ,479 6,494 9,479 6, NY_AP , Cardiac Arrhythmia & Conduction Disorders W CC ,870 5,309 7,672 4, NJ_MK , Cardiac Arrhythmia & Conduction Disorders W/O CC ,280 4,262 4,912 3, NJ_MK , Angina Pectoris ,472 2,348 4,318 1, NJ_MK , Syncope & Collapse W CC ,993 3,920 5,742 3, NJ_MK , Syncope & Collapse W/O CC 59-5,404 3,128 5,274 2, NJ_MK , Chest Pain ,848 2,992 4,701 2, NJ_MK , Other Circulatory System Diagnoses W CC 30-7,625 5,390 7,250 4, NJ_MK , Other Circulatory System Diagnoses W/O CC 7-4,371 1,769 4,371 1, NJ_Mix , Rectal Resection W CC 5-19,154 8,362 19,154 8, NY_AP , Rectal Resection W/O CC 2-19,148 3,285 19,148 3, NJ_Mix , Major Small & Large Bowel Procedures W CC 47-21,224 8,920 20,931 8, NJ_MK , Major Small & Large Bowel Procedures W/O CC 13-13,937 9,516 13,274 7, NJ_Mix , Peritoneal Adhesiolysis W CC 9-20,958 14,371 20,958 14, NJ_Mix , Peritoneal Adhesiolysis W/O CC 9-9,018 3,990 9,018 3, NJ_Mix , Minor Small & Large Bowel Procedures W CC 4-14,385 6,614 14,385 6, NY_AP , Minor Small & Large Bowel Procedures W/O CC 3-11,852 1,646 11,852 1, NJ_Mix , Stomach, Esophageal & Duodenal Procedures Age >17 W CC 14-21,094 9,685 21,094 9, NJ_MK , Stomach, Esophageal & Duodenal Procedures Age >17 W/O CC 7-13,101 5,353 13,101 5, NJ_Mix , Stomach, Esophageal & Duodenal Procedures Age < ,081 2,466 4,934 2, NJ_MK , Anal & Stomal Procedures W CC 8-13,114 6,418 13,111 6, NJ_Mix , Anal & Stomal Procedures W/O CC 7-7,023 4,204 7,023 4, NJ_Mix , Hernia Procedures Except Inguinal & Femoral Age >17 W CC 11-11,494 7,792 11,125 6, NJ_Mix , Hernia Procedures Except Inguinal & Femoral Age >17 W/O CC 3-5,976 1,590 5,976 1, NJ_Mix , Inguinal & Femoral Hernia Procedures Age >17 W CC 1-5,165-5, NJ_Mix , Inguinal & Femoral Hernia Procedures Age >17 W/O CC NJ_Mix , Hernia Procedures Age < ,134 1,970 4,088 1, NJ_MK , Appendectomy W Complicated Principal Diag W CC 10-10,538 3,562 10,529 3, NJ_MK , Appendectomy W Complicated Principal Diag W/O CC 18-7,929 4,429 7,685 3, NJ_MK , Appendectomy W/O Complicated Principal Diag W CC 8-10,374 9,931 9,722 8, NJ_Mix , Appendectomy W/O Complicated Principal Diag W/O CC 31-4,726 1,724 4,630 1, NJ_MK , Mouth Procedures W CC 1-2,245-2, NY_AP , Mouth Procedures W/O CC 2-8,003 2,533 8,003 2, NJ_Mix , Other Digestive System O.R. Procedures W CC 6-15,836 4,296 15,836 4, NJ_MK , Other Digestive System O.R. Procedures W/O CC 1-9,098-9, NJ_Mix , Digestive Malignancy W CC 48-13,165 10,809 12,343 8, NJ_MK , Digestive Malignancy W/O CC 3-9,529 6,691 9,529 6, NY_AP , G.I. Hemorrhage W CC ,594 6,423 8,233 4, NJ_MK , G.I. Hemorrhage W/O CC 65-5,657 3,310 5,504 2, NJ_MK , Complicated Peptic Ulcer 8 1 8,186 1,573 8,186 1, NJ_MK , Uncomplicated Peptic Ulcer W CC 4-8,189 3,329 8,189 3, NJ_Mix , Uncomplicated Peptic Ulcer W/O CC 4-4,439 1,155 4,439 1, NJ_Mix , Inflammatory Bowel Disease ,840 5,088 6,557 4, NJ_MK , G.I. Obstruction W CC 47-7,097 4,864 6,812 3, NJ_MK , G.I. Obstruction W/O CC 27-6,566 4,933 6,220 3, NJ_MK , Esophagitis, Gastroent & Misc Digest Disord Age >17 W CC 117-7,584 7,619 7,010 4, NJ_MK ,000

4 Average StDev Claims with s Capped at old Average Stable Weight 183 Esophagitis, Gastroent & Misc Digest Disord Age >17 W/O CC ,620 2,510 4,503 2, NJ_MK , Dental & Oral Dis Except Extractions & Restorations, Age > ,813 5,341 5,400 4, NJ_Mix , Dental & Oral Dis Except Extractions & Restorations, Age < ,402 3,430 3,040 2, NY_AP , Dental Extractions & Restorations 3-5, , NJ_Mix , Other Digestive System Diagnoses Age >17 W CC ,262 4,114 6,050 3, NJ_MK , Other Digestive System Diagnoses Age >17 W/O CC 40-3,705 2,142 3,621 1, NJ_MK , Pancreas, Liver & Shunt Procedures W CC 7-36,855 19,360 36,855 19, NJ_Mix , Pancreas, Liver & Shunt Procedures W/O CC 1-17,628-17, NJ_Mix , Biliary Tract Proc Except Only Cholecyst W or W/O C.D.E. W CC 3-23,477 9,542 23,477 9, NY_AP , Biliary Tract Proc Except Only Cholecyst W or W/O C.D.E. W/O CC 3-21,134 6,422 21,134 6, NJ_Mix , Cholecystectomy W C.D.E. W CC 1-24,629-24, NJ_Mix , Cholecystectomy W C.D.E. W/O CC 2-22,831 11,282 22,831 11, NY_AP , Cholecystectomy W/O C.D.E. W CC 8-11,638 3,901 11,638 3, NJ_MK , Cholecystectomy W/O C.D.E. W/O CC 9-13,300 8,061 13,300 8, NJ_Mix , Hepatobiliary Diagnostic Procedure for Malignancy 1-13,254-13, NY_AP , Hepatobiliary Diagnostic Procedure for Non-Malignancy 1-13,433-13, NY_AP , Other Hepatobiliary or Pancreas O.R. Procedures ,176 14,987 21,176 14, NY_AP , Cirrhosis & Alcoholic Hepatitis ,227 9,708 7,313 5, NJ_MK , Malignancy of Hepatobiliary System or Pancreas ,911 10,644 11,089 8, NJ_MK , Disorders of Pancreas Except Malignancy ,278 4,301 6,038 3, NJ_MK , Disorders of Liver Except Malig, Cirr, Alc Hepa W CC ,488 7,600 6,858 5, NJ_MK , Disorders of Liver Except Malig, Cirr, Alc Hepa W/O CC 12-4,154 2,623 4,030 2, NJ_Mix , Disorders of the Biliary Tract W CC ,855 8,338 8,287 6, NJ_MK , Disorders of the Biliary Tract W/O CC 23-5,470 3,265 5,452 3, NJ_MK , Maj Joint & Limb Reattach Proc of Low Ext, Exc Hip, Exc for Comp 24-21,882 14,331 21,132 12, NJ_MK , Hip & Femur Procedures Except Major Joint Age >17 W CC 24-21,418 21,941 19,403 14, NJ_Mix , Hip & Femur Procedures Except Major Joint Age >17 W/O CC ,563 9,268 15,556 9, NJ_Mix , Hip & Femur Procedures Except Major Joint Age < ,467 21,843 15,264 14, NY_AP , Amputation for Musculoskelet System & Conn Tissue Disorders 12-8,781 3,113 8,781 3, NJ_MK , Biopsies of Musculoskeletal System & Connective Tissue ,023 13,757 21,023 13, NJ_Mix , Wnd Debrid & Skin Grft Exc Opn Wnd, for Ms & Conn Tis Dis, Exc Ha 16-21,421 12,441 21,005 11, NJ_Mix , Lower Extrem & Humer Proc Exc Hip, Foot, Femur Age >17 W CC 21-13,278 8,313 12,856 7, NJ_MK , Lower Extrem & Humer Proc Exc Hip, Foot, Femur Age >17 W/O CC ,626 6,896 11,353 6, NJ_MK , Lower Extrem & Humer Proc Exc Hip, Foot, Femur Age < ,598 6,761 7,173 5, NJ_Mix , Knee Procedures W CC 4-11,453 3,609 11,453 3, NY_AP , Knee Procedures W/O CC 3-10,959 7,650 10,959 7, NJ_Mix , Major Shoulder/Elbow Proc, or Oth Upper Extremity Proc W CC 4-8,939 2,749 8,939 2, NJ_Mix , Shoulder, Elbow or Forearm Proc, Exc Major Joint Proc, W/O CC 10-9,515 4,721 9,515 4, NJ_Mix , Foot Procedures 14-9,575 4,896 9,575 4, NJ_Mix , Soft Tissue Procedures W CC 11-12,884 6,260 12,774 6, NJ_Mix , Soft Tissue Procedures W/O CC 9-8,675 5,931 8,533 5, NJ_Mix , Major Thumb or Joint Proc, or Oth Hand or Wrist Proc W CC 6-8,993 4,654 8,993 4, NJ_Mix , Hand or Wrist Proc, Except Major Joint Proc, W/O CC 3-2, , NJ_Mix , Local Excision & Removal of Int Fix Devices of Hip & Femur 3-36,506 31,425 36,506 31, NY_AP , Arthroscopy NY_AP , Other Musculoskelet Sys & Conn Tiss O.R. Proc W CC 9-20,451 10,890 20,260 10, NJ_Mix , Other Musculoskelet Sys & Conn Tiss O.R. Proc W/O CC ,919 8,481 15,919 8, NJ_Mix , Fractures of Femur ,207 5,051 5,783 3, T-Test - NJ_MK , Fractures of Hip & Pelvis 5-8,823 5,217 8,823 5, NY_AP , Sprains, Strains, & Dislocations of Hip, Pelvis & Thigh 2-1, , NY_AP , Osteomyelitis 24-11,920 13,102 10,902 10, NJ_Mix , Pathological Fractures & Muscskelet & Conn Tiss Malignancy 33-10,539 9,244 9,931 7, NJ_MK , Connective Tissue Disorders W CC 22-8,795 8,991 8,199 7, NJ_Mix , Connective Tissue Disorders W/O CC ,729 5,019 8,729 5, NJ_Mix , Septic Arthritis 2 1 4,841 2,487 4,841 2, NY_AP ,000

5 Average StDev Claims with s Capped at old Average Stable Weight 243 Medical Back Problems ,807 4,428 6,584 3, NJ_MK , Bone Diseases & Specific Arthropathies W CC 13-10,954 13,822 9,428 8, NJ_Mix , Bone Diseases & Specific Arthropathies W/O CC 4-5,179 3,646 5,179 3, NJ_Mix , Non-Specific Arthropathies 5-4,158 1,649 4,158 1, NY_AP , Signs & Symptoms of Musculoskeletal System & Conn Tissue 30-6,172 10,440 5,009 4, NJ_Mix , Tendonitis, Myositis & Bursitis 20-5,412 2,945 5,306 2, NJ_MK , Malfunction, Reaction or Comp of Orthopedic Device or Procedure ,397 8,321 6,626 5, NY_AP , Fx, Sprn, Strn & Disl of Forearm, Hand, Foot Age >17 W CC 2-7, , NY_AP , Fx, Sprn, Strn & Disl of Forearm, Hand, Foot Age >17 W/O CC 4-3,109 1,196 3,109 1, NJ_Mix , Fx, Sprn, Strn & Disl of Forearm, Hand, Foot Age <18 5-4,661 3,151 4,661 3, NY_AP , Fx, Sprn, Strn & Disl of Uparm, Lowleg Ex Foot Age >17 W CC ,185 3,661 7,185 3, NJ_Mix , Fx, Sprn, Strn & Disl of Uparm, Lowleg Ex Foot Age >17 W/O CC 8-4,250 2,904 4,170 2, NJ_Mix , Fx, Sprn, Strn & Disl of Uparm, Lowleg Ex Foot Age <18 6-2,541 1,655 2,481 1, NY_AP , Other Musculoskeletal System & Connective Tissue Diagnoses 3 1 5,983 1,906 5,983 1, NJ_Mix , Total Mastectomy for Malignancy W CC 25-8,972 6,010 8,671 5, NJ_MK , Total Mastectomy for Malignancy W/O CC 29-7,159 3,652 7,085 3, NJ_MK , Subtotal Mastectomy for Malignancy W CC 6-11,714 8,402 11,714 8, NJ_Mix , Subtotal Mastectomy for Malignancy W/O CC 4-6,834 2,106 6,834 2, NJ_Mix , Breast Proc for Non-Malignancy Except Biopsy & Local Excision 4-9,625 1,835 9,625 1, NJ_Mix , Breast Biopsy & Local Excision for Non-Malignancy 3-11,147 3,328 11,147 3, NJ_Mix , Skin Graft &/or Debrid for Skn Ulcer, Cellulitis W CC 25-15,081 10,529 14,421 8, NJ_MK , Skin Graft &/or Debrid for Skn Ulcer, Cellulitis W/O CC 7-9,669 4,485 9,669 4, NJ_Mix , Skin Graft &/or Debrid Exc for Skin Ulcer, Cellulitis W CC 1-6,080-6, NY_AP , Skin Graft &/or Debrid Exc for Skin Ulcer, Cellulitis W/O CC ,775-10, NY_AP , Perianal & Pilonidal Procedures NY_AP , Skin, Subcutaneous Tissue & Breast Plastic Procedures 7-7,040 3,271 6,941 3, NY_AP , Other Skin, Subcut Tiss & Breast Proc W CC ,751 16,437 15,236 10, NJ_Mix , Other Skin, Subcut Tiss & Breast Proc W/O CC 12-6,592 4,302 6,391 3, NJ_Mix , Skin Ulcers ,731 4,626 7,633 4, NJ_MK , Major Skin Disorders W CC 7 1 7,027 3,312 7,027 3, NJ_Mix , Major Skin Disorders W/O CC 1-1,280-1, NY_AP , Malignant Breast Disorders W CC 6-9,659 5,293 9,659 5, NJ_Mix , Malignant Breast Disorders W/O CC NY_AP , Non-Malignant Breast Disorders 11-5,792 3,749 5,552 3, NJ_Mix , Cellulitis Age >17 W CC ,215 7,174 6,860 4, NJ_MK , Cellulitis Age >17 W/O CC 113-5,043 2,692 4,940 2, NJ_MK , Cellulitis Age < ,790 1,974 3,693 1, NJ_MK , Trauma to the Skin, Subcut Tiss & Breast Age >17 W CC 12-5,013 3,424 4,692 2, NJ_Mix , Trauma to the Skin, Subcut Tiss & Breast Age >17 W/O CC 6-3,477 1,258 3,477 1, NJ_Mix , Trauma to the Skin, Subcut Tiss & Breast Age <18 7-3,017 1,053 3,017 1, NJ_MK , Minor Skin Disorders W CC ,187 4,062 6,029 3, NJ_Mix , Minor Skin Disorders W/O CC 25-3,470 2,042 3,378 1, NJ_MK , Amputat of Low Limb for Endocrine, Nutrit, & Metabol Disorders ,153 17,875 21,029 14, NJ_MK , Adrenal & Pituitary Procedures 4-31,962 15,709 31,962 15, NJ_Mix , Skin Graft & Wound Debrid for Endoc, Nutrit & Metab Disorders 21-14,527 10,704 13,581 7, NJ_MK , Gastric Procedures for Obesity 13-11,289 3,010 11,262 2, NJ_MK , Parathyroid Procedures 4-6,008 1,409 6,008 1, NY_AP , Thyroid Procedures 12-7,482 2,306 7,482 2, NJ_MK , Thyroglossal Procedures NY_AP , Other Endocrine, Nutrit & Metab O.R. Proc W CC 15-26,286 22,763 25,081 19, NY_AP , Other Endocrine, Nutrit & Metab O.R. Proc W/O CC 1-6,292-6, NY_AP , Diabetes Age > ,914 6,552 6,505 4, NJ_MK , Diabetes Age < ,467 4,027 5,213 3, NJ_MK , Nutritional & Misc Metabolic Disorders Age >17 W CC ,184 4,709 5,868 3, NJ_MK , Nutritional & Misc Metabolic Disorders Age >17 W/O CC 54-5,303 3,750 5,070 2, NJ_MK ,000

6 Average StDev Claims with s Capped at old Average Stable Weight 298 Nutritional & Misc Metabolic Disorders Age < ,290 2,945 3,068 2, NJ_MK , Inborn Errors of Metabolism 7-8,438 6,871 8,144 6, NY_AP , Endocrine Disorders W CC 22-9,297 7,507 9,024 6, NJ_Mix , Endocrine Disorders W/O CC 5-4,518 2,374 4,518 2, NJ_Mix , Kidney Transplant 8-29,026 9,954 29,026 9, NJ_MK , Kidney And Ureter Procedures for Neoplasm 3-12,669 3,797 12,669 3, NJ_Mix , Kidney And Ureter Procedures for Non-Neoplasm W CC 22-15,783 10,343 15,204 8, NJ_MK , Kidney And Ureter Procedures for Non-Neoplasm W/O CC 13-10,111 6,097 9,597 4, NJ_Mix , Prostatectomy W CC NY_AP , Prostatectomy W/O CC NY_AP , Minor Bladder Procedures W CC 4-17,796 9,250 17,796 9, NY_AP , Minor Bladder Procedures W/O CC 3-5,650 2,538 5,650 2, NY_AP , Transurethral Procedures W CC 23-13,172 10,337 12,238 6, NJ_MK , Transurethral Procedures W/O CC 6-6,224 1,232 6,224 1, NJ_MK , Urethral Procedures Age >17 W CC 2-7,984 1,531 7,984 1, NY_AP , Urethral Procedures Age >17 W/O CC NY_AP , Urethral Procedures Age < NY_AP , Other Kidney & URInary Tract Procedures 55-17,762 11,073 17,138 8, NJ_MK , Renal Failure ,725 8,216 8,131 6, NJ_MK , Admit for Renal Dialysis 2-7,924 4,879 7,924 4, NY_AP , Kidney & URInary Tract Neoplasms W CC 6-7,614 3,055 7,614 3, NY_AP , Kidney & URInary Tract Neoplasms W/O CC 1-6,154-6, NJ_Mix , Kidney & URInary Tract Infections Age >17 W CC ,194 5,276 6,912 4, NJ_MK , Kidney & URInary Tract Infections Age >17 W/O CC 91-4,835 3,998 4,528 2, NJ_MK , Kidney & URInary Tract Infections Age < ,991 3,067 3,719 1, NJ_MK , URInary Stones W CC, &/or ESW Lithotripsy 30-5,656 3,323 5,453 2, NJ_MK , URInary Stones W/O CC 14-4,006 2,742 3,848 2, NJ_Mix , Kidney & URInary Tract Signs & Symptoms Age >17 W CC 9-7,892 8,988 7,239 7, NY_AP , Kidney & URInary Tract Signs & Symptoms Age >17 W/O CC 1-9,956-9, NY_AP , Kidney & URInary Tract Signs & Symptoms Age < NY_AP , Urethral Stricture Age >17 W CC NY_AP , Urethral Stricture Age >17 W/O CC NY_AP , Urethral Stricture Age < NY_AP , Other Kidney & URInary Tract Diagnoses Age >17 W CC ,021 8,459 9,424 6, NJ_MK , Other Kidney & URInary Tract Diagnoses Age >17 W/O CC 6-4,561 2,730 4,479 2, NJ_Mix , Other Kidney & URInary Tract Diagnoses Age < ,084 1,968 4,084 1, NY_AP , Major Male Pelvic Procedures W CC 2-21,248 2,772 21,248 2, NY_AP , Major Male Pelvic Procedures W/O CC 4-12,943 1,864 12,943 1, NJ_Mix , Transurethral Prostatectomy W CC 4-8,624 6,067 8,624 6, NY_AP , Transurethral Prostatectomy W/O CC 7-4,660 1,604 4,659 1, NJ_MK , Testes Procedures, for Malignancy NY_AP , Testes Procedures, Non-Malignancy Age >17 1-4,851-4, NJ_Mix , Testes Procedures, Non-Malignancy Age <18 2-5,076 1,186 5,076 1, NY_AP , Penis Procedures 1-18,519-18, NY_AP , Other Male Reproductive Syst O.R. Proc for Malignancy 1-11,676-11, NY_AP , Other Male Reproductive Syst O.R. Proc Except for Malignancy 2-5,548 1,796 5,548 1, NY_AP , Malignancy, Male Reproductive System, W CC 3-9,323 8,500 9,323 8, NY_AP , Malignancy, Male Reproductive System, W/O CC 1-3,919-3, NY_AP , Benign Prostatic Hypertrophy W CC 4-4,382 1,540 4,382 1, NY_AP , Benign Prostatic Hypertrophy W/O CC 1-3,306-3, NY_AP , Inflammation of the Male Reproductive System 22-6,259 2,824 6,259 2, NJ_MK , Sterilization, Male NY_AP , Other Male Reproductive System Diagnoses 3-2, , NY_AP , Pelvic Evisceration, Radical Hysterect & Radical Vulvectomy 1-11,358-11, NJ_Mix , Uterine, Adnexa Proc for Non-Ovarian/Adnexal Malignancy W CC 1-79,193-79, NY_AP ,818

7 Average StDev Claims with s Capped at old Average Stable Weight 355 Uterine, Adnexa Proc for Non-Ovarian/Adnexal Malignancy W/O CC NJ_Mix , Female Reproductive System Reconstructive Procedures 4-5,297 1,167 5,297 1, NJ_Mix , Uterine & Adnexa Proc for Ovarian or Adnexal Malignancy 2-20,553 11,789 20,553 11, NJ_Mix , Uterine & Adnexa Proc for Ca In Situ & Non-Malignancy W CC 9-8,770 2,684 8,644 2, NJ_MK , Uterine & Adnexa Proc for Ca In Situ & Non-Malignancy W/O CC 17-7,555 3,108 7,489 2, NJ_MK , Vagina, Cervix & Vulva Procedures 9-6,077 3,765 5,926 3, NJ_Mix , Laparoscopy or Incisional Tubal Interruption 8-7,241 2,240 7,241 2, NJ_MK , Endoscopic Tubal Interruption NY_AP , D&C, Conization & Radio-Implant, for Malignancy 12-8,655 5,687 8,068 3, NJ_Mix , D&C, Conization Except for Malignancy 4-4,138 1,888 4,138 1, NJ_Mix , Other Female Reproductive System O.R. Procedures 1-24,176-24, NY_AP , Malignancy, Female Reproductive System, W CC ,854 6,697 12,854 6, NY_AP , Malignancy, Female Reproductive System, W/O CC 3-3, , NY_AP , Infections, Female Reproductive System 15-4,211 1,923 4,059 1, NJ_MK , Menstrual & Other Female Reproductive System Disorders ,804 3,299 4,697 3, NJ_Mix , Cesarean Section W CC ,102 5,106 6,808 2, NJ_MK , Cesarean Section W/O CC 3, ,230 2,509 6,161 1, NJ_MK , Vaginal Delivery W Complicating Diagnoses 2, ,067 5,011 4,914 2, NJ_MK , Vaginal Delivery W/O Complicating Diagnoses 7,227-4,212 1,310 4,173 1, NJ_MK , Vaginal Delivery W Sterilization &/or D&C 266-5,840 2,065 5,755 1, NJ_MK , Vaginal Delivery W O.R. Proc Except Steril &/or D&C 65-5,390 2,610 5,248 2, NJ_MK , Postpartum & Post Abortion Diagnoses W/O O.R. Procedure ,068 11,691 5,129 5, NJ_MK , Postpartum & Post Abortion Diagnoses W O.R. Procedure 19-8,956 9,351 7,967 5, NJ_Mix , Ectopic Pregnancy 93-5,374 2,573 5,282 2, NJ_MK , Threatened Abortion ,941 4,157 3,592 2, NJ_MK , Abortion W/O D&C 88-3,234 2,043 3,129 1, NJ_MK , Abortion W D&C, Aspiration Curettage or Hysterotomy 101-4,801 4,467 4,406 2, NJ_MK , False Labor 15-2,449 1,442 2,403 1, NY_AP , Splenectomy Age > ,461 9,353 18,461 9, NY_AP , Splenectomy Age < ,089-11, NY_AP , Other O.R. Procedures of Blood And Blood Forming Organs 2-20,999 14,351 20,999 14, NJ_Mix , Red Blood Cell Disorders Age > ,982 5,409 6,689 4, NJ_MK , Coagulation Disorders 19-7,337 5,120 7,230 4, NJ_Mix , Reticuloendothelial & Immunity Disorders W CC 40-8,038 4,477 7,817 3, NJ_MK , Reticuloendothelial & Immunity Disorders W/O CC 24-5,589 4,500 5,243 3, NJ_MK , Lymphoma & Non-Acute Leukemia W Other O.R. Proc W CC 5-14,242 10,149 14,242 10, T-Test - NJ_MK , Lymphoma & Non-Acute Leukemia W Other O.R. Proc W/O CC ,991 11,243 14,704 10, NJ_Mix , Lymphoma & Non-Acute Leukemia W CC 18-13,155 12,026 12,501 10, NJ_Mix , Lymphoma & Non-Acute Leukemia W/O CC ,898 5,800 7,612 5, NJ_Mix , Myeloprolif Disord or Poor Diff Neopl W Maj O.R.Proc W CC 2-34,653 26,717 34,653 26, NY_AP , Myeloprolif Disord or Poor Diff Neopl W Maj O.R.Proc W/O CC 1-7,547-7, NJ_Mix , Myeloprolif Disorders or Poorly Diff Neoplasms W Other Procedure 4-14,284 4,425 14,284 4, NJ_Mix , Radiotherapy 5-8,624 2,689 8,624 2, NJ_Mix , Chemotherapy 291-7,734 5,052 7,487 4, NJ_MK , Other Myeloprolif Dis or Poor Diff Neopl Diag W CC 6-10,183 1,774 10,183 1, NJ_MK , Other Myeloprolif Dis or Poor Diff Neopl Diag W/O CC 3-5,502 4,287 5,502 4, NY_AP , Septicemia Age < ,490 20,341 7,269 10, NY_AP , Postoperative & Post-Traumatic Infections 49-8,846 9,113 8,091 6, NJ_MK , Fever of Unknown Origin Age >17 W CC 21-8,801 5,890 8,419 4, NJ_MK , Fever of Unknown Origin Age >17 W/O CC 16-3,654 2,224 3,482 1, NJ_MK , Viral Illness Age > ,479 7,328 5,738 4, NJ_Mix , Viral Illness & Fever of Unknown Origin Age < ,040 1,775 2,917 1, NJ_MK , Other Infectious & Parasitic Diseases Diagnoses ,593 5,075 6,329 4, NJ_MK , O.R. Procedure W Principal Diagnoses of Mental Illness 16-25,909 20,441 25,065 18, NJ_Mix , Acute Adjustment Reaction & Psychosocial Dysfunction 59-4,822 2,912 4,661 2, NJ_MK ,000

8 Average StDev Claims with s Capped at old Average Stable Weight 426 Depressive Neuroses ,295 4,693 5,012 2, NJ_MK , Neuroses Except Depressive 264-5,468 4,130 5,165 2, NJ_MK , Disorders of Personality & Impulse Control ,759 4,587 6,433 3, NJ_MK , Organic Disturbances & Mental Retardation 42-8,303 12,788 7,110 6, NY_AP , Psychoses 5, ,361 7,814 7,957 5, NJ_MK , Childhood Mental Disorders 617-7,272 6,208 6,831 4, NJ_MK , Other Mental Disorder Diagnoses 4-4, , NY_AP , Skin Grafts for Injuries 3-58,080 31,048 58,080 31, NY_AP , Wound Debridements for Injuries Except Open Wounds 5-26,943 22,882 26,943 22, NY_AP , Hand Procedures for Injuries NJ_Mix , Other O.R. Procedures for Injuries W CC 9-11,340 3,030 11,340 3, NJ_MK , Other O.R. Procedures for Injuries W/O CC ,031 2,762 5,933 2, NJ_MK , Injuries to Unspecified or Multiple Sites Age >17 W CC 5-6,830 2,938 6,830 2, NY_AP , Injuries to Unspecified or Multiple Sites Age >17 W/O CC 3-4,159 1,924 4,159 1, NJ_Mix , Injuries to Unspecified or Multiple Sites Age <18 3-2, , NY_AP , Allergic Reactions Age >17 5-2,913 1,075 2,913 1, NJ_Mix , Allergic Reactions Age <18 1-1,595-1, NY_AP , Poisoning & Toxic Effects of Drugs Age >17 W CC ,303 6,275 6,953 4, NJ_MK , Poisoning & Toxic Effects of Drugs Age >17 W/O CC ,711 3,567 4,466 2, NJ_MK , Poisoning & Toxic Effects of Drugs Age < ,975 1,911 2,880 1, NJ_MK , Complications of Treatment W CC 17-8,272 5,824 7,814 4, NJ_Mix , Complications of Treatment W/O CC 6-4,574 2,349 4,574 2, NJ_Mix , Other Injury, Poisoning & Toxic Effect Diagnosis W CC 7 1 5,279 3,725 5,279 3, NY_AP , Other Injury, Poisoning & Toxic Effect Diagnosis W/O CC 10-4,438 5,085 4,013 3, NJ_Mix , O.R. Proc W Diagnoses of Other Contact W Health Services 5-20,227 19,625 20,141 19, NY_AP , Rehabilitation ,905 24,854 40,905 24, NY_AP , Signs & Symptoms W CC ,735 23,981 6,972 8, NJ_MK , Signs & Symptoms W/O CC 28-4,874 2,914 4,798 2, NJ_MK , Aftercare W History of Malignancy as Secondary Diagnosis NY_AP , Aftercare W/O History of Malignancy as Secondary Diagnosis 1-7,573-7, NY_AP , Other Factors Influencing Health Status 23-4,897 5,995 4,272 3, NJ_Mix , Extensive O.R. Procedure Unrelated to Principal Diagnosis ,721 56,350 34,755 30, NJ_MK , Principal Diagnosis Invalid as Discharge Diagnosis , Ungroupable , Bilateral or Multiple Major Joint Procs of Lower Extremity ,061 7,473 22,061 7, NJ_MK , Prostatic O.R. Procedure Unrelated to Principal Diagnosis NY_AP , Non-Extensive O.R. Procedure Unrelated to Principal Diagnosis ,985 29,407 23,538 22, NJ_MK , Other Vascular Procedures W CC 35-21,749 12,472 21,373 11, NJ_MK , Other Vascular Procedures W/O CC 14-9,658 3,285 9,658 3, NJ_MK , Liver Transplant And/Or Intestinal Transplant 7-80,675 30,729 80,675 30, NJ_Mix , Tracheostomy for Face, Mouth & Neck Diagnoses ,294 24,390 36,049 21, NJ_Mix , Major Joint & Limb Reattachment Procedures of Upper Extremity 3-10,363 3,523 10,363 3, NJ_Mix , Laparoscopic Cholecystectomy W/O C.D.E. W CC 60-11,350 5,406 11,055 4, NJ_MK , Laparoscopic Cholecystectomy W/O C.D.E. W/O CC 76-7,778 3,377 7,697 3, NJ_MK , Craniotomy W Major CC ,575 35,652 61,931 34, NJ_MK , Nervous System Procedures Except Craniotomy W Major CC 29-46,959 48,923 43,267 37, NJ_Mix , Tia, Precerebral Occlusions, Seizure & Headache W Major CC ,207 9,371 10,657 7, NJ_MK , Other Nervous System Disord Except Tia, Seizure & Headache W Majo ,468 21,487 20,217 16, NJ_MK , Eye Procedures W Major CC NY_AP , Eye Disorders W Major CC ,065 21,639 14,354 17, NY_AP , Ent & Mouth Procedures Except Major Head & Neck W Major CC 7-34,837 26,516 34,837 26, NY_AP , Major Chest Procedures W Major CC ,415 16,570 31,266 16, NJ_MK , Respiratory Procedures Except Major Chest W Major CC 48-29,607 24,709 27,859 18, NJ_MK , Respiratory Infections & Inflammations Exc Simple Pneumonia W Maj ,239 11,043 13,498 8, NJ_MK , Simple Pneumonia & Oth Respiratory Disord Exc Bronchitis, Asthma ,774 10,127 12,172 8, NJ_MK ,623