NOTICE OF HOSPITAL PRICE INCREASE FOR SSM HEALTH ST. MARY'S HOSPITAL-JANESVILLE 3400 E Racine St., Janesville, WI 53546 Fiscal Year 1-1-2020 to 12-31-2020 Percent Charge Element Previous New Dollar Rate Rate Increase Increase Room & Board- Med/Surg/Gyn Obstetrics Newborn Level I Newborn Level II Newborn Level III Surgical ICU Medical ICU ICU Intermediate CCU Intermediate $2,145.00 2,324.00 1,107.00 1,648.00 2,196.00 6,058.00 6,058.00 4,128.00 4,128.00 1,329.00 $2,124.25 2,300.65 1,096.18 1,631.42 2,174.47 5,997.57 5,997.57 4,087.61 4,087.61 1,229.33 $20.75 23.35 10.82 16.58 21.53 60.43 60.43 40.39 40.39 99.67 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 8.1% Emergency Room Level IV Labor Level I Level Il Level IIl Level IV Delivery Level I Level II Circumcision 142.00 169.00 185.00 199.00 130.24 155.45 169.41 182.13 11.76 13.55 15.59 16.87 9.0% 8.7% 9.2% 9.3% 1,929.00 2,317.00 523.00 1,770.03 2,125.86 479.45 Annual Percentage Price Increase is 3%, effective January 1, 2020 The Annual Percentage Price Increase for 2019 was 3%, effective January 1, 2019 This increase will allow SSM Health St. Mary's Hospital Janesville to continue to invest in continually improving technologies and exceptional medical staff to provide 158.97 191.14 43.55 9.0% 9.0% 9.1% high-quality, high-value care for our community. NOTICE OF HOSPITAL PRICE INCREASE FOR SSM HEALTH ST. MARY'S HOSPITAL-JANESVILLE 3400 E Racine St., Janesville, WI 53546 Fiscal Year 1-1-2020 to 12-31-2020 Percent Charge Element Previous New Dollar Rate Rate Increase Increase Room & Board- Med/Surg/Gyn Obstetrics Newborn Level I Newborn Level II Newborn Level III Surgical ICU Medical ICU ICU Intermediate CCU Intermediate $2,145.00 2,324.00 1,107.00 1,648.00 2,196.00 6,058.00 6,058.00 4,128.00 4,128.00 1,329.00 $2,124.25 2,300.65 1,096.18 1,631.42 2,174.47 5,997.57 5,997.57 4,087.61 4,087.61 1,229.33 $20.75 23.35 10.82 16.58 21.53 60.43 60.43 40.39 40.39 99.67 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 8.1% Emergency Room Level IV Labor Level I Level Il Level IIl Level IV Delivery Level I Level II Circumcision 142.00 169.00 185.00 199.00 130.24 155.45 169.41 182.13 11.76 13.55 15.59 16.87 9.0% 8.7% 9.2% 9.3% 1,929.00 2,317.00 523.00 1,770.03 2,125.86 479.45 Annual Percentage Price Increase is 3%, effective January 1, 2020 The Annual Percentage Price Increase for 2019 was 3%, effective January 1, 2019 This increase will allow SSM Health St. Mary's Hospital Janesville to continue to invest in continually improving technologies and exceptional medical staff to provide 158.97 191.14 43.55 9.0% 9.0% 9.1% high-quality, high-value care for our community.