1 640 Normal Newborn, Birthweight 2500g+ $2,718 $1,658 $ Vaginal Delivery $6,410 $3,910 $2,244

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1 Fort HealthCare 611 East Sherman Avenue Fort Atkinson, WI s for 75 Most Common Types of Hospitalizations in Wisconsin: April March 2012 (Uncomplicated Cases Only) NR = No Cases Reported Rank APR-DRG* Description * Estimated s * Private Normal Newborn, Birthweight 2500g+ $2,718 $1,658 $ Vaginal Delivery $6,410 $3,910 $2, Knee Replacement $31,457 $19,189 $11, Cesarean Delivery $9,494 $5,791 $3, Pneumonia $6,485 $3,956 $2, Blood Infection/Septicemia $10,014 $6,109 $3, Heart Failure $8,178 $4,989 $2, Hip Replacement $36,802 $22,449 $12, Bipolar Disorders Psychoses Chronic Obstructive Pulmonary Disease $9,790 $5,972 $3, Heart Abnormal Rhythm and Conduction Disorders $10,436 $6,366 $3, Alchohol Abuse/Dependence $4,069 $2,482 $1, Cellulitis and Other Bacterial Skin Infections $8,572 $5,229 $3, Kidney/Urinary Tract Infection $8,751 $5,338 $3, Rehabilitation Renal Failure Major Bowel Procedures $23,215 $14,161 $8, Stroke and Precerebral Occlusion with Infarct $20,776 $12,673 $7, Angioplasty without Heart Attack Gastroenteritis $8,881 $5,417 $3, Schizophrenia Angioplasty with Heart Attack Other Digestive System Diagnoses $10,222 $6,235 $3, Depression Respiratory Infections and Inflammations $20,774 $12,672 $7,271

2 NR = No Cases Reported Rank APR-DRG* Description * Estimated s * Private Intestinal Obstruction without Surgery $7,356 $4,487 $2, Pulmonary Edema/Respiratory Failure $3,460 $2,111 $1, Poisoning of Medicinal Agents $6,812 $4,155 $2, Diabetes Disorders of Pancreas Except Malignancy $5,840 $3,562 $2, Laparoscopic Cholecystectomy $17,773 $10,842 $6, Dorsal and Lumbar Fusion Without Principal Diagnosis of Back Curvature Uterine Procedures without Tumor $17,198 $10,491 $6, Pulmonary Embolism $19,681 $12,005 $6, Signs & Symptoms $3,174 $1,936 $1, Other Back/Neck Disorders, Fractures, Injuries $9,980 $6,088 $3, Appendectomy $14,798 $9,027 $5, Seizure $8,391 $5,119 $2, Circulatory Disorders with Heart Attack Hip/Thigh Surgery with Trauma Diagnosis $24,637 $15,029 $8, Peptic Ulcer/Gastritis $14,093 $8,597 $4, Other Vascular Procedures Other Knee/Lower Leg Surgery $13,501 $8,236 $4, Diverticulitis & Diverticulosis $8,846 $5,396 $3, Other Electrolyte Disorders $10,797 $6,586 $3, Shoulder/Upper Arm, Forearm Surgery $7,468 $4,555 $2, Chest Pain with Angina Pectoris or Coronary Atherosclerosis Cardiac Catheterization with Principal Diagnosis of Ischemic Heart Disease Red Blood Cell Disorders Except Sickle Cell Anemia Crisis Other Musculoskeletal System and Connective Tissue Diagnoses $10,529 $6,423 $3,685 $10,566 $6,445 $3,698 $6,362 $3,881 $2, Fainting and Collapse $16,218 $9,893 $5, Asthma $6,035 $3,681 $2, Back/Neck Procedures Except Dorsal and Lumbar Fusion Upper Spinal Fusion Peripheral and Other Vascular Disorders $5,626 $3,432 $1,969

3 NR = No Cases Reported Rank APR-DRG* Description * Estimated s * Private Other and Unspecified Gastrointestinal Hemorrhage Extracranial Vascular Procedures Major G.I. Bacterial Infections $5,397 $3,292 $1, Chemotherapy Cardiac Catheterization without Principal Diagnosis of Ischemic Heart Disease Opioid Abuse/Dependence Postoperative and Post-Traumatic Infections Respiratory System Signs, Symptoms and Minor Diagnoses $9,227 $5,628 $3, Hypovolemia $5,532 $3,375 $1, Other Antepartum Diagnoses Neuroses Other Than Depression Chest Pain $12,033 $7,340 $4, Transient Ischemia $16,077 $9,807 $5, Abdominal Pain $9,141 $5,576 $3, Malfunctions, Reactions & Comp Of Gu Device, Graft Or Transplant Pneumothorax & Pleural Effusion $7,233 $4,412 $2, Other Disorders of Nervous System $8,262 $5,040 $2, Craniotomy Except For Trauma Pacemaker Implant without Heart Attack, Heart Failure or Shock $21,970 $13,402 $7,690 Fort HealthCare is proud of its mission to 'Improve the Health of the Community'. We strive to offer exceptional care at reasonable cost to patients and payors and believe that concerns over payment of a medical bill should never get in the way of a patient receiving excellent healthcare. Our goal is to work with each individual and offer financial aid options such as the Community Care Program and self pay discounts. For more information, please contact the Fort HealthCare Business Office at (866) This report was produced in part by using computer software created, owned and licensed by the 3M Company. All copyrights in and to the 3M APR DRG Software, and to the 3M APR DRG Classification System(s) (including the selection, coordination and arrangement of all codes) are owned by 3M. All rights reserved. s for 75 Most Common Types of Outpatient Surgical Procedures in Wisconsin: April March 2012

4 Diagnostic Colonoscopy (45378) $2,934 $1,790 $1,027 $4,744 $2,894 $1,660 Cataract Surgery with Intraocular Lens - Stage 1 (66984) Upper GI Endoscopy with Biopsy (43239) $6,914 $4,217 $2,420 $7,002 $4,271 $2,451 $2,996 $1,828 $1,049 $5,293 $3,229 $1,853 Colonoscopy and Biopsy (45380) $3,425 $2,089 $1,199 $5,397 $3,292 $1,889 Lesion Removal Colonoscopy by Snare Technique (45385) Injection into Lumbar or Sacral Area, Single Level (64483) Drain/Inject Major Joint or Bursa (20610) Injection into Paravertebral Facet Joint w Image Guidance, Lumbar or Sacral (64493) Knee Arthroscopy/Surgery with Medial or Lateral Meniscectomy (29881) Colorectal Cancer Screening; Colonscopy, Not High Risk (G0121) $4,110 $2,507 $1,438 $4,408 $2,689 $1,543 $13,059 $7,966 $4,571 $13,888 $8,472 $4,861 $2,956 $1,803 $1,034 NR NR NR Carpal Tunnel Surgery (64721) $4,960 $3,026 $1,736 $5,575 $3,401 $1,951 Uppr GI Endoscopy- Diagnostic (43235) Lesion Removal Colonoscopy by Hot Biopsy or Cautery (45384) Colorectal Cancer Screening ; Colonoscopy, High Risk (G0105) Creation of Eardrum Opening (69436) Left Heart Artery/Ventricle Angiography (93458) Removal of Tonsils And Adenoids - < Age 12 (42820) Laparoscopic Cholecystectomy (47562) Unlisted Dental Surgery Procedure (41899) Repair Initial Ingunial Hernia, > = 5 years, Reducible (49505) $2,436 $1,486 $852 $4,332 $2,643 $1,516 $3,406 $2,077 $1,192 $4,599 $2,806 $1,610 $2,952 $1,801 $1,033 NR NR NR $5,297 $3,231 $1,854 $6,848 $4,177 $2,397 $5,920 $3,611 $2,072 $6,937 $4,231 $2,428 $12,828 $7,825 $4,490 $13,606 $8,300 $4,762 $9,127 $5,568 $3,195 $9,848 $6,007 $3,447

5 Injection into Paravertebral Facet Joint w Image Guidance, Cervical or Thor (64490) After Cataract Laser Surgery (66821) Unlisted Cystourethoscopy (52000) $3,787 $2,310 $1,326 $5,332 $3,252 $1,866 Percutaneous Breast Biopsy with Device and Imaging (19103) NR NR NR $5,030 $3,068 $1,760 Hysteroscopy with Biopsy (58558) $7,691 $4,692 $2,692 $7,110 $4,337 $2,488 Destruction by Neurolytic Agent, Nerve of Lumbar or Sacral Area, Single Lev (64622) Cataract Surgery- Complex (66982) $7,758 $4,732 $2,715 NR NR NR Laparoscopic Cholecystectomy w X-ray of Liver and Bile Duct (47563) Knee Arthroscopy/Surgery w Medical and Lateral Meniscectomy (29880) Arthroscopic Rotator Cuff Repair (29827) Shoulder Arthroscopy/Surgery with Decompression (29826) Removal of Support Implant (barred wire, pin, screw, metal band, nail, rod) (20680) Uppr GI Endoscopy with Guide Wire (43248) Esophageal Endoscopy with Dilation (43249) $13,628 $8,313 $4,770 $13,881 $8,468 $4,859 $13,151 $8,022 $4,603 $13,736 $8,379 $4,808 $16,943 $10,335 $5,930 $19,052 $11,622 $6,668 $15,046 $9,178 $5,266 $15,868 $9,680 $5,554 $6,836 $4,170 $2,393 $9,520 $5,807 $3,332 $2,048 $1,250 $717 $4,399 $2,683 $1,540 $3,982 $2,429 $1,394 $4,383 $2,674 $1,534 Repair of Nasal Septum (30520) $9,021 $5,503 $3,157 $7,477 $4,561 $2,617 Removal of Tonsils (42826) $5,998 $3,659 $2,099 $7,134 $4,352 $2,497 Incision of Finger Tendon Sheath (26055) Hysteroscopy with Ablation (58563) Colonoscopy with Lesion Removal (45383) Cystourethroscopy with Lithotripsy (52353) Laparoscopic Hernia Repair - Initial (49650) $4,415 $2,693 $1,545 $5,163 $3,149 $1,807 $10,126 $6,177 $3,544 $15,816 $9,648 $5,535 $3,347 $2,041 $1,171 $3,732 $2,277 $1,306 $10,417 $6,355 $3,646 $11,557 $7,050 $4,045

6 Percutaneous Breast Biopsy with Imaging (19102) $2,345 $1,430 $821 NR NR NR Correction of Bunion (28296) $7,280 $4,441 $2,548 $9,384 $5,724 $3,284 Repair Umbilical Hernia, > = 5 Yrs - Reducible (49585) Knee Arthroscopy/Surgery with Anterior Cruciate Ligament Repair (29888) $6,751 $4,118 $2,363 $12,390 $7,558 $4,336 $18,854 $11,501 $6,599 $20,085 $12,252 $7,030 Low Back Disk Surgery (63030) Laparoscopic Appendectomy (44970) Cystourethroscopy with Stent (52332) Fragmenting of Kidney Stone (50590) Injections; Single or Multiple Trigger Points, 1 or 2 Muscles (20552) $13,672 $8,340 $4,785 $18,883 $11,518 $6,609 $5,254 $3,205 $1,839 $9,500 $5,795 $3,325 $20,354 $12,416 $7,124 $23,391 $14,268 $8,187 Removal of Adenoids (42830) $5,268 $3,214 $1,844 $5,708 $3,482 $1,998 Destruction of Premalignant Lesion (17000) Needle Biopsy of Liver (47000) $4,178 $2,549 $1,462 $5,730 $3,495 $2,005 Mastectomy, Partial (19301) NR NR NR $9,176 $5,597 $3,212 Removal of Breast Lesion (19120) $4,912 $2,996 $1,719 $5,461 $3,331 $1,911 Removal of Fluid in Abdominal Cavity (49080) Excision Breast Lesion with Preoperative Placement Radiological Marker (19125) Laparoscopy - Removal of Adnexal Structures (58661) Mohs Micrographic Tissue Removal (17311) Laparoscopy- Excision of Lesions of Ovary or Pelvic Area (58662) Debridement, Open Wound <= 20 Square Centimeters (97597) $2,010 $1,226 $703 NR NR NR $8,440 $5,148 $2,954 $7,923 $4,833 $2,773 $12,094 $7,377 $4,233 $11,795 $7,195 $4,128 $11,539 $7,039 $4,039 $14,637 $8,928 $5,123 Repair Bladder Defect (57288) $7,904 $4,821 $2,766 $11,411 $6,961 $3,994 Destruction of Benign Lesions up to 14 Lesions (17110)

7 Insertion of Central Venous Catheter >= 5 years (36569) Knee Arthroscopy/Surgery with Shaving of Cartilage (29877) Right and Left Heart Artery/Ventricle Angiography (93460) Biopsy Skin and Subcutaneous Tissue; 1 Lesion (11100) $13,267 $8,093 $4,643 NR NR NR Bone Marrow Biopsy (38221) Repair of Hammertoe (28285) $5,224 $3,186 $1,828 $8,668 $5,287 $3,034 Repair Rotator Cuff, Chronic (23412) Destruction by Neurolytic Agent w Imaging, Lumbar or Sacral (64635) Placement of Drug Eluting Stent, Single Vessel (G0290) NR NR NR $15,786 $9,629 $5,525 Remove Impacted Ear Wax (69210) $4,994 $3,046 $1,748 NR NR NR Remove Tonsils and Adenoids >= Age 12 (42821) Removal of Central Venous Device w Port or Pump (36590) $6,245 $3,809 $2,186 $6,665 $4,066 $2,333 Information about quality and safety of care for Fort HealthCare may be found at * Estimated s based on average percent of billed charges collected. * An APR-DRG (All Patient Refined Diagnosis Related Group) is a way to describe the reason for hospitalization based on the patient s medical condition, procedures performed (if any), and, in some cases, the age and/or sex of the patient. * charge means the charge is at the 50th percentile. In other words, half of the patients in this category had charges below this amount and half had charges above this amount.

1 640 Normal Newborn, Birthweight 2500g+ $3,032 $1,850 $1, Vaginal Delivery $6,350 $3,874 $2,223

1 640 Normal Newborn, Birthweight 2500g+ $3,032 $1,850 $1, Vaginal Delivery $6,350 $3,874 $2,223 Fort HealthCare 611 East Sherman Avenue Fort Atkinson, WI 53538 920-568-5000 s for 75 Most Common Types of Hospitalizations in Wisconsin: January 2012 - December 2012 (Uncomplicated Cases Only) NR = No