NOTICE OF HOSPITAL PRICE INCREASE FOR SSM HEALTH . MARY'S HOSPITAL-JANESVILLE ST. 3400 E Racine St., Janesville, WI 53546 Fiscal Year 1-1-2021 to 12-31-2021 Charge Element Previous Rate New Dollar Rate Percent Increase Increase Room & Board - Med/Surg/Gyn Obstetrics Newborn Level I Newborn Level II Newborn Level II Surgical ICU Medical ICU ICU Intermediate CCU Intermediate Emergency Room Level IV Labor Level I Level II Level III Level IV $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 $2,209.00 2,394.00 1,140.00 1,697.00 2,262.00 6,058.00 6,058.00 4,252.00 4,252.00 1,369.00 $64.00 70.00 33.00 49.00 66.00 0.00 0.00 124.00 124.00 40.00 3.0% 3.0% 3.0% 3.0% 3.0% 0.0% 0.0% 3.0% 3.0% 3.0% 142.00 169.00 185.00 199.00 146.00 174.00 191.00 205.00 4.00 5.00 6.00 6.00 2.8% 3.0% 3.2% 3.0% Delivery Level I Level II Circumcision 1,929.00 2,317.00 523.00 2,025.00 2,433.00 523.00 96.00 116.00 0.00 5.0% 5.0% 0.0% Annual Percentage Price Increase is 3%, effective January 1, 2021 The Annual Percentage Price Increase for 2020 was 3%, effective January 1, 2020. This increase will allow SSM Health St. Mary's Hospital Janesville to continue to invest in exceptional staff, facilities, and technologies to continue to provide high quality, high value care for our community. NOTICE OF HOSPITAL PRICE INCREASE FOR SSM HEALTH . MARY'S HOSPITAL-JANESVILLE ST. 3400 E Racine St., Janesville, WI 53546 Fiscal Year 1-1-2021 to 12-31-2021 Charge Element Previous Rate New Dollar Rate Percent Increase Increase Room & Board - Med/Surg/Gyn Obstetrics Newborn Level I Newborn Level II Newborn Level II Surgical ICU Medical ICU ICU Intermediate CCU Intermediate Emergency Room Level IV Labor Level I Level II Level III Level IV $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 $2,209.00 2,394.00 1,140.00 1,697.00 2,262.00 6,058.00 6,058.00 4,252.00 4,252.00 1,369.00 $64.00 70.00 33.00 49.00 66.00 0.00 0.00 124.00 124.00 40.00 3.0% 3.0% 3.0% 3.0% 3.0% 0.0% 0.0% 3.0% 3.0% 3.0% 142.00 169.00 185.00 199.00 146.00 174.00 191.00 205.00 4.00 5.00 6.00 6.00 2.8% 3.0% 3.2% 3.0% Delivery Level I Level II Circumcision 1,929.00 2,317.00 523.00 2,025.00 2,433.00 523.00 96.00 116.00 0.00 5.0% 5.0% 0.0% Annual Percentage Price Increase is 3%, effective January 1, 2021 The Annual Percentage Price Increase for 2020 was 3%, effective January 1, 2020. This increase will allow SSM Health St. Mary's Hospital Janesville to continue to invest in exceptional staff, facilities, and technologies to continue to provide high quality, high value care for our community.