New Exhibit 10A Hospital Calendar Year 2006 Valid Claim Set (Part 1 … 2020. 10. 13. · Hospital...

Exhibit 10AHospital Calendar Year 2006 Valid Claim Set (Part 1 of 2):

MedicareProvider

AdmitDate

DischargeDate Age Sex

DischargeStatus

PaidDRG

Version 24

AP-DRG

Lengthof

StayAcuteDays

SubAcuteDays Billed

AcuteBilled

SubAcuteBilled Allowed

Costto

ChargeRatio

MarginalCost

CostOutlierPaid

AWPDay

OutlierThreshold

AWPDay

OutlierPayment

Version24

Weight

DRGAverageLengthof Stay

TransferLength

ofStay

TransferAdj CMIWeight

310001 11/28/06 12/05/06 46 F 01 001 001 7 7 0 127,584.81 127,584.81 0.00 20,532.51 0.1754 0.00 0.00 21 0.00 3.2119 7 7 3.2119310001 12/22/06 01/05/07 54 M 01 001 001 14 14 0 185,590.10 185,590.10 0.00 20,532.51 0.1754 0.00 0.00 21 0.00 3.2119 7 14 3.2119310001 07/05/06 07/14/06 60 F 03 001 002 9 9 0 92,348.42 92,348.42 0.00 3,610.25 0.1754 0.00 0.00 16 0.00 2.7378 5 9 2.7378310001 08/02/06 08/04/06 43 F 01 468 007 2 2 0 46,927.43 46,927.43 0.00 3,099.29 0.1754 0.00 0.00 33 0.00 2.3212 6 2 2.3212310001 10/09/06 10/20/06 61 F 02 007 007 11 11 0 118,567.24 118,567.24 0.00 9,677.54 0.1754 0.00 0.00 33 0.00 2.3212 6 11 2.3212310001 06/27/06 06/30/06 1 M 01 008 008 3 3 0 58,917.50 58,917.50 0.00 2,961.23 0.1754 0.00 0.00 10 0.00 1.4428 5 3 1.4428310001 01/04/06 01/12/06 53 F 06 010 010 8 8 0 72,673.54 72,673.54 0.00 6,533.46 0.1754 0.00 0.00 16 0.00 1.2829 5 8 1.2829310001 10/06/06 10/09/06 60 F 05 012 012 3 3 0 25,462.23 25,462.23 0.00 1,319.20 0.1754 0.00 0.00 23 0.00 1.0623 5 3 1.0623310001 12/15/06 12/19/06 49 F 01 012 012 4 4 0 29,697.46 29,697.46 0.00 5,926.73 0.1754 0.00 0.00 23 0.00 1.0623 5 4 1.0623310001 07/05/06 07/10/06 15 F 01 013 013 5 5 0 52,774.74 52,774.74 0.00 4,531.88 0.1754 0.00 0.00 28 0.00 1.0800 5 5 1.0800310001 02/08/06 02/15/06 15 F 01 014 014 7 7 0 80,683.96 80,683.96 0.00 9,588.28 0.1754 0.00 0.00 19 0.00 1.4805 7 7 1.4805310001 02/11/06 02/13/06 70 F 01 014 014 2 2 0 31,830.90 31,830.90 0.00 5,020.68 0.1754 0.00 0.00 19 0.00 1.4805 7 2 1.4805310001 04/28/06 05/01/06 58 M 62 014 014 3 3 0 36,102.79 36,102.79 0.00 9,588.28 0.1754 0.00 0.00 19 0.00 1.4805 7 3 1.4805310001 04/02/06 04/04/06 73 M 01 014 014 2 2 0 32,373.53 32,373.53 0.00 5,020.68 0.1754 0.00 0.00 19 0.00 1.4805 7 2 1.4805310001 05/14/06 05/22/06 65 M 01 014 014 8 8 0 79,806.61 79,806.61 0.00 9,588.28 0.1754 0.00 0.00 19 0.00 1.4805 7 8 1.4805310001 10/15/06 10/18/06 69 M 01 014 014 3 3 0 42,894.24 42,894.24 0.00 9,588.28 0.1754 0.00 0.00 19 0.00 1.4805 7 3 1.4805310001 09/08/06 09/13/06 49 F 01 019 019 5 5 0 56,257.53 56,257.53 0.00 4,259.37 0.1754 0.00 0.00 24 0.00 0.7888 4 5 0.7888310001 08/19/06 08/21/06 65 F 01 019 019 2 2 0 26,922.48 26,922.48 0.00 4,259.37 0.1754 0.00 0.00 24 0.00 0.7888 4 2 0.7888310001 03/28/06 04/07/06 23 M 01 024 024 10 10 0 125,486.09 125,486.09 0.00 5,043.60 0.1754 0.00 0.00 17 0.00 0.7922 4 10 0.7922310001 06/16/06 06/18/06 41 M 01 024 024 2 2 0 19,918.43 19,918.43 0.00 5,043.60 0.1754 0.00 0.00 17 0.00 0.7922 4 2 0.7922310001 04/11/06 04/15/06 29 M 01 024 024 4 4 0 40,351.63 40,351.63 0.00 5,043.60 0.1754 0.00 0.00 17 0.00 0.7922 4 4 0.7922310001 07/20/06 07/22/06 44 M 01 024 024 2 2 0 22,954.93 22,954.93 0.00 5,043.60 0.1754 0.00 0.00 17 0.00 0.7922 4 2 0.7922310001 09/20/06 09/25/06 49 F 01 024 024 5 5 0 39,196.50 39,196.50 0.00 5,043.60 0.1754 0.00 0.00 17 0.00 0.7922 4 5 0.7922310001 01/21/06 01/26/06 35 M 01 025 025 5 5 0 45,326.21 45,326.21 0.00 3,327.94 0.1754 0.00 0.00 8 0.00 0.6931 3 5 0.6931310001 06/10/06 06/21/06 35 F 01 025 025 11 11 0 133,125.70 133,125.70 0.00 3,448.20 0.1754 0.00 0.00 8 0.00 0.6931 3 11 0.6931310001 07/07/06 07/13/06 22 M 01 025 025 6 6 0 73,097.73 73,097.73 0.00 3,448.20 0.1754 0.00 0.00 8 0.00 0.6931 3 6 0.6931310001 07/16/06 07/20/06 20 M 01 025 025 4 4 0 45,739.18 45,739.18 0.00 1,756.49 0.1754 0.00 0.00 8 0.00 0.6931 3 4 0.6931310001 10/31/06 11/02/06 49 F 01 025 025 2 2 0 26,121.38 26,121.38 0.00 3,448.20 0.1754 0.00 0.00 8 0.00 0.6931 3 2 0.6931310001 01/02/06 01/03/06 35 F 01 035 035 1 1 0 12,513.39 12,513.39 0.00 943.19 0.1754 0.00 0.00 30 0.00 0.7574 2 1 0.7574310001 06/09/06 06/12/06 15 M 01 533 035 3 3 0 36,436.00 36,436.00 0.00 9,017.29 0.1754 0.00 0.00 30 0.00 0.7574 2 3 0.7574310001 03/24/06 03/28/06 74 F 01 035 035 4 4 0 42,586.06 42,586.06 0.00 3,271.69 0.1754 0.00 0.00 30 0.00 0.7574 2 4 0.7574310001 07/25/06 07/26/06 43 F 01 014 035 1 1 0 20,549.52 20,549.52 0.00 2,510.34 0.1754 0.00 0.00 30 0.00 0.7574 2 1 0.7574310001 09/13/06 09/14/06 25 F 01 035 035 1 1 0 18,008.53 18,008.53 0.00 977.27 0.1754 0.00 0.00 30 0.00 0.7574 2 1 0.7574310001 11/29/06 12/03/06 1 M 01 044 044 4 4 0 27,600.45 27,600.45 0.00 2,920.48 0.1754 0.00 0.00 5 0.00 0.4071 2 4 0.4071310001 01/23/06 01/24/06 5 F 01 058 058 1 1 0 12,254.29 12,254.29 0.00 1,851.72 0.1754 0.00 0.00 8 0.00 0.6663 3 1 0.6663310001 02/13/06 02/15/06 4 M 01 060 060 2 2 0 33,412.76 33,412.76 0.00 1,944.17 0.1754 0.00 0.00 4 0.00 0.5894 2 2 0.5894310001 05/22/06 05/23/06 2 M 01 060 060 1 1 0 17,269.34 17,269.34 0.00 1,944.17 0.1754 0.00 0.00 4 0.00 0.5894 2 1 0.5894310001 04/14/06 04/15/06 64 M 02 064 064 1 1 0 12,314.51 12,314.51 0.00 1,725.67 0.1754 0.00 0.00 19 0.00 1.0927 5 1 0.2185310001 03/10/06 03/14/06 65 F 01 065 065 4 4 0 48,112.36 48,112.36 0.00 5,075.25 0.1754 0.00 0.00 8 0.00 0.6643 3 4 0.6643310001 04/13/06 04/17/06 67 F 01 065 065 4 4 0 42,101.35 42,101.35 0.00 5,075.25 0.1754 0.00 0.00 8 0.00 0.6643 3 4 0.6643310001 05/17/06 05/21/06 99 F 01 065 065 4 4 0 50,440.05 50,440.05 0.00 5,075.25 0.1754 0.00 0.00 8 0.00 0.6643 3 4 0.6643310001 07/06/06 07/08/06 76 M 01 065 065 2 2 0 29,749.02 29,749.02 0.00 5,075.25 0.1754 0.00 0.00 8 0.00 0.6643 3 2 0.6643310001 07/24/06 07/27/06 89 F 01 065 065 3 3 0 26,378.10 26,378.10 0.00 5,075.25 0.1754 0.00 0.00 8 0.00 0.6643 3 3 0.6643310001 05/07/06 05/09/06 70 F 01 065 065 2 2 0 33,227.76 33,227.76 0.00 5,075.25 0.1754 0.00 0.00 8 0.00 0.6643 3 2 0.6643310001 07/20/06 07/22/06 23 M 01 068 068 2 2 0 16,373.36 16,373.36 0.00 4,361.71 0.1754 0.00 0.00 8 0.00 0.5855 3 2 0.5855310001 04/19/06 04/25/06 52 F 01 069 069 6 6 0 48,900.45 48,900.45 0.00 2,716.40 0.1754 0.00 0.00 5 0.00 0.4129 2 6 0.4129310001 01/08/06 01/12/06 56 F 01 076 076 4 4 0 46,718.67 46,718.67 0.00 14,493.03 0.1754 0.00 0.00 23 0.00 2.5834 10 4 2.5834310001 02/23/06 02/24/06 17 F 01 076 076 1 1 0 24,543.61 24,543.61 0.00 1,390.84 0.1754 0.00 0.00 23 0.00 2.5834 10 1 2.5834310001 06/08/06 06/15/06 57 F 03 076 076 7 7 0 79,022.76 79,022.76 0.00 15,016.75 0.1754 0.00 0.00 23 0.00 2.5834 10 7 2.5834310001 09/11/06 09/20/06 49 M 01 076 076 9 9 0 102,497.45 102,497.45 0.00 15,016.75 0.1754 0.00 0.00 23 0.00 2.5834 10 9 2.5834310001 03/03/06 03/10/06 55 F 51 078 078 7 7 0 67,157.90 67,157.90 0.00 10,214.63 0.1754 0.00 0.00 20 0.00 1.6340 8 7 1.6340310001 09/17/06 09/20/06 49 M 07 080 080 3 2 1 19,622.79 19,621.79 1.00 7,735.63 0.1754 0.00 0.00 16 0.00 1.1537 5 2 1.1537310001 01/12/06 01/26/06 54 M 62 082 082 14 14 0 122,756.21 122,756.21 0.00 6,814.41 0.1754 0.00 0.00 20 0.00 1.5074 6 14 1.5074310001 03/17/06 03/23/06 36 F 20 082 082 6 6 0 57,705.25 57,705.25 0.00 7,060.65 0.1754 0.00 0.00 20 0.00 1.5074 6 6 1.5074310001 02/02/06 02/05/06 55 F 01 082 082 3 3 0 45,641.82 45,641.82 0.00 7,060.65 0.1754 0.00 0.00 20 0.00 1.5074 6 3 1.5074310001 01/27/06 02/07/06 61 M 20 541 082 11 11 0 76,371.34 76,371.34 0.00 4,609.02 0.1754 0.00 0.00 20 0.00 1.5074 6 11 1.5074310001 07/19/06 07/28/06 49 M 03 082 082 9 9 0 72,915.83 72,915.83 0.00 7,060.65 0.1754 0.00 0.00 20 0.00 1.5074 6 9 1.5074310001 09/24/06 09/24/06 63 F 20 082 082 0 0 0 10,888.74 10,888.74 0.00 1,592.22 0.1754 0.00 0.00 20 0.00 1.5074 6 0 1.5074310001 10/05/06 10/13/06 59 M 06 082 082 8 8 0 69,147.37 69,147.37 0.00 7,060.65 0.1754 0.00 0.00 20 0.00 1.5074 6 8 1.5074310001 11/11/06 11/14/06 82 F 01 087 087 3 3 0 34,094.91 34,094.91 0.00 5,431.45 0.1754 0.00 0.00 11 0.00 1.2195 5 3 1.2195310001 01/25/06 01/30/06 95 F 06 088 088 5 5 0 44,599.63 44,599.63 0.00 6,095.47 0.1754 0.00 0.00 17 0.00 0.9119 4 5 0.9119310001 02/16/06 02/19/06 58 M 01 088 088 3 3 0 32,032.40 32,032.40 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 3 0.9119310001 04/06/06 04/09/06 69 F 01 088 088 3 3 0 26,204.81 26,204.81 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 3 0.9119310001 05/28/06 05/31/06 69 F 01 088 088 3 3 0 26,034.83 26,034.83 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 3 0.9119310001 06/29/06 07/02/06 67 M 01 088 088 3 3 0 37,257.32 37,257.32 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 3 0.9119310001 07/12/06 07/20/06 63 M 01 088 088 8 8 0 69,161.20 69,161.20 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 8 0.9119310001 08/07/06 08/14/06 39 M 01 088 088 7 7 0 58,085.24 58,085.24 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 7 0.9119310001 07/30/06 08/03/06 63 F 01 088 088 4 4 0 41,272.12 41,272.12 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 4 0.9119310001 06/16/06 06/27/06 81 M 01 088 088 11 11 0 120,853.73 120,853.73 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 11 0.9119310001 09/12/06 09/19/06 52 F 03 088 088 7 7 0 75,315.06 75,315.06 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 7 0.9119310001 09/28/06 10/02/06 52 F 01 088 088 4 4 0 47,560.38 47,560.38 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 4 0.9119310001 10/27/06 10/30/06 48 F 01 088 088 3 3 0 39,022.30 39,022.30 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 3 0.9119310001 11/28/06 12/04/06 47 M 01 088 088 6 6 0 57,112.19 57,112.19 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 6 0.9119310001 10/21/06 10/25/06 76 M 01 088 088 4 4 0 44,944.00 44,944.00 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 4 0.9119310001 07/01/06 07/05/06 86 F 01 088 088 4 4 0 40,502.76 40,502.76 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 4 0.9119

Myers and Stauffer LC Claims_2006.xls [Valid_Claims_Part1] 7/9/2009


MedicareProvider

AdmitDate


DischargeStatus

PaidDRG

Version 24

AP-DRG

Lengthof

StayAcuteDays

SubAcuteDays Billed

AcuteBilled


Costto

ChargeRatio

MarginalCost

CostOutlierPaid

AWPDay

OutlierThreshold

AWPDay

OutlierPayment

Version24

Weight


TransferLength

ofStay


310001 12/02/06 12/07/06 33 M 01 088 088 5 5 0 47,591.43 47,591.43 0.00 6,315.74 0.1754 0.00 0.00 17 0.00 0.9119 4 5 0.9119310001 01/10/06 01/17/06 55 M 01 541 089 7 7 0 52,330.07 52,330.07 0.00 8,155.22 0.1754 0.00 0.00 12 0.00 0.9960 5 7 0.9960310001 04/01/06 04/04/06 62 F 01 089 089 3 3 0 33,490.15 33,490.15 0.00 6,547.23 0.1754 0.00 0.00 12 0.00 0.9960 5 3 0.9960310001 04/08/06 04/15/06 60 M 01 089 089 7 7 0 93,715.59 93,715.59 0.00 6,547.23 0.1754 0.00 0.00 12 0.00 0.9960 5 7 0.9960310001 07/20/06 07/22/06 48 M 01 089 089 2 2 0 20,185.92 20,185.92 0.00 6,547.23 0.1754 0.00 0.00 12 0.00 0.9960 5 2 0.9960310001 11/11/06 11/16/06 77 F 01 089 089 5 5 0 41,391.21 41,391.21 0.00 6,547.23 0.1754 0.00 0.00 12 0.00 0.9960 5 5 0.9960310001 12/10/06 12/12/06 59 M 01 089 089 2 2 0 17,967.13 17,967.13 0.00 6,547.23 0.1754 0.00 0.00 12 0.00 0.9960 5 2 0.9960310001 12/16/06 12/19/06 47 M 01 089 089 3 3 0 29,954.84 29,954.84 0.00 6,547.23 0.1754 0.00 0.00 12 0.00 0.9960 5 3 0.9960310001 12/27/06 12/31/06 58 F 01 089 089 4 4 0 38,046.37 38,046.37 0.00 6,547.23 0.1754 0.00 0.00 12 0.00 0.9960 5 4 0.9960310001 08/17/06 08/21/06 55 F 01 092 092 4 4 0 33,792.85 33,792.85 0.00 7,940.56 0.1754 0.00 0.00 13 0.00 0.9300 4 4 0.9300310001 11/13/06 11/17/06 55 F 06 092 092 4 4 0 38,517.22 38,517.22 0.00 7,940.56 0.1754 0.00 0.00 13 0.00 0.9300 4 4 0.9300310001 05/10/06 05/13/06 48 M 01 096 096 3 3 0 30,537.42 30,537.42 0.00 5,251.93 0.1754 0.00 0.00 8 0.00 0.6430 3 3 0.6430310001 10/23/06 10/26/06 55 F 06 096 096 3 3 0 34,939.39 34,939.39 0.00 5,251.93 0.1754 0.00 0.00 8 0.00 0.6430 3 3 0.6430310001 11/26/06 11/27/06 50 F 01 096 096 1 1 0 18,526.03 18,526.03 0.00 1,491.15 0.1754 0.00 0.00 8 0.00 0.6430 3 1 0.6430310001 11/22/06 11/24/06 22 M 01 096 096 2 2 0 19,701.61 19,701.61 0.00 5,251.93 0.1754 0.00 0.00 8 0.00 0.6430 3 2 0.6430310001 12/02/06 12/04/06 80 F 01 097 096 2 2 0 21,071.87 21,071.87 0.00 3,756.62 0.1754 0.00 0.00 8 0.00 0.6430 3 2 0.6430310001 01/01/06 01/04/06 54 F 01 097 097 3 3 0 28,927.85 28,927.85 0.00 3,625.62 0.1754 0.00 0.00 7 0.00 0.5777 3 3 0.5777310001 01/02/06 01/06/06 0 F 01 628 097 4 4 0 28,439.70 28,439.70 0.00 2,630.50 0.1754 0.00 0.00 7 0.00 0.5777 3 4 0.5777310001 02/11/06 02/15/06 42 F 01 097 097 4 4 0 37,164.24 37,164.24 0.00 3,756.62 0.1754 0.00 0.00 7 0.00 0.5777 3 4 0.5777310001 02/20/06 02/23/06 42 F 01 097 097 3 3 0 31,086.32 31,086.32 0.00 3,756.62 0.1754 0.00 0.00 7 0.00 0.5777 3 3 0.5777310001 01/24/06 01/26/06 71 F 01 097 097 2 2 0 22,576.09 22,576.09 0.00 3,625.62 0.1754 0.00 0.00 7 0.00 0.5777 3 2 0.5777310001 07/25/06 07/26/06 43 F 01 097 097 1 1 0 16,197.50 16,197.50 0.00 1,346.99 0.1754 0.00 0.00 7 0.00 0.5777 3 1 0.5777310001 09/21/06 09/23/06 68 F 01 097 097 2 2 0 17,764.66 17,764.66 0.00 3,756.62 0.1754 0.00 0.00 7 0.00 0.5777 3 2 0.5777310001 09/19/06 09/22/06 40 F 01 097 097 3 3 0 27,561.85 27,561.85 0.00 3,756.62 0.1754 0.00 0.00 7 0.00 0.5777 3 3 0.5777310001 03/29/06 03/31/06 70 F 01 097 097 2 2 0 19,789.60 19,789.60 0.00 3,756.62 0.1754 0.00 0.00 7 0.00 0.5777 3 2 0.5777310001 12/28/06 12/29/06 58 M 01 101 101 1 1 0 14,146.22 14,146.22 0.00 928.72 0.1754 0.00 0.00 6 0.00 0.6374 3 1 0.6374310001 10/28/06 10/30/06 52 M 03 101 102 2 2 0 21,445.39 21,445.39 0.00 5,584.68 0.1754 0.00 0.00 8 0.00 0.5144 2 2 0.5144310001 02/17/06 02/23/06 44 M 06 105 105 6 6 0 168,582.79 168,582.79 0.00 29,596.80 0.1754 0.00 0.00 20 0.00 5.5656 10 6 5.5656310001 06/06/06 06/12/06 62 F 03 105 105 6 6 0 178,471.84 178,471.84 0.00 29,596.80 0.1754 0.00 0.00 20 0.00 5.5656 10 6 5.5656310001 08/10/06 08/26/06 82 F 62 547 105 16 16 0 319,497.78 319,497.78 0.00 35,515.33 0.1754 1,474.92 1,106.19 20 0.00 5.5656 10 16 5.5656310001 02/02/06 02/20/06 61 M 01 104 105 18 18 0 461,857.61 461,857.61 0.00 40,471.03 0.1754 26,444.83 19,833.62 20 0.00 5.5656 10 18 5.5656310001 08/14/06 08/22/06 70 F 01 104 105 8 8 0 194,050.52 194,050.52 0.00 40,471.03 0.1754 0.00 0.00 20 0.00 5.5656 10 8 5.5656310001 10/21/06 10/29/06 79 M 01 106 107 8 8 0 205,058.28 205,058.28 0.00 32,156.17 0.1754 0.00 0.00 26 0.00 5.2123 10 8 5.2123310001 07/06/06 07/16/06 75 F 06 108 108 10 10 0 191,809.53 191,809.53 0.00 29,095.83 0.1754 0.00 0.00 13 0.00 3.4442 5 10 3.4442310001 01/28/06 02/07/06 75 M 01 107 109 10 10 0 237,248.79 237,248.79 0.00 24,495.69 0.1754 0.00 0.00 13 0.00 4.0944 7 10 4.0944310001 10/28/06 11/06/06 74 M 01 107 109 9 9 0 201,094.56 201,094.56 0.00 24,495.69 0.1754 0.00 0.00 13 0.00 4.0944 7 9 4.0944310001 08/16/06 08/26/06 71 M 06 107 109 10 10 0 215,691.86 215,691.86 0.00 24,495.69 0.1754 0.00 0.00 13 0.00 4.0944 7 10 4.0944310001 02/05/06 02/14/06 57 M 01 546 109 9 9 0 231,327.77 231,327.77 0.00 35,863.95 0.1754 0.00 0.00 13 0.00 4.0944 7 9 4.0944310001 03/13/06 03/14/06 59 M 01 112 112 1 1 0 115,544.69 115,544.69 0.00 1,267.63 0.1754 0.00 0.00 11 0.00 1.5467 3 1 1.5467310001 03/17/06 03/18/06 67 F 01 112 112 1 1 0 58,684.24 58,684.24 0.00 1,267.63 0.1754 0.00 0.00 11 0.00 1.5467 3 1 1.5467310001 05/01/06 05/04/06 78 F 01 112 112 3 3 0 148,853.11 148,853.11 0.00 13,000.92 0.1754 1,108.84 831.63 11 0.00 1.5467 3 3 1.5467310001 10/04/06 10/05/06 63 F 01 112 112 1 1 0 87,468.33 87,468.33 0.00 1,267.63 0.1754 0.00 0.00 11 0.00 1.5467 3 1 1.5467310001 11/28/06 12/05/06 69 F 01 108 112 7 7 0 127,652.80 127,652.80 0.00 29,095.83 0.1754 0.00 0.00 11 0.00 1.5467 3 7 1.5467310001 05/17/06 05/18/06 48 M 01 112 112 1 1 0 101,359.25 101,359.25 0.00 1,267.63 0.1754 0.00 0.00 11 0.00 1.5467 3 1 1.5467310001 07/05/06 07/23/06 85 M 62 113 113 18 18 0 177,289.34 177,289.34 0.00 21,271.72 0.1754 0.00 0.00 35 0.00 3.0628 14 18 3.0628310001 11/02/06 11/02/06 58 M 02 120 115 0 0 0 158,794.65 158,794.65 0.00 2,552.94 0.1754 0.00 0.00 22 0.00 4.7185 7 0 0.6741310001 03/16/06 03/21/06 72 M 01 116 116 5 5 0 135,257.07 135,257.07 0.00 21,556.86 0.1754 0.00 0.00 19 0.00 2.8361 4 5 2.8361310001 05/03/06 05/04/06 58 M 06 116 116 1 1 0 34,557.65 34,557.65 0.00 1,267.63 0.1754 0.00 0.00 19 0.00 2.8361 4 1 2.8361310001 07/15/06 07/18/06 58 M 01 116 116 3 3 0 59,424.59 59,424.59 0.00 21,556.86 0.1754 0.00 0.00 19 0.00 2.8361 4 3 2.8361310001 09/28/06 09/29/06 57 M 01 116 116 1 1 0 172,647.34 172,647.34 0.00 1,267.63 0.1754 0.00 0.00 19 0.00 2.8361 4 1 2.8361310001 12/10/06 12/13/06 71 F 01 116 116 3 3 0 57,253.53 57,253.53 0.00 21,556.86 0.1754 0.00 0.00 19 0.00 2.8361 4 3 2.8361310001 06/30/06 07/05/06 76 M 01 121 121 5 5 0 52,559.84 52,559.84 0.00 14,519.30 0.1754 0.00 0.00 28 0.00 2.3300 8 5 2.3300310001 10/30/06 11/04/06 56 M 01 121 121 5 5 0 52,571.83 52,571.83 0.00 14,519.30 0.1754 0.00 0.00 28 0.00 2.3300 8 5 2.3300310001 10/28/06 11/09/06 56 M 03 121 121 12 12 0 155,636.68 155,636.68 0.00 14,519.30 0.1754 0.00 0.00 28 0.00 2.3300 8 12 2.3300310001 12/23/06 12/30/06 77 M 01 121 121 7 7 0 67,630.90 67,630.90 0.00 14,519.30 0.1754 0.00 0.00 28 0.00 2.3300 8 7 2.3300310001 06/25/06 06/27/06 67 F 01 122 122 2 2 0 36,040.51 36,040.51 0.00 9,298.23 0.1754 0.00 0.00 9 0.00 1.2617 4 2 1.2617310001 01/13/06 01/18/06 67 M 01 124 124 5 5 0 70,342.35 70,342.35 0.00 6,036.42 0.1754 0.00 0.00 13 0.00 1.3771 4 5 1.3771310001 05/31/06 06/02/06 67 M 01 124 124 2 2 0 37,760.39 37,760.39 0.00 6,254.55 0.1754 0.00 0.00 13 0.00 1.3771 4 2 1.3771310001 02/15/06 02/18/06 64 F 02 125 125 3 3 0 52,340.94 52,340.94 0.00 3,316.13 0.1754 0.00 0.00 10 0.00 1.0818 3 3 1.0818310001 04/06/06 04/11/06 48 M 62 125 125 5 5 0 58,883.81 58,883.81 0.00 3,316.13 0.1754 0.00 0.00 10 0.00 1.0818 3 5 1.0818310001 05/21/06 05/23/06 58 M 01 125 125 2 2 0 37,034.79 37,034.79 0.00 3,316.13 0.1754 0.00 0.00 10 0.00 1.0818 3 2 1.0818310001 08/30/06 08/31/06 51 F 01 125 125 1 1 0 23,757.21 23,757.21 0.00 3,316.13 0.1754 0.00 0.00 10 0.00 1.0818 3 1 1.0818310001 09/12/06 09/13/06 54 M 01 125 125 1 1 0 26,473.27 26,473.27 0.00 3,316.13 0.1754 0.00 0.00 10 0.00 1.0818 3 1 1.0818310001 02/08/06 02/10/06 59 M 01 127 127 2 2 0 18,012.11 18,012.11 0.00 7,107.33 0.1754 0.00 0.00 13 0.00 0.9707 4 2 0.9707310001 02/10/06 02/24/06 73 F 01 127 127 14 14 0 161,285.46 161,285.46 0.00 7,107.33 0.1754 3,289.47 2,467.10 13 0.00 0.9707 4 14 0.9707310001 04/24/06 04/27/06 0 M 01 127 127 3 3 0 22,952.52 22,952.52 0.00 7,107.33 0.1754 0.00 0.00 13 0.00 0.9707 4 3 0.9707310001 07/05/06 07/10/06 76 F 01 127 127 5 5 0 44,742.59 44,742.59 0.00 7,107.33 0.1754 0.00 0.00 13 0.00 0.9707 4 5 0.9707310001 07/17/06 07/22/06 48 M 01 127 127 5 5 0 54,728.88 54,728.88 0.00 7,107.33 0.1754 0.00 0.00 13 0.00 0.9707 4 5 0.9707310001 07/14/06 07/15/06 48 M 01 127 127 1 1 0 17,999.92 17,999.92 0.00 2,990.24 0.1754 0.00 0.00 13 0.00 0.9707 4 1 0.9707310001 07/24/06 07/28/06 76 F 03 127 127 4 4 0 50,686.84 50,686.84 0.00 7,107.33 0.1754 0.00 0.00 13 0.00 0.9707 4 4 0.9707310001 08/01/06 08/04/06 65 F 01 127 127 3 3 0 32,820.43 32,820.43 0.00 7,107.33 0.1754 0.00 0.00 13 0.00 0.9707 4 3 0.9707310001 08/11/06 08/17/06 75 F 03 127 127 6 6 0 52,070.95 52,070.95 0.00 7,107.33 0.1754 0.00 0.00 13 0.00 0.9707 4 6 0.9707310001 11/27/06 12/01/06 49 M 01 127 127 4 4 0 43,807.05 43,807.05 0.00 7,107.33 0.1754 0.00 0.00 13 0.00 0.9707 4 4 0.9707310001 08/09/06 08/14/06 43 M 03 127 127 5 5 0 50,819.13 50,819.13 0.00 7,107.33 0.1754 0.00 0.00 13 0.00 0.9707 4 5 0.9707310001 03/17/06 03/24/06 61 M 01 127 127 7 7 0 80,126.31 80,126.31 0.00 7,107.33 0.1754 0.00 0.00 13 0.00 0.9707 4 7 0.9707



MedicareProvider

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DischargeStatus

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Version 24

AP-DRG

Lengthof

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310001 09/05/06 09/11/06 62 M 01 127 127 6 6 0 72,604.32 72,604.32 0.00 7,107.33 0.1754 0.00 0.00 13 0.00 0.9707 4 6 0.9707310001 05/23/06 05/30/06 62 M 01 127 127 7 7 0 78,184.03 78,184.03 0.00 7,107.33 0.1754 0.00 0.00 13 0.00 0.9707 4 7 0.9707310001 11/30/06 12/02/06 0 M 01 127 127 2 2 0 20,916.43 20,916.43 0.00 7,107.33 0.1754 0.00 0.00 13 0.00 0.9707 4 2 0.9707310001 10/12/06 10/17/06 87 F 01 127 127 5 5 0 59,530.53 59,530.53 0.00 7,107.33 0.1754 0.00 0.00 13 0.00 0.9707 4 5 0.9707310001 03/03/06 03/10/06 47 F 03 128 128 7 7 0 62,251.79 62,251.79 0.00 6,006.35 0.1754 0.00 0.00 15 0.00 1.0677 10 7 1.0677310001 11/13/06 11/22/06 56 F 06 130 130 9 9 0 64,177.59 64,177.59 0.00 6,238.79 0.1754 0.00 0.00 14 0.00 1.0381 5 9 1.0381310001 04/19/06 04/22/06 81 M 01 131 131 3 3 0 44,824.75 44,824.75 0.00 4,723.36 0.1754 0.00 0.00 10 0.00 0.8431 5 3 0.8431310001 08/07/06 08/09/06 45 M 06 131 131 2 2 0 17,851.38 17,851.38 0.00 4,723.36 0.1754 0.00 0.00 10 0.00 0.8431 5 2 0.8431310001 01/04/06 01/09/06 93 F 01 132 133 5 5 0 45,492.34 45,492.34 0.00 3,465.83 0.1754 0.00 0.00 7 0.00 0.6472 3 5 0.6472310001 04/26/06 04/28/06 67 F 02 132 133 2 2 0 31,226.72 31,226.72 0.00 3,187.40 0.1754 0.00 0.00 7 0.00 0.6472 3 2 0.4315310001 08/17/06 08/18/06 69 M 01 132 133 1 1 0 17,273.98 17,273.98 0.00 1,593.70 0.1754 0.00 0.00 7 0.00 0.6472 3 1 0.6472310001 11/06/06 11/07/06 70 F 01 134 134 1 1 0 20,048.47 20,048.47 0.00 1,282.01 0.1754 0.00 0.00 11 0.00 0.6183 3 1 0.6183310001 06/30/06 07/02/06 5 F 01 137 137 2 2 0 14,720.76 14,720.76 0.00 2,913.54 0.1754 0.00 0.00 12 0.00 1.3098 6 2 1.3098310001 01/19/06 01/21/06 62 F 03 138 138 2 2 0 29,511.36 29,511.36 0.00 5,433.84 0.1754 0.00 0.00 11 0.00 0.9526 4 2 0.9526310001 01/24/06 01/28/06 43 F 06 138 138 4 4 0 42,672.75 42,672.75 0.00 5,433.84 0.1754 0.00 0.00 11 0.00 0.9526 4 4 0.9526310001 01/12/06 01/16/06 87 M 01 138 138 4 4 0 41,900.20 41,900.20 0.00 5,433.84 0.1754 0.00 0.00 11 0.00 0.9526 4 4 0.9526310001 06/15/06 06/23/06 62 F 03 138 138 8 8 0 85,624.03 85,624.03 0.00 5,630.19 0.1754 0.00 0.00 11 0.00 0.9526 4 8 0.9526310001 09/24/06 09/25/06 60 F 01 139 139 1 1 0 12,267.25 12,267.25 0.00 1,338.97 0.1754 0.00 0.00 5 0.00 0.5514 2 1 0.5514310001 09/04/06 09/05/06 71 M 01 139 139 1 1 0 13,922.91 13,922.91 0.00 1,338.97 0.1754 0.00 0.00 5 0.00 0.5514 2 1 0.5514310001 02/14/06 02/16/06 75 F 01 140 140 2 2 0 37,156.56 37,156.56 0.00 5,095.59 0.1754 0.00 0.00 7 0.00 0.7001 3 2 0.7001310001 03/01/06 03/03/06 61 M 01 140 140 2 2 0 39,828.25 39,828.25 0.00 5,095.59 0.1754 0.00 0.00 7 0.00 0.7001 3 2 0.7001310001 10/23/06 10/25/06 64 F 01 140 140 2 2 0 29,907.76 29,907.76 0.00 5,095.59 0.1754 0.00 0.00 7 0.00 0.7001 3 2 0.7001310001 12/03/06 12/05/06 60 M 01 140 140 2 2 0 40,625.99 40,625.99 0.00 5,095.59 0.1754 0.00 0.00 7 0.00 0.7001 3 2 0.7001310001 09/07/06 09/08/06 68 M 01 140 140 1 1 0 20,740.27 20,740.27 0.00 1,558.45 0.1754 0.00 0.00 7 0.00 0.7001 3 1 0.7001310001 03/28/06 03/30/06 61 M 01 144 141 2 2 0 35,218.51 35,218.51 0.00 6,617.45 0.1754 0.00 0.00 10 0.00 0.8193 4 2 0.8193310001 04/01/06 04/03/06 53 F 01 141 141 2 2 0 27,380.12 27,380.12 0.00 5,229.56 0.1754 0.00 0.00 10 0.00 0.8193 4 2 0.8193310001 04/11/06 04/15/06 61 M 01 141 141 4 4 0 74,781.25 74,781.25 0.00 5,229.56 0.1754 0.00 0.00 10 0.00 0.8193 4 4 0.8193310001 07/25/06 07/26/06 58 M 01 141 141 1 1 0 16,520.93 16,520.93 0.00 1,105.06 0.1754 0.00 0.00 10 0.00 0.8193 4 1 0.8193310001 08/11/06 08/12/06 63 F 01 141 141 1 1 0 20,284.89 20,284.89 0.00 1,105.06 0.1754 0.00 0.00 10 0.00 0.8193 4 1 0.8193310001 09/07/06 09/09/06 45 F 01 141 141 2 2 0 25,795.89 25,795.89 0.00 5,229.56 0.1754 0.00 0.00 10 0.00 0.8193 4 2 0.8193310001 03/04/06 03/09/06 73 F 01 142 142 5 5 0 58,341.20 58,341.20 0.00 3,905.40 0.1754 0.00 0.00 6 0.00 0.6086 3 5 0.6086310001 08/12/06 08/17/06 33 F 01 142 142 5 5 0 56,839.19 56,839.19 0.00 3,905.40 0.1754 0.00 0.00 6 0.00 0.6086 3 5 0.6086310001 10/09/06 10/11/06 55 F 01 142 142 2 2 0 32,887.75 32,887.75 0.00 3,905.40 0.1754 0.00 0.00 6 0.00 0.6086 3 2 0.6086310001 11/05/06 11/10/06 100 F 01 142 142 5 5 0 65,873.40 65,873.40 0.00 3,905.40 0.1754 0.00 0.00 6 0.00 0.6086 3 5 0.6086310001 09/26/06 09/28/06 79 M 01 141 142 2 2 0 27,483.71 27,483.71 0.00 5,229.56 0.1754 0.00 0.00 6 0.00 0.6086 3 2 0.6086310001 12/16/06 12/19/06 38 F 01 142 142 3 3 0 50,090.18 50,090.18 0.00 3,905.40 0.1754 0.00 0.00 6 0.00 0.6086 3 3 0.6086310001 01/15/06 01/17/06 61 F 01 143 143 2 2 0 26,083.61 26,083.61 0.00 4,019.37 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 01/30/06 01/31/06 61 M 01 143 143 1 1 0 26,301.69 26,301.69 0.00 1,500.65 0.1754 0.00 0.00 7 0.00 0.5705 2 1 0.5705310001 02/01/06 02/07/06 55 F 01 143 143 6 6 0 53,337.32 53,337.32 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 6 0.5705310001 03/08/06 03/10/06 63 F 01 143 143 2 2 0 28,930.94 28,930.94 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 03/21/06 03/22/06 49 M 01 143 143 1 1 0 12,542.65 12,542.65 0.00 1,500.65 0.1754 0.00 0.00 7 0.00 0.5705 2 1 0.5705310001 04/08/06 04/10/06 44 M 01 143 143 2 2 0 33,799.17 33,799.17 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 04/07/06 04/09/06 48 M 01 143 143 2 2 0 24,667.38 24,667.38 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 04/12/06 04/15/06 77 M 01 143 143 3 3 0 32,139.96 32,139.96 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 3 0.5705310001 04/25/06 04/27/06 42 F 01 143 143 2 2 0 35,060.51 35,060.51 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 05/30/06 05/31/06 62 F 01 143 143 1 1 0 14,980.65 14,980.65 0.00 1,500.65 0.1754 0.00 0.00 7 0.00 0.5705 2 1 0.5705310001 06/13/06 06/15/06 62 F 07 143 143 2 2 0 21,516.06 21,516.06 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 06/05/06 06/09/06 51 M 03 143 143 4 4 0 43,537.69 43,537.69 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 4 0.5705310001 06/08/06 06/09/06 64 F 03 143 143 1 1 0 15,673.55 15,673.55 0.00 1,500.65 0.1754 0.00 0.00 7 0.00 0.5705 2 1 0.5705310001 03/06/06 03/07/06 72 F 01 143 143 1 1 0 31,553.40 31,553.40 0.00 1,500.65 0.1754 0.00 0.00 7 0.00 0.5705 2 1 0.5705310001 06/13/06 06/20/06 65 F 01 143 143 7 7 0 79,468.63 79,468.63 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 7 0.5705310001 07/22/06 07/24/06 62 F 06 143 143 2 2 0 36,235.54 36,235.54 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 04/01/06 04/03/06 67 F 01 143 143 2 2 0 24,147.14 24,147.14 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 08/02/06 08/03/06 56 F 01 143 143 1 1 0 22,619.35 22,619.35 0.00 1,500.65 0.1754 0.00 0.00 7 0.00 0.5705 2 1 0.5705310001 08/05/06 08/07/06 49 F 01 143 143 2 2 0 29,897.71 29,897.71 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 07/29/06 08/01/06 53 F 01 143 143 3 3 0 39,368.29 39,368.29 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 3 0.5705310001 08/09/06 08/11/06 40 F 01 143 143 2 2 0 31,326.57 31,326.57 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 09/07/06 09/08/06 48 F 01 143 143 1 1 0 12,756.06 12,756.06 0.00 1,500.65 0.1754 0.00 0.00 7 0.00 0.5705 2 1 0.5705310001 08/09/06 08/11/06 60 M 01 143 143 2 2 0 36,114.47 36,114.47 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 08/11/06 08/13/06 57 F 01 143 143 2 2 0 23,167.41 23,167.41 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 10/07/06 10/08/06 77 M 01 143 143 1 1 0 18,903.08 18,903.08 0.00 1,500.65 0.1754 0.00 0.00 7 0.00 0.5705 2 1 0.5705310001 01/11/06 01/13/06 45 M 01 143 143 2 2 0 25,788.65 25,788.65 0.00 4,019.37 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 06/02/06 06/04/06 54 F 01 143 143 2 2 0 24,178.54 24,178.54 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 11/10/06 11/13/06 52 M 03 143 143 3 3 0 43,749.52 43,749.52 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 3 0.5705310001 11/17/06 11/19/06 77 M 01 143 143 2 2 0 18,584.13 18,584.13 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 09/18/06 09/19/06 66 F 01 143 143 1 1 0 22,594.53 22,594.53 0.00 1,500.65 0.1754 0.00 0.00 7 0.00 0.5705 2 1 0.5705310001 12/03/06 12/06/06 67 M 01 143 143 3 3 0 34,308.12 34,308.12 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 3 0.5705310001 12/19/06 12/20/06 43 F 01 143 143 1 1 0 22,872.96 22,872.96 0.00 1,500.65 0.1754 0.00 0.00 7 0.00 0.5705 2 1 0.5705310001 12/27/06 12/31/06 43 F 01 143 143 4 4 0 42,773.72 42,773.72 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 4 0.5705310001 11/11/06 11/13/06 75 M 01 143 143 2 2 0 20,654.12 20,654.12 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 10/16/06 10/18/06 45 M 01 143 143 2 2 0 25,300.49 25,300.49 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 06/24/06 06/26/06 65 F 01 143 143 2 2 0 37,893.66 37,893.66 0.00 4,164.61 0.1754 0.00 0.00 7 0.00 0.5705 2 2 0.5705310001 01/24/06 01/25/06 73 F 01 145 145 1 1 0 23,760.50 23,760.50 0.00 1,641.45 0.1754 0.00 0.00 7 0.00 0.5703 2 1 0.5703310001 06/30/06 07/04/06 74 M 01 149 149 4 4 0 52,537.46 52,537.46 0.00 9,399.23 0.1754 0.00 0.00 16 0.00 1.7707 7 4 1.7707310001 02/14/06 02/19/06 63 F 01 154 154 5 5 0 81,296.64 81,296.64 0.00 13,987.14 0.1754 0.00 0.00 26 0.00 2.9951 10 5 2.9951



MedicareProvider

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Version 24

AP-DRG

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Version24

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TransferLength

ofStay


310001 05/07/06 05/08/06 0 M 01 156 156 1 1 0 19,672.29 19,672.29 0.00 1,501.95 0.1754 0.00 0.00 11 0.00 1.4695 6 1 1.4695310001 12/26/06 12/28/06 0 M 01 156 156 2 2 0 23,304.06 23,304.06 0.00 5,727.45 0.1754 0.00 0.00 11 0.00 1.4695 6 2 1.4695310001 10/29/06 10/31/06 26 F 01 166 158 2 2 0 43,480.70 43,480.70 0.00 6,569.53 0.1754 0.00 0.00 7 0.00 0.6035 2 2 0.6035310001 11/03/06 11/06/06 27 M 01 160 160 3 3 0 41,191.89 41,191.89 0.00 3,692.51 0.1754 0.00 0.00 8 0.00 0.8174 2 3 0.8174310001 09/29/06 10/05/06 63 F 06 160 160 6 6 0 55,532.91 55,532.91 0.00 3,692.51 0.1754 0.00 0.00 8 0.00 0.8174 2 6 0.8174310001 06/24/06 06/27/06 0 M 01 163 163 3 3 0 34,103.22 34,103.22 0.00 2,358.55 0.1754 0.00 0.00 7 0.00 0.6330 2 3 0.6330310001 01/06/06 01/10/06 5 F 01 164 164 4 4 0 38,198.71 38,198.71 0.00 9,279.42 0.1754 0.00 0.00 15 0.00 1.7225 9 4 1.7225310001 10/17/06 10/21/06 70 F 01 164 164 4 4 0 40,028.03 40,028.03 0.00 9,614.73 0.1754 0.00 0.00 15 0.00 1.7225 9 4 1.7225310001 04/29/06 05/06/06 7 F 01 165 165 7 7 0 58,103.13 58,103.13 0.00 6,913.01 0.1754 0.00 0.00 9 0.00 1.0711 5 7 1.0711310001 09/21/06 09/30/06 12 M 01 165 165 9 9 0 84,065.26 84,065.26 0.00 6,913.01 0.1754 0.00 0.00 9 0.00 1.0711 5 9 1.0711310001 10/10/06 10/14/06 7 F 01 165 165 4 4 0 39,021.92 39,021.92 0.00 6,913.01 0.1754 0.00 0.00 9 0.00 1.0711 5 4 1.0711310001 05/15/06 05/17/06 58 M 01 171 171 2 2 0 33,182.45 33,182.45 0.00 4,283.28 0.1754 0.00 0.00 12 0.00 1.2233 4 2 1.2233310001 05/04/06 05/10/06 65 F 01 172 172 6 6 0 66,328.95 66,328.95 0.00 8,215.86 0.1754 0.00 0.00 18 0.00 1.3410 5 6 1.3410310001 08/13/06 08/30/06 56 F 06 172 172 17 17 0 124,105.95 124,105.95 0.00 8,215.86 0.1754 0.00 0.00 18 0.00 1.3410 5 17 1.3410310001 08/29/06 09/01/06 81 F 01 172 172 3 3 0 32,668.00 32,668.00 0.00 8,215.86 0.1754 0.00 0.00 18 0.00 1.3410 5 3 1.3410310001 11/23/06 11/27/06 62 F 01 172 172 4 4 0 45,682.99 45,682.99 0.00 8,215.86 0.1754 0.00 0.00 18 0.00 1.3410 5 4 1.3410310001 02/27/06 03/12/06 48 M 01 174 174 13 13 0 118,012.77 118,012.77 0.00 6,110.10 0.1754 0.00 0.00 11 0.00 1.1336 4 13 1.1336310001 03/18/06 03/23/06 56 F 01 182 174 5 5 0 46,501.62 46,501.62 0.00 4,789.43 0.1754 0.00 0.00 11 0.00 1.1336 4 5 1.1336310001 05/11/06 05/19/06 53 M 03 174 174 8 8 0 85,736.84 85,736.84 0.00 6,110.10 0.1754 0.00 0.00 11 0.00 1.1336 4 8 1.1336310001 06/07/06 06/13/06 39 M 01 174 174 6 6 0 55,789.61 55,789.61 0.00 6,110.10 0.1754 0.00 0.00 11 0.00 1.1336 4 6 1.1336310001 05/01/06 05/05/06 59 M 01 468 174 4 4 0 69,512.66 69,512.66 0.00 17,212.60 0.1754 0.00 0.00 11 0.00 1.1336 4 4 1.1336310001 07/18/06 07/24/06 64 F 01 174 174 6 6 0 67,107.52 67,107.52 0.00 6,110.10 0.1754 0.00 0.00 11 0.00 1.1336 4 6 1.1336310001 08/11/06 08/12/06 58 F 01 182 174 1 1 0 13,590.50 13,590.50 0.00 1,030.61 0.1754 0.00 0.00 11 0.00 1.1336 4 1 1.1336310001 08/24/06 08/27/06 58 F 01 188 174 3 3 0 31,010.49 31,010.49 0.00 5,830.96 0.1754 0.00 0.00 11 0.00 1.1336 4 3 1.1336310001 07/28/06 08/01/06 69 M 01 174 174 4 4 0 36,743.19 36,743.19 0.00 6,110.10 0.1754 0.00 0.00 11 0.00 1.1336 4 4 1.1336310001 12/24/06 12/27/06 40 M 01 174 174 3 3 0 35,852.85 35,852.85 0.00 6,110.10 0.1754 0.00 0.00 11 0.00 1.1336 4 3 1.1336310001 02/22/06 02/24/06 0 M 01 777 175 2 2 0 27,932.99 27,932.99 0.00 1,976.02 0.1754 0.00 0.00 11 0.00 0.8787 3 2 0.8787310001 11/10/06 11/13/06 60 F 01 183 175 3 3 0 29,508.11 29,508.11 0.00 3,296.58 0.1754 0.00 0.00 11 0.00 0.8787 3 3 0.8787310001 01/21/06 01/25/06 92 F 62 176 176 4 4 0 55,090.55 55,090.55 0.00 5,724.42 0.1754 0.00 0.00 8 0.00 0.8519 3 4 0.8519310001 07/17/06 07/19/06 61 M 01 176 176 2 2 0 26,087.13 26,087.13 0.00 5,931.28 0.1754 0.00 0.00 8 0.00 0.8519 3 2 0.8519310001 07/16/06 07/22/06 56 F 01 177 177 6 6 0 56,471.71 56,471.71 0.00 5,743.62 0.1754 0.00 0.00 7 0.00 0.8292 3 6 0.8292310001 02/27/06 03/03/06 21 F 01 179 179 4 4 0 39,817.06 39,817.06 0.00 5,262.59 0.1754 0.00 0.00 12 0.00 0.9008 4 4 0.9008310001 09/20/06 09/23/06 20 F 01 179 179 3 3 0 28,092.49 28,092.49 0.00 5,262.59 0.1754 0.00 0.00 12 0.00 0.9008 4 3 0.9008310001 11/09/06 11/14/06 37 F 01 179 179 5 5 0 39,404.08 39,404.08 0.00 5,262.59 0.1754 0.00 0.00 12 0.00 0.9008 4 5 0.9008310001 10/12/06 10/19/06 20 F 01 179 179 7 7 0 50,591.95 50,591.95 0.00 5,262.59 0.1754 0.00 0.00 12 0.00 0.9008 4 7 0.9008310001 05/18/06 05/21/06 19 F 01 179 179 3 3 0 26,833.61 26,833.61 0.00 5,262.59 0.1754 0.00 0.00 12 0.00 0.9008 4 3 0.9008310001 06/12/06 06/16/06 19 F 01 179 179 4 4 0 34,167.62 34,167.62 0.00 5,262.59 0.1754 0.00 0.00 12 0.00 0.9008 4 4 0.9008310001 10/10/06 10/19/06 14 M 01 179 179 9 9 0 83,785.26 83,785.26 0.00 5,262.59 0.1754 0.00 0.00 12 0.00 0.9008 4 9 0.9008310001 03/20/06 03/30/06 61 F 03 180 180 10 10 0 104,594.36 104,594.36 0.00 4,621.86 0.1754 0.00 0.00 11 0.00 0.8663 4 10 0.8663310001 10/10/06 10/13/06 43 F 01 180 180 3 3 0 36,486.00 36,486.00 0.00 4,621.86 0.1754 0.00 0.00 11 0.00 0.8663 4 3 0.8663310001 08/11/06 08/15/06 20 F 01 180 180 4 4 0 32,915.87 32,915.87 0.00 4,621.86 0.1754 0.00 0.00 11 0.00 0.8663 4 4 0.8663310001 11/02/06 11/09/06 20 F 01 180 180 7 7 0 54,838.92 54,838.92 0.00 4,621.86 0.1754 0.00 0.00 11 0.00 0.8663 4 7 0.8663310001 04/29/06 05/01/06 78 F 01 182 182 2 2 0 27,272.39 27,272.39 0.00 4,789.43 0.1754 0.00 0.00 12 0.00 0.9212 4 2 0.9212310001 06/08/06 06/14/06 48 M 01 182 182 6 6 0 55,753.10 55,753.10 0.00 4,789.43 0.1754 0.00 0.00 12 0.00 0.9212 4 6 0.9212310001 06/18/06 06/22/06 74 F 03 182 182 4 4 0 37,702.71 37,702.71 0.00 4,789.43 0.1754 0.00 0.00 12 0.00 0.9212 4 4 0.9212310001 07/18/06 07/27/06 75 F 03 182 182 9 9 0 81,654.69 81,654.69 0.00 4,789.43 0.1754 0.00 0.00 12 0.00 0.9212 4 9 0.9212310001 10/25/06 11/01/06 56 F 01 182 182 7 7 0 60,658.51 60,658.51 0.00 4,789.43 0.1754 0.00 0.00 12 0.00 0.9212 4 7 0.9212310001 10/20/06 11/01/06 18 M 01 182 182 12 12 0 118,880.73 118,880.73 0.00 4,789.43 0.1754 0.00 0.00 12 0.00 0.9212 4 12 0.9212310001 11/11/06 11/16/06 18 M 01 182 182 5 5 0 53,002.04 53,002.04 0.00 4,789.43 0.1754 0.00 0.00 12 0.00 0.9212 4 5 0.9212310001 11/29/06 12/07/06 18 M 01 182 182 8 8 0 71,992.33 71,992.33 0.00 4,789.43 0.1754 0.00 0.00 12 0.00 0.9212 4 8 0.9212310001 02/02/06 02/06/06 58 M 01 182 182 4 4 0 39,270.16 39,270.16 0.00 4,789.43 0.1754 0.00 0.00 12 0.00 0.9212 4 4 0.9212310001 12/12/06 12/18/06 57 F 01 423 182 6 6 0 71,631.56 71,631.56 0.00 5,121.83 0.1754 0.00 0.00 12 0.00 0.9212 4 6 0.9212310001 12/02/06 12/19/06 65 F 62 182 182 17 17 0 152,607.37 152,607.37 0.00 4,789.43 0.1754 1,767.33 1,325.50 12 0.00 0.9212 4 17 0.9212310001 11/30/06 12/02/06 50 M 01 182 182 2 2 0 28,386.28 28,386.28 0.00 4,789.43 0.1754 0.00 0.00 12 0.00 0.9212 4 2 0.9212310001 02/19/06 02/23/06 57 F 01 183 183 4 4 0 64,662.02 64,662.02 0.00 3,296.58 0.1754 0.00 0.00 7 0.00 0.6924 3 4 0.6924310001 05/31/06 06/03/06 37 F 01 183 183 3 3 0 29,355.98 29,355.98 0.00 3,296.58 0.1754 0.00 0.00 7 0.00 0.6924 3 3 0.6924310001 07/28/06 08/01/06 46 M 01 183 183 4 4 0 39,110.22 39,110.22 0.00 3,296.58 0.1754 0.00 0.00 7 0.00 0.6924 3 4 0.6924310001 08/25/06 08/27/06 70 F 01 182 183 2 2 0 29,551.62 29,551.62 0.00 4,789.43 0.1754 0.00 0.00 7 0.00 0.6924 3 2 0.6924310001 11/04/06 11/06/06 43 F 01 183 183 2 2 0 22,203.73 22,203.73 0.00 3,296.58 0.1754 0.00 0.00 7 0.00 0.6924 3 2 0.6924310001 12/01/06 12/04/06 71 F 06 183 183 3 3 0 40,943.43 40,943.43 0.00 3,296.58 0.1754 0.00 0.00 7 0.00 0.6924 3 3 0.6924310001 12/26/06 12/27/06 74 F 01 182 183 1 1 0 10,773.45 10,773.45 0.00 1,030.61 0.1754 0.00 0.00 7 0.00 0.6924 3 1 0.6924310001 12/30/06 12/31/06 36 F 07 183 183 1 1 0 15,595.23 15,595.23 0.00 3,296.58 0.1754 0.00 0.00 7 0.00 0.6924 3 1 0.6924310001 11/28/06 12/01/06 48 M 01 183 183 3 3 0 26,826.71 26,826.71 0.00 3,296.58 0.1754 0.00 0.00 7 0.00 0.6924 3 3 0.6924310001 01/16/06 01/20/06 51 F 01 185 185 4 4 0 39,073.00 39,073.00 0.00 3,127.96 0.1754 0.00 0.00 5 0.00 0.5204 2 4 0.5204310001 04/03/06 04/07/06 3 M 01 187 187 4 4 0 43,416.50 43,416.50 0.00 3,761.07 0.1754 0.00 0.00 7 0.00 0.7625 3 4 0.7625310001 01/23/06 01/27/06 20 M 62 188 188 4 4 0 47,354.26 47,354.26 0.00 5,627.60 0.1754 0.00 0.00 8 0.00 0.7488 3 4 0.7488310001 01/22/06 01/25/06 63 F 01 188 188 3 3 0 26,842.53 26,842.53 0.00 1,268.59 0.1754 0.00 0.00 8 0.00 0.7488 3 3 0.7488310001 04/24/06 04/26/06 77 F 01 188 188 2 2 0 28,961.88 28,961.88 0.00 5,830.96 0.1754 0.00 0.00 8 0.00 0.7488 3 2 0.7488310001 01/20/06 01/21/06 63 M 01 191 191 1 1 0 45,730.35 45,730.35 0.00 964.89 0.1754 0.00 0.00 26 0.00 4.4938 20 1 4.4938310001 07/07/06 07/17/06 72 M 01 197 197 10 10 0 97,516.57 97,516.57 0.00 8,189.09 0.1754 0.00 0.00 15 0.00 1.9304 7 10 1.9304310001 01/13/06 01/19/06 50 M 03 202 202 6 6 0 52,918.30 52,918.30 0.00 6,116.82 0.1754 0.00 0.00 16 0.00 0.9693 4 6 0.9693310001 06/08/06 06/13/06 63 M 01 557 202 5 5 0 37,969.44 37,969.44 0.00 10,747.33 0.1754 0.00 0.00 16 0.00 0.9693 4 5 0.9693310001 12/28/06 01/04/07 38 M 01 202 202 7 7 0 56,201.82 56,201.82 0.00 6,337.86 0.1754 0.00 0.00 16 0.00 0.9693 4 7 0.9693310001 05/23/06 05/25/06 63 M 51 203 203 2 2 0 26,247.78 26,247.78 0.00 996.19 0.1754 0.00 0.00 20 0.00 1.4648 6 2 1.4648310001 10/02/06 10/05/06 60 F 01 203 203 3 3 0 31,794.36 31,794.36 0.00 6,411.83 0.1754 0.00 0.00 20 0.00 1.4648 6 3 1.4648



MedicareProvider

AdmitDate


DischargeStatus

PaidDRG

Version 24

AP-DRG

Lengthof

StayAcuteDays

SubAcuteDays Billed

AcuteBilled


Costto

ChargeRatio

MarginalCost

CostOutlierPaid

AWPDay

OutlierThreshold

AWPDay

OutlierPayment

Version24

Weight


TransferLength

ofStay


310001 08/18/06 08/21/06 34 M 01 204 204 3 3 0 31,653.94 31,653.94 0.00 5,336.34 0.1754 0.00 0.00 11 0.00 0.8555 4 3 0.8555310001 09/04/06 09/05/06 53 M 01 204 204 1 1 0 14,294.98 14,294.98 0.00 1,512.00 0.1754 0.00 0.00 11 0.00 0.8555 4 1 0.8555310001 10/16/06 10/22/06 57 M 01 204 204 6 6 0 52,309.58 52,309.58 0.00 5,336.34 0.1754 0.00 0.00 11 0.00 0.8555 4 6 0.8555310001 10/24/06 10/27/06 51 M 06 204 204 3 3 0 27,696.73 27,696.73 0.00 5,336.34 0.1754 0.00 0.00 11 0.00 0.8555 4 3 0.8555310001 11/18/06 11/21/06 43 F 01 204 204 3 3 0 28,059.15 28,059.15 0.00 5,336.34 0.1754 0.00 0.00 11 0.00 0.8555 4 3 0.8555310001 11/16/06 12/01/06 70 F 06 204 204 15 15 0 129,959.74 129,959.74 0.00 5,336.34 0.1754 0.00 0.00 11 0.00 0.8555 4 15 0.8555310001 03/23/06 03/27/06 59 M 01 205 205 4 4 0 37,164.54 37,164.54 0.00 6,805.75 0.1754 0.00 0.00 12 0.00 0.9435 4 4 0.9435310001 01/24/06 01/26/06 50 M 03 205 205 2 2 0 28,645.45 28,645.45 0.00 6,568.41 0.1754 0.00 0.00 12 0.00 0.9435 4 2 0.9435310001 08/20/06 09/06/06 63 F 06 205 205 17 17 0 149,378.84 149,378.84 0.00 6,805.75 0.1754 1,201.05 900.79 12 0.00 0.9435 4 17 0.9435310001 10/14/06 10/22/06 93 F 06 205 205 8 8 0 85,851.19 85,851.19 0.00 6,805.75 0.1754 0.00 0.00 12 0.00 0.9435 4 8 0.9435310001 11/21/06 11/24/06 45 F 01 205 205 3 3 0 24,405.39 24,405.39 0.00 2,234.38 0.1754 0.00 0.00 12 0.00 0.9435 4 3 0.9435310001 06/13/06 06/17/06 59 F 01 207 207 4 4 0 46,652.78 46,652.78 0.00 4,873.35 0.1754 0.00 0.00 14 0.00 1.2594 5 4 1.2594310001 08/09/06 08/13/06 80 M 01 208 208 4 4 0 42,897.08 42,897.08 0.00 3,290.18 0.1754 0.00 0.00 6 0.00 0.6050 3 4 0.6050310001 12/15/06 12/18/06 89 F 62 209 209 3 3 0 52,783.86 52,783.86 0.00 19,774.82 0.1754 0.00 0.00 8 0.00 2.0846 4 3 2.0846310001 03/15/06 03/24/06 49 M 62 210 210 9 9 0 91,977.93 91,977.93 0.00 15,837.18 0.1754 0.00 0.00 14 0.00 2.0344 7 9 2.0344310001 11/15/06 11/18/06 64 F 62 210 210 3 3 0 52,785.71 52,785.71 0.00 3,802.89 0.1754 0.00 0.00 14 0.00 2.0344 7 3 2.0344310001 08/13/06 08/22/06 23 M 06 211 210 9 9 0 108,561.90 108,561.90 0.00 13,049.16 0.1754 0.00 0.00 14 0.00 2.0344 7 9 2.0344310001 10/18/06 10/25/06 11 F 06 212 212 7 7 0 186,072.11 186,072.11 0.00 5,791.91 0.1754 7,637.05 5,727.79 11 0.00 1.2522 3 7 1.2522310001 08/14/06 09/02/06 59 M 06 216 216 19 19 0 163,233.47 163,233.47 0.00 9,693.21 0.1754 0.00 0.00 20 0.00 2.6531 15 19 2.6531310001 05/27/06 06/05/06 50 M 62 218 218 9 9 0 109,827.64 109,827.64 0.00 7,775.78 0.1754 0.00 0.00 20 0.00 1.9093 5 9 1.9093310001 09/02/06 09/05/06 58 M 06 218 218 3 3 0 60,506.21 60,506.21 0.00 7,775.78 0.1754 0.00 0.00 20 0.00 1.9093 5 3 1.9093310001 06/16/06 06/19/06 61 F 01 219 219 3 3 0 54,899.31 54,899.31 0.00 6,791.31 0.1754 0.00 0.00 8 0.00 1.2956 3 3 1.2956310001 03/08/06 04/29/06 36 F 01 227 227 52 52 0 386,763.54 386,763.54 0.00 28,891.75 0.1754 35,209.47 26,407.10 31 0.00 1.0753 3 52 1.0753310001 02/10/06 02/11/06 16 F 01 230 230 1 1 0 26,222.62 26,222.62 0.00 2,532.45 0.1754 0.00 0.00 24 0.00 1.7811 6 1 1.7811310001 12/08/06 12/12/06 48 F 06 235 235 4 4 0 29,034.75 29,034.75 0.00 2,578.57 0.1754 0.00 0.00 18 0.00 1.0601 4 4 1.0601310001 12/27/06 12/28/06 48 F 01 235 235 1 1 0 12,598.44 12,598.44 0.00 2,011.78 0.1754 0.00 0.00 18 0.00 1.0601 4 1 1.0601310001 02/16/06 02/20/06 63 M 01 239 239 4 4 0 34,119.37 34,119.37 0.00 9,583.88 0.1754 0.00 0.00 19 0.00 1.5322 6 4 1.5322310001 03/21/06 03/31/06 40 F 03 239 239 10 10 0 80,184.49 80,184.49 0.00 9,583.88 0.1754 0.00 0.00 19 0.00 1.5322 6 10 1.5322310001 08/09/06 08/16/06 58 F 03 239 239 7 7 0 74,998.94 74,998.94 0.00 9,583.88 0.1754 0.00 0.00 19 0.00 1.5322 6 7 1.5322310001 12/11/06 12/20/06 0 F 01 239 239 9 9 0 63,716.35 63,716.35 0.00 9,583.88 0.1754 0.00 0.00 19 0.00 1.5322 6 9 1.5322310001 02/08/06 02/13/06 1 F 01 240 240 5 5 0 39,648.18 39,648.18 0.00 6,337.43 0.1754 0.00 0.00 19 0.00 1.2740 5 5 1.2740310001 02/01/06 02/09/06 2 F 01 240 240 8 8 0 57,523.18 57,523.18 0.00 6,337.43 0.1754 0.00 0.00 19 0.00 1.2740 5 8 1.2740310001 08/16/06 08/17/06 6 F 01 241 241 1 1 0 16,143.64 16,143.64 0.00 867.23 0.1754 0.00 0.00 7 0.00 0.7303 2 1 0.7303310001 03/27/06 03/31/06 38 F 01 243 243 4 4 0 26,976.42 26,976.42 0.00 4,933.46 0.1754 0.00 0.00 13 0.00 0.9272 4 4 0.9272310001 05/23/06 05/25/06 37 F 01 243 243 2 2 0 26,526.00 26,526.00 0.00 4,933.46 0.1754 0.00 0.00 13 0.00 0.9272 4 2 0.9272310001 07/20/06 07/26/06 53 F 01 243 243 6 6 0 62,643.17 62,643.17 0.00 1,881.69 0.1754 0.00 0.00 13 0.00 0.9272 4 6 0.9272310001 09/22/06 09/25/06 54 M 62 244 244 3 3 0 33,904.42 33,904.42 0.00 5,280.21 0.1754 0.00 0.00 12 0.00 0.8025 4 3 0.8025310001 10/16/06 10/18/06 61 F 03 244 244 2 2 0 18,991.95 18,991.95 0.00 5,280.21 0.1754 0.00 0.00 12 0.00 0.8025 4 2 0.8025310001 11/14/06 11/15/06 64 F 01 247 247 1 1 0 17,448.20 17,448.20 0.00 1,414.48 0.1754 0.00 0.00 7 0.00 0.5222 3 1 0.5222310001 08/23/06 08/25/06 44 F 06 257 257 2 2 0 30,118.86 30,118.86 0.00 7,636.00 0.1754 0.00 0.00 7 0.00 0.8564 2 2 0.8564310001 06/20/06 07/17/06 63 F 01 263 263 27 27 0 244,632.27 244,632.27 0.00 15,356.51 0.1754 0.00 0.00 23 0.00 2.1984 10 27 2.1984310001 04/26/06 05/02/06 53 M 06 263 263 6 6 0 51,291.41 51,291.41 0.00 15,356.51 0.1754 0.00 0.00 23 0.00 2.1984 10 6 2.1984310001 07/25/06 08/11/06 63 F 62 269 269 17 17 0 166,928.63 166,928.63 0.00 6,861.23 0.1754 4,279.28 3,209.46 15 0.00 1.2870 5 17 1.2870310001 05/06/06 05/15/06 77 M 01 272 272 9 9 0 68,305.80 68,305.80 0.00 6,361.08 0.1754 0.00 0.00 12 0.00 0.8414 5 9 0.8414310001 03/24/06 04/02/06 56 F 01 273 273 9 9 0 65,690.41 65,690.41 0.00 4,458.38 0.1754 0.00 0.00 6 0.00 0.5086 3 9 0.5086310001 06/06/06 06/08/06 82 F 01 274 274 2 2 0 29,924.26 29,924.26 0.00 7,306.14 0.1754 0.00 0.00 18 0.00 2.3640 13 2 2.3640310001 10/03/06 10/15/06 51 F 20 274 274 12 12 0 83,501.08 83,501.08 0.00 7,306.14 0.1754 0.00 0.00 18 0.00 2.3640 13 12 2.3640310001 09/26/06 09/27/06 47 F 01 276 276 1 1 0 18,611.77 18,611.77 0.00 4,016.59 0.1754 0.00 0.00 8 0.00 0.5689 3 1 0.5689310001 02/16/06 02/21/06 19 M 01 277 277 5 5 0 43,477.47 43,477.47 0.00 5,408.81 0.1754 0.00 0.00 16 0.00 0.8916 5 5 0.8916310001 08/21/06 08/25/06 40 M 01 277 277 4 4 0 28,411.71 28,411.71 0.00 5,408.81 0.1754 0.00 0.00 16 0.00 0.8916 5 4 0.8916310001 06/18/06 06/21/06 73 M 01 277 277 3 3 0 23,968.48 23,968.48 0.00 5,408.81 0.1754 0.00 0.00 16 0.00 0.8916 5 3 0.8916310001 10/25/06 10/27/06 50 F 01 277 277 2 2 0 17,304.87 17,304.87 0.00 5,408.81 0.1754 0.00 0.00 16 0.00 0.8916 5 2 0.8916310001 11/29/06 12/05/06 64 F 06 277 277 6 6 0 48,335.02 48,335.02 0.00 5,408.81 0.1754 0.00 0.00 16 0.00 0.8916 5 6 0.8916310001 12/03/06 12/07/06 57 F 01 277 277 4 4 0 45,823.99 45,823.99 0.00 5,408.81 0.1754 0.00 0.00 16 0.00 0.8916 5 4 0.8916310001 12/19/06 01/11/07 64 F 06 277 277 23 23 0 212,200.46 212,200.46 0.00 5,408.81 0.1754 12,219.96 9,164.97 16 0.00 0.8916 5 23 0.8916310001 02/14/06 02/27/06 63 F 01 278 278 13 13 0 96,764.82 96,764.82 0.00 4,335.51 0.1754 0.00 0.00 11 0.00 0.7008 4 13 0.7008310001 04/21/06 04/24/06 63 F 06 278 278 3 3 0 23,474.19 23,474.19 0.00 4,335.51 0.1754 0.00 0.00 11 0.00 0.7008 4 3 0.7008310001 09/20/06 09/23/06 77 M 01 278 278 3 3 0 25,755.21 25,755.21 0.00 4,335.51 0.1754 0.00 0.00 11 0.00 0.7008 4 3 0.7008310001 11/02/06 11/03/06 49 F 06 278 278 1 1 0 12,937.07 12,937.07 0.00 1,463.51 0.1754 0.00 0.00 11 0.00 0.7008 4 1 0.7008310001 06/06/06 06/12/06 58 M 01 280 280 6 6 0 63,266.13 63,266.13 0.00 3,485.76 0.1754 0.00 0.00 6 0.00 0.6124 2 6 0.6124310001 08/05/06 08/14/06 43 F 01 280 280 9 9 0 69,138.96 69,138.96 0.00 3,485.76 0.1754 0.00 0.00 6 0.00 0.6124 2 9 0.6124310001 08/23/06 08/25/06 58 M 01 284 284 2 2 0 17,176.53 17,176.53 0.00 2,529.76 0.1754 0.00 0.00 7 0.00 0.4573 3 2 0.4573310001 10/12/06 10/20/06 44 M 01 287 287 8 8 0 64,822.81 64,822.81 0.00 11,915.40 0.1754 0.00 0.00 22 0.00 1.9038 9 8 1.9038310001 02/01/06 02/05/06 53 F 01 288 288 4 4 0 63,480.23 63,480.23 0.00 7,703.58 0.1754 0.00 0.00 6 0.00 1.8395 3 4 1.8395310001 02/04/06 02/05/06 73 F 01 294 294 1 1 0 10,709.03 10,709.03 0.00 1,070.28 0.1754 0.00 0.00 22 0.00 0.9008 4 1 0.9008310001 07/23/06 07/26/06 69 F 01 294 294 3 3 0 27,924.48 27,924.48 0.00 6,007.21 0.1754 0.00 0.00 22 0.00 0.9008 4 3 0.9008310001 02/13/06 02/16/06 66 F 01 294 294 3 3 0 34,191.24 34,191.24 0.00 6,007.21 0.1754 0.00 0.00 22 0.00 0.9008 4 3 0.9008310001 10/15/06 10/16/06 47 M 01 294 294 1 1 0 10,877.75 10,877.75 0.00 1,070.28 0.1754 0.00 0.00 22 0.00 0.9008 4 1 0.9008310001 02/11/06 03/20/06 3 F 01 295 295 37 37 0 236,724.58 236,724.58 0.00 22,759.95 0.1754 16,521.49 12,391.12 10 0.00 0.6764 3 37 0.6764310001 08/11/06 08/14/06 16 F 01 295 295 3 3 0 23,027.32 23,027.32 0.00 4,201.25 0.1754 0.00 0.00 10 0.00 0.6764 3 3 0.6764310001 01/20/06 01/22/06 46 M 07 296 296 2 2 0 23,463.40 23,463.40 0.00 5,351.45 0.1754 0.00 0.00 12 0.00 0.7876 4 2 0.7876310001 02/11/06 02/17/06 20 M 06 296 296 6 6 0 65,380.69 65,380.69 0.00 5,544.83 0.1754 0.00 0.00 12 0.00 0.7876 4 6 0.7876310001 03/29/06 04/04/06 61 M 01 296 296 6 6 0 66,531.02 66,531.02 0.00 5,544.83 0.1754 0.00 0.00 12 0.00 0.7876 4 6 0.7876310001 05/02/06 05/04/06 46 M 07 296 296 2 2 0 20,867.80 20,867.80 0.00 5,544.83 0.1754 0.00 0.00 12 0.00 0.7876 4 2 0.7876310001 06/04/06 06/07/06 58 M 62 296 296 3 3 0 22,600.45 22,600.45 0.00 5,544.83 0.1754 0.00 0.00 12 0.00 0.7876 4 3 0.7876



MedicareProvider

AdmitDate


DischargeStatus

PaidDRG

Version 24

AP-DRG

Lengthof

StayAcuteDays

SubAcuteDays Billed

AcuteBilled


Costto

ChargeRatio

MarginalCost

CostOutlierPaid

AWPDay

OutlierThreshold

AWPDay

OutlierPayment

Version24

Weight


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ofStay


310001 06/16/06 06/23/06 61 F 03 296 296 7 7 0 63,166.81 63,166.81 0.00 5,544.83 0.1754 0.00 0.00 12 0.00 0.7876 4 7 0.7876310001 08/10/06 08/12/06 53 F 06 296 296 2 2 0 23,367.02 23,367.02 0.00 5,544.83 0.1754 0.00 0.00 12 0.00 0.7876 4 2 0.7876310001 08/24/06 08/25/06 92 F 01 296 296 1 1 0 12,413.65 12,413.65 0.00 1,564.41 0.1754 0.00 0.00 12 0.00 0.7876 4 1 0.7876310001 09/28/06 10/01/06 59 M 01 296 296 3 3 0 43,250.20 43,250.20 0.00 5,544.83 0.1754 0.00 0.00 12 0.00 0.7876 4 3 0.7876310001 10/16/06 10/18/06 60 F 01 296 296 2 2 0 16,673.74 16,673.74 0.00 5,544.83 0.1754 0.00 0.00 12 0.00 0.7876 4 2 0.7876310001 10/23/06 10/27/06 22 M 01 296 296 4 4 0 37,674.67 37,674.67 0.00 5,544.83 0.1754 0.00 0.00 12 0.00 0.7876 4 4 0.7876310001 12/04/06 12/06/06 43 M 03 296 296 2 2 0 16,780.35 16,780.35 0.00 5,544.83 0.1754 0.00 0.00 12 0.00 0.7876 4 2 0.7876310001 12/03/06 12/06/06 60 F 20 296 296 3 3 0 22,657.13 22,657.13 0.00 5,544.83 0.1754 0.00 0.00 12 0.00 0.7876 4 3 0.7876310001 11/30/06 12/01/06 63 F 01 296 296 1 1 0 12,234.71 12,234.71 0.00 1,564.41 0.1754 0.00 0.00 12 0.00 0.7876 4 1 0.7876310001 12/11/06 12/13/06 46 M 01 296 296 2 2 0 16,890.12 16,890.12 0.00 5,544.83 0.1754 0.00 0.00 12 0.00 0.7876 4 2 0.7876310001 06/20/06 06/23/06 69 F 01 296 296 3 3 0 34,195.52 34,195.52 0.00 5,544.83 0.1754 0.00 0.00 12 0.00 0.7876 4 3 0.7876310001 09/06/06 09/08/06 74 F 03 297 297 2 2 0 33,496.45 33,496.45 0.00 3,828.84 0.1754 0.00 0.00 12 0.00 0.7871 4 2 0.7871310001 04/10/06 04/14/06 2 M 01 566 298 4 4 0 27,662.60 27,662.60 0.00 9,412.43 0.1754 0.00 0.00 13 0.00 0.3656 2 4 0.3656310001 05/31/06 06/17/06 1 M 01 298 298 17 17 0 146,639.23 146,639.23 0.00 2,852.41 0.1754 720.52 540.39 13 0.00 0.3656 2 17 0.3656310001 09/17/06 09/20/06 4 M 01 298 298 3 3 0 24,927.82 24,927.82 0.00 2,852.41 0.1754 0.00 0.00 13 0.00 0.3656 2 3 0.3656310001 09/26/06 09/29/06 14 M 01 298 298 3 3 0 32,845.43 32,845.43 0.00 2,852.41 0.1754 0.00 0.00 13 0.00 0.3656 2 3 0.3656310001 01/21/06 01/22/06 15 F 01 299 299 1 1 0 7,615.22 7,615.22 0.00 2,140.24 0.1754 0.00 0.00 8 0.00 0.5845 3 1 0.5845310001 11/28/06 11/30/06 22 M 01 300 300 2 2 0 17,879.69 17,879.69 0.00 5,278.56 0.1754 0.00 0.00 11 0.00 0.9237 4 2 0.9237310001 10/16/06 10/17/06 63 F 01 300 301 1 1 0 14,912.39 14,912.39 0.00 681.37 0.1754 0.00 0.00 13 0.00 0.6695 3 1 0.6695310001 06/17/06 07/01/06 61 F 01 304 304 14 14 0 135,252.43 135,252.43 0.00 9,567.13 0.1754 0.00 0.00 14 0.00 1.5144 5 14 1.5144310001 02/27/06 03/10/06 27 F 01 567 310 11 11 0 115,614.75 115,614.75 0.00 22,867.74 0.1754 0.00 0.00 8 0.00 0.9179 2 11 0.9179310001 02/28/06 03/09/06 78 M 01 311 311 9 9 0 90,802.13 90,802.13 0.00 4,909.18 0.1754 0.00 0.00 5 0.00 0.6970 2 9 0.6970310001 11/30/06 12/02/06 23 F 01 311 311 2 2 0 34,261.82 34,261.82 0.00 4,909.18 0.1754 0.00 0.00 5 0.00 0.6970 2 2 0.6970310001 01/08/06 01/21/06 49 M 06 315 315 13 13 0 141,095.33 141,095.33 0.00 12,416.52 0.1754 0.00 0.00 22 0.00 2.2568 7 13 2.2568310001 10/05/06 10/07/06 56 F 06 315 315 2 2 0 37,414.13 37,414.13 0.00 5,304.32 0.1754 0.00 0.00 22 0.00 2.2568 7 2 2.2568310001 09/04/06 09/16/06 41 F 01 315 315 12 12 0 166,180.86 166,180.86 0.00 12,865.20 0.1754 0.00 0.00 22 0.00 2.2568 7 12 2.2568310001 03/21/06 04/08/06 24 F 01 316 316 18 18 0 169,701.21 169,701.21 0.00 6,980.56 0.1754 4,765.59 3,574.19 16 0.00 1.2065 5 18 1.2065310001 05/03/06 05/10/06 51 M 62 316 316 7 7 0 83,374.58 83,374.58 0.00 6,980.56 0.1754 0.00 0.00 16 0.00 1.2065 5 7 1.2065310001 05/11/06 05/15/06 49 M 01 316 316 4 4 0 33,042.79 33,042.79 0.00 6,980.56 0.1754 0.00 0.00 16 0.00 1.2065 5 4 1.2065310001 06/20/06 06/27/06 44 F 02 316 316 7 7 0 53,484.27 53,484.27 0.00 6,980.56 0.1754 0.00 0.00 16 0.00 1.2065 5 7 1.2065310001 08/01/06 08/04/06 78 M 01 316 316 3 3 0 32,041.07 32,041.07 0.00 6,980.56 0.1754 0.00 0.00 16 0.00 1.2065 5 3 1.2065310001 08/16/06 08/28/06 62 F 06 316 316 12 12 0 110,821.68 110,821.68 0.00 6,980.56 0.1754 0.00 0.00 16 0.00 1.2065 5 12 1.2065310001 10/16/06 10/21/06 49 M 01 316 316 5 5 0 60,524.96 60,524.96 0.00 6,980.56 0.1754 0.00 0.00 16 0.00 1.2065 5 5 1.2065310001 12/19/06 12/22/06 43 M 01 316 316 3 3 0 27,986.18 27,986.18 0.00 6,980.56 0.1754 0.00 0.00 16 0.00 1.2065 5 3 1.2065310001 12/11/06 12/16/06 46 F 01 316 316 5 5 0 58,563.05 58,563.05 0.00 6,980.56 0.1754 0.00 0.00 16 0.00 1.2065 5 5 1.2065310001 08/08/06 08/18/06 46 F 01 316 316 10 10 0 93,635.96 93,635.96 0.00 6,980.56 0.1754 0.00 0.00 16 0.00 1.2065 5 10 1.2065310001 05/09/06 05/10/06 59 F 01 320 320 1 1 0 12,761.74 12,761.74 0.00 1,458.24 0.1754 0.00 0.00 12 0.00 0.9014 4 1 0.9014310001 04/14/06 04/17/06 72 F 01 320 320 3 3 0 28,441.36 28,441.36 0.00 5,614.04 0.1754 0.00 0.00 12 0.00 0.9014 4 3 0.9014310001 02/23/06 03/01/06 41 F 01 320 320 6 6 0 97,265.41 97,265.41 0.00 5,614.04 0.1754 0.00 0.00 12 0.00 0.9014 4 6 0.9014310001 11/17/06 11/19/06 50 M 01 320 320 2 2 0 21,252.83 21,252.83 0.00 5,614.04 0.1754 0.00 0.00 12 0.00 0.9014 4 2 0.9014310001 07/18/06 07/19/06 87 M 01 321 321 1 1 0 18,787.69 18,787.69 0.00 1,498.93 0.1754 0.00 0.00 10 0.00 0.6656 3 1 0.6656310001 08/18/06 08/21/06 37 F 01 321 321 3 3 0 29,120.82 29,120.82 0.00 3,910.60 0.1754 0.00 0.00 10 0.00 0.6656 3 3 0.6656310001 11/21/06 11/23/06 83 F 01 320 321 2 2 0 35,172.30 35,172.30 0.00 5,614.04 0.1754 0.00 0.00 10 0.00 0.6656 3 2 0.6656310001 02/18/06 02/20/06 0 M 01 322 322 2 2 0 13,891.93 13,891.93 0.00 3,165.60 0.1754 0.00 0.00 6 0.00 0.4835 3 2 0.4835310001 03/30/06 04/07/06 17 F 01 322 322 8 8 0 63,887.35 63,887.35 0.00 3,165.60 0.1754 0.00 0.00 6 0.00 0.4835 3 8 0.4835310001 05/04/06 05/06/06 0 M 01 322 322 2 2 0 15,425.87 15,425.87 0.00 3,165.60 0.1754 0.00 0.00 6 0.00 0.4835 3 2 0.4835310001 06/09/06 06/11/06 0 F 01 322 322 2 2 0 14,192.12 14,192.12 0.00 3,165.60 0.1754 0.00 0.00 6 0.00 0.4835 3 2 0.4835310001 05/10/06 05/12/06 0 F 01 322 322 2 2 0 15,526.54 15,526.54 0.00 3,165.60 0.1754 0.00 0.00 6 0.00 0.4835 3 2 0.4835310001 07/06/06 07/07/06 16 F 01 323 323 1 1 0 13,591.83 13,591.83 0.00 1,998.69 0.1754 0.00 0.00 9 0.00 0.7778 3 1 0.7778310001 01/13/06 01/18/06 75 M 01 325 325 5 5 0 38,346.69 38,346.69 0.00 4,358.15 0.1754 0.00 0.00 12 0.00 0.9620 7 5 0.9620310001 07/24/06 08/05/06 51 M 01 331 331 12 12 0 112,724.57 112,724.57 0.00 6,498.59 0.1754 0.00 0.00 21 0.00 1.3084 5 12 1.3084310001 11/22/06 11/25/06 18 F 01 331 332 3 3 0 25,617.17 25,617.17 0.00 6,498.59 0.1754 0.00 0.00 11 0.00 0.6631 3 3 0.6631310001 04/23/06 05/01/06 15 M 01 333 333 8 8 0 118,726.65 118,726.65 0.00 3,006.09 0.1754 0.00 0.00 11 0.00 0.8585 5 8 0.8585310001 11/02/06 11/03/06 62 M 01 337 337 1 1 0 23,085.08 23,085.08 0.00 1,267.63 0.1754 0.00 0.00 7 0.00 0.6790 2 1 0.6790310001 04/07/06 04/10/06 58 F 01 357 357 3 3 0 29,623.78 29,623.78 0.00 13,310.22 0.1754 0.00 0.00 19 0.00 1.9768 6 3 1.9768310001 12/15/06 12/18/06 8 F 01 357 357 3 3 0 43,390.83 43,390.83 0.00 13,310.22 0.1754 0.00 0.00 19 0.00 1.9768 6 3 1.9768310001 11/13/06 11/15/06 50 F 01 360 360 2 2 0 26,130.02 26,130.02 0.00 2,689.21 0.1754 0.00 0.00 10 0.00 0.7142 2 2 0.7142310001 09/11/06 09/13/06 53 F 01 359 361 2 2 0 41,082.54 41,082.54 0.00 5,351.91 0.1754 0.00 0.00 6 0.00 0.7562 2 2 0.7562310001 09/12/06 09/14/06 20 F 01 367 367 2 2 0 36,860.71 36,860.71 0.00 3,318.19 0.1754 0.00 0.00 11 0.00 0.9892 5 2 0.9892310001 01/08/06 01/13/06 20 F 01 370 370 5 5 0 37,796.14 37,796.14 0.00 5,562.89 0.1754 0.00 0.00 8 0.00 0.9584 4 5 0.9584310001 01/11/06 01/15/06 24 F 01 370 370 4 4 0 35,739.38 35,739.38 0.00 5,562.89 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 01/29/06 02/02/06 22 F 01 370 370 4 4 0 31,284.42 31,284.42 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 01/21/06 01/26/06 28 F 01 370 370 5 5 0 33,835.13 33,835.13 0.00 5,562.89 0.1754 0.00 0.00 8 0.00 0.9584 4 5 0.9584310001 02/28/06 03/04/06 40 F 01 370 370 4 4 0 31,394.81 31,394.81 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 03/01/06 03/07/06 41 F 01 370 370 6 6 0 43,300.56 43,300.56 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 6 0.9584310001 01/25/06 02/01/06 32 F 01 370 370 7 7 0 64,069.26 64,069.26 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 7 0.9584310001 03/28/06 04/01/06 34 F 01 370 370 4 4 0 27,954.88 27,954.88 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 03/30/06 04/04/06 33 F 01 370 370 5 5 0 32,967.55 32,967.55 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 5 0.9584310001 03/29/06 04/03/06 33 F 01 370 370 5 5 0 38,231.60 38,231.60 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 5 0.9584310001 04/07/06 04/12/06 28 F 01 370 370 5 5 0 36,881.35 36,881.35 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 5 0.9584310001 04/17/06 04/20/06 24 F 01 370 370 3 3 0 21,205.44 21,205.44 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 3 0.9584310001 03/03/06 03/07/06 31 F 01 370 370 4 4 0 28,592.73 28,592.73 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 01/03/06 01/10/06 25 F 01 370 370 7 7 0 51,056.55 51,056.55 0.00 5,562.89 0.1754 0.00 0.00 8 0.00 0.9584 4 7 0.9584310001 04/15/06 04/19/06 42 F 01 370 370 4 4 0 24,508.07 24,508.07 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 03/21/06 03/26/06 28 F 01 370 370 5 5 0 36,620.23 36,620.23 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 5 0.9584



MedicareProvider

AdmitDate


DischargeStatus

PaidDRG

Version 24

AP-DRG

Lengthof

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SubAcuteDays Billed

AcuteBilled


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ChargeRatio

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CostOutlierPaid

AWPDay

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AWPDay

OutlierPayment

Version24

Weight


TransferLength

ofStay


310001 04/27/06 05/02/06 28 F 01 370 370 5 5 0 37,734.36 37,734.36 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 5 0.9584310001 05/09/06 05/13/06 35 F 01 370 370 4 4 0 27,846.43 27,846.43 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 05/16/06 05/20/06 29 F 01 370 370 4 4 0 30,635.86 30,635.86 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 05/19/06 05/25/06 30 F 01 370 370 6 6 0 41,446.66 41,446.66 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 6 0.9584310001 05/18/06 05/23/06 31 F 01 370 370 5 5 0 46,590.77 46,590.77 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 5 0.9584310001 05/25/06 05/29/06 24 F 01 370 370 4 4 0 31,209.03 31,209.03 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 06/01/06 06/06/06 26 F 01 370 370 5 5 0 39,479.64 39,479.64 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 5 0.9584310001 04/06/06 04/12/06 30 F 01 370 370 6 6 0 41,563.67 41,563.67 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 6 0.9584310001 06/08/06 06/13/06 28 F 01 370 370 5 5 0 36,337.60 36,337.60 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 5 0.9584310001 01/22/06 01/26/06 33 F 01 370 370 4 4 0 28,761.25 28,761.25 0.00 5,562.89 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 05/28/06 06/02/06 22 F 01 370 370 5 5 0 36,091.81 36,091.81 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 5 0.9584310001 05/06/06 05/10/06 32 F 01 370 370 4 4 0 28,437.28 28,437.28 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 05/13/06 05/17/06 36 F 01 370 370 4 4 0 26,917.46 26,917.46 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 05/27/06 05/30/06 24 F 01 370 370 3 3 0 24,578.89 24,578.89 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 3 0.9584310001 06/13/06 06/25/06 23 F 01 370 370 12 12 0 96,141.20 96,141.20 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 12 0.9584310001 07/06/06 07/10/06 34 F 01 370 370 4 4 0 27,244.98 27,244.98 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 08/08/06 08/14/06 21 F 08 370 370 6 6 0 46,034.84 46,034.84 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 6 0.9584310001 08/01/06 08/05/06 36 F 01 370 370 4 4 0 30,286.82 30,286.82 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 08/24/06 08/29/06 35 F 01 370 370 5 5 0 40,320.22 40,320.22 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 5 0.9584310001 08/18/06 09/07/06 31 F 01 370 370 20 20 0 157,125.64 157,125.64 0.00 16,270.01 0.1754 2,559.84 1,919.88 8 0.00 0.9584 4 20 0.9584310001 07/17/06 07/25/06 19 F 01 370 370 8 8 0 52,619.19 52,619.19 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 8 0.9584310001 09/22/06 09/26/06 34 F 06 370 370 4 4 0 30,813.94 30,813.94 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 06/16/06 06/19/06 24 F 01 370 370 3 3 0 21,346.65 21,346.65 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 3 0.9584310001 04/30/06 05/03/06 24 F 01 370 370 3 3 0 21,080.75 21,080.75 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 3 0.9584310001 07/01/06 07/04/06 21 F 01 370 370 3 3 0 21,332.61 21,332.61 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 3 0.9584310001 07/18/06 07/22/06 28 F 01 370 370 4 4 0 26,521.52 26,521.52 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 10/26/06 10/31/06 27 F 01 370 370 5 5 0 38,687.18 38,687.18 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 5 0.9584310001 11/11/06 11/14/06 29 F 01 370 370 3 3 0 24,410.87 24,410.87 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 3 0.9584310001 11/17/06 11/21/06 43 F 01 370 370 4 4 0 28,919.85 28,919.85 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 07/25/06 08/21/06 24 F 01 370 370 27 27 0 192,599.24 192,599.24 0.00 19,947.15 0.1754 8,781.91 6,586.43 8 0.00 0.9584 4 27 0.9584310001 11/20/06 11/26/06 20 F 01 370 370 6 6 0 42,428.72 42,428.72 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 6 0.9584310001 10/09/06 10/12/06 24 F 01 370 370 3 3 0 27,699.37 27,699.37 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 3 0.9584310001 08/28/06 08/31/06 20 F 01 370 370 3 3 0 21,015.68 21,015.68 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 3 0.9584310001 12/18/06 12/24/06 22 F 01 370 370 6 6 0 50,078.25 50,078.25 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 6 0.9584310001 12/30/06 01/03/07 21 F 01 370 370 4 4 0 30,618.22 30,618.22 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 11/30/06 12/04/06 27 F 01 370 370 4 4 0 33,273.49 33,273.49 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 08/31/06 09/05/06 25 F 01 370 370 5 5 0 40,297.71 40,297.71 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 5 0.9584310001 12/07/06 12/11/06 28 F 01 370 370 4 4 0 27,410.71 27,410.71 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 4 0.9584310001 10/31/06 11/06/06 26 F 01 370 370 6 6 0 47,700.31 47,700.31 0.00 5,763.91 0.1754 0.00 0.00 8 0.00 0.9584 4 6 0.9584310001 01/03/06 01/09/06 28 F 01 371 371 6 6 0 42,180.64 42,180.64 0.00 4,891.82 0.1754 0.00 0.00 5 0.00 0.8416 3 6 0.8416310001 01/10/06 01/14/06 35 F 01 371 371 4 4 0 30,093.65 30,093.65 0.00 4,891.82 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 01/15/06 01/18/06 21 F 01 371 371 3 3 0 25,153.09 25,153.09 0.00 4,891.82 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 01/03/06 01/07/06 25 F 01 371 371 4 4 0 28,811.56 28,811.56 0.00 4,891.82 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 01/17/06 01/21/06 27 F 01 371 371 4 4 0 30,970.20 30,970.20 0.00 4,891.82 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 01/25/06 01/29/06 22 F 01 371 371 4 4 0 30,602.74 30,602.74 0.00 4,891.82 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 01/27/06 01/31/06 38 F 01 371 371 4 4 0 27,416.10 27,416.10 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 01/25/06 01/31/06 22 F 01 371 371 6 6 0 39,889.68 39,889.68 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 6 0.8416310001 02/03/06 02/06/06 20 F 01 371 371 3 3 0 25,262.41 25,262.41 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 02/09/06 02/13/06 32 F 01 371 371 4 4 0 27,324.96 27,324.96 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 02/13/06 02/16/06 23 F 01 371 371 3 3 0 28,461.98 28,461.98 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 02/14/06 02/17/06 23 F 01 371 371 3 3 0 21,730.39 21,730.39 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 02/08/06 02/12/06 24 F 01 371 371 4 4 0 27,858.18 27,858.18 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 02/03/06 02/07/06 22 F 01 371 371 4 4 0 27,772.54 27,772.54 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 02/23/06 02/27/06 22 F 01 371 371 4 4 0 30,214.68 30,214.68 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 03/04/06 03/09/06 33 F 01 371 371 5 5 0 33,365.19 33,365.19 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 5 0.8416310001 03/11/06 03/15/06 21 F 01 371 371 4 4 0 27,924.80 27,924.80 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 03/10/06 03/13/06 25 F 01 371 371 3 3 0 21,773.56 21,773.56 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 02/27/06 03/02/06 29 F 01 371 371 3 3 0 21,196.88 21,196.88 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 02/07/06 02/11/06 32 F 01 371 371 4 4 0 28,148.05 28,148.05 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 02/21/06 02/25/06 33 F 01 371 371 4 4 0 27,795.56 27,795.56 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 01/31/06 02/04/06 42 F 01 371 371 4 4 0 30,107.21 30,107.21 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 03/29/06 04/02/06 18 F 01 371 371 4 4 0 27,737.34 27,737.34 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 03/27/06 03/31/06 33 F 01 371 371 4 4 0 27,935.67 27,935.67 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 03/27/06 03/31/06 38 F 01 371 371 4 4 0 27,183.60 27,183.60 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 03/29/06 04/02/06 35 F 01 371 371 4 4 0 33,178.81 33,178.81 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 04/13/06 04/18/06 21 F 01 371 371 5 5 0 36,015.89 36,015.89 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 5 0.8416310001 01/30/06 02/04/06 30 F 01 371 371 5 5 0 36,232.43 36,232.43 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 5 0.8416310001 04/13/06 04/17/06 21 F 01 371 371 4 4 0 27,245.63 27,245.63 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 04/28/06 05/03/06 20 F 01 371 371 5 5 0 35,387.61 35,387.61 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 5 0.8416310001 05/04/06 05/08/06 24 F 01 371 371 4 4 0 31,357.08 31,357.08 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 03/13/06 03/17/06 16 F 01 371 371 4 4 0 27,642.79 27,642.79 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 02/15/06 02/19/06 39 F 01 371 371 4 4 0 30,596.10 30,596.10 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 05/01/06 05/04/06 28 F 01 371 371 3 3 0 26,207.68 26,207.68 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 05/08/06 05/11/06 35 F 01 371 371 3 3 0 26,367.60 26,367.60 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 05/22/06 05/27/06 33 F 01 371 371 5 5 0 33,905.54 33,905.54 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 5 0.8416



MedicareProvider

AdmitDate


DischargeStatus

PaidDRG

Version 24

AP-DRG

Lengthof

StayAcuteDays

SubAcuteDays Billed

AcuteBilled


Costto

ChargeRatio

MarginalCost

CostOutlierPaid

AWPDay

OutlierThreshold

AWPDay

OutlierPayment

Version24

Weight


TransferLength

ofStay


310001 05/22/06 05/26/06 29 F 01 371 371 4 4 0 34,400.47 34,400.47 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 05/26/06 05/29/06 33 F 01 371 371 3 3 0 23,964.85 23,964.85 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 04/25/06 04/28/06 32 F 01 371 371 3 3 0 21,088.68 21,088.68 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 06/12/06 06/16/06 25 F 01 371 371 4 4 0 30,050.37 30,050.37 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 06/05/06 06/09/06 36 F 01 371 371 4 4 0 29,358.56 29,358.56 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 06/09/06 06/14/06 25 F 01 371 371 5 5 0 35,959.34 35,959.34 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 5 0.8416310001 04/27/06 05/01/06 23 F 01 371 371 4 4 0 31,206.64 31,206.64 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 06/24/06 06/27/06 23 F 01 371 371 3 3 0 24,208.22 24,208.22 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 05/03/06 05/06/06 28 F 01 371 371 3 3 0 21,053.85 21,053.85 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 06/23/06 06/27/06 27 F 01 371 371 4 4 0 31,398.36 31,398.36 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 03/31/06 04/05/06 33 F 01 371 371 5 5 0 34,396.33 34,396.33 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 5 0.8416310001 06/10/06 06/15/06 30 F 01 371 371 5 5 0 41,689.74 41,689.74 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 5 0.8416310001 06/27/06 07/01/06 28 F 01 371 371 4 4 0 27,787.52 27,787.52 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 07/07/06 07/10/06 22 F 01 371 371 3 3 0 21,115.52 21,115.52 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 07/10/06 07/14/06 30 F 06 371 371 4 4 0 27,911.13 27,911.13 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 06/20/06 06/23/06 31 F 01 371 371 3 3 0 25,320.69 25,320.69 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 05/18/06 05/22/06 37 F 01 371 371 4 4 0 29,619.72 29,619.72 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 05/17/06 05/20/06 24 F 01 371 371 3 3 0 21,489.69 21,489.69 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 08/07/06 08/11/06 29 F 01 371 371 4 4 0 31,455.39 31,455.39 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 07/31/06 08/05/06 29 F 01 371 371 5 5 0 35,877.37 35,877.37 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 5 0.8416310001 08/10/06 08/13/06 23 F 01 371 371 3 3 0 21,318.88 21,318.88 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 06/19/06 06/24/06 41 F 01 371 371 5 5 0 37,570.79 37,570.79 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 5 0.8416310001 08/10/06 08/14/06 29 F 01 371 371 4 4 0 26,857.57 26,857.57 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 08/23/06 08/27/06 20 F 01 371 371 4 4 0 27,618.26 27,618.26 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 08/11/06 08/13/06 32 F 01 371 371 2 2 0 20,767.41 20,767.41 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 2 0.8416310001 09/07/06 09/11/06 35 F 01 371 371 4 4 0 31,231.53 31,231.53 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 09/11/06 09/14/06 25 F 01 371 371 3 3 0 24,055.15 24,055.15 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 09/26/06 09/30/06 27 F 01 371 371 4 4 0 27,593.80 27,593.80 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 09/24/06 09/28/06 29 F 01 371 371 4 4 0 26,800.19 26,800.19 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 09/27/06 10/01/06 24 F 01 371 371 4 4 0 26,966.17 26,966.17 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 07/27/06 08/01/06 39 F 01 371 371 5 5 0 34,755.51 34,755.51 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 5 0.8416310001 10/08/06 10/12/06 22 F 01 371 371 4 4 0 26,748.88 26,748.88 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 09/19/06 09/22/06 32 F 01 371 371 3 3 0 21,265.26 21,265.26 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 04/10/06 04/15/06 23 F 01 371 371 5 5 0 36,437.53 36,437.53 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 5 0.8416310001 11/05/06 11/08/06 27 F 01 371 371 3 3 0 21,129.50 21,129.50 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 08/17/06 08/21/06 35 F 01 371 371 4 4 0 29,122.40 29,122.40 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 10/30/06 11/03/06 19 F 01 371 371 4 4 0 34,008.48 34,008.48 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 10/12/06 10/15/06 31 F 01 371 371 3 3 0 20,962.09 20,962.09 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 07/01/06 07/05/06 25 F 01 371 371 4 4 0 29,734.12 29,734.12 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 11/21/06 11/25/06 34 F 01 371 371 4 4 0 30,715.92 30,715.92 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 12/04/06 12/07/06 24 F 01 371 371 3 3 0 21,271.01 21,271.01 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 12/05/06 12/08/06 27 F 01 371 371 3 3 0 21,818.31 21,818.31 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 01/11/06 01/15/06 24 F 01 371 371 4 4 0 33,887.99 33,887.99 0.00 4,891.82 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 12/12/06 12/17/06 21 F 01 371 371 5 5 0 38,308.85 38,308.85 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 5 0.8416310001 12/04/06 12/08/06 27 F 01 371 371 4 4 0 31,089.31 31,089.31 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 12/16/06 12/19/06 27 F 01 371 371 3 3 0 23,987.57 23,987.57 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 12/19/06 12/22/06 31 F 01 371 371 3 3 0 21,064.71 21,064.71 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 12/22/06 12/26/06 36 F 01 371 371 4 4 0 26,852.83 26,852.83 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 12/09/06 12/13/06 18 F 01 371 371 4 4 0 31,641.01 31,641.01 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 12/29/06 01/01/07 20 F 01 371 371 3 3 0 21,064.60 21,064.60 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 12/28/06 01/02/07 24 F 01 371 371 5 5 0 35,755.03 35,755.03 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 5 0.8416310001 11/27/06 11/30/06 33 F 01 371 371 3 3 0 21,340.06 21,340.06 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 12/09/06 12/12/06 27 F 01 371 371 3 3 0 21,181.09 21,181.09 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 12/02/06 12/06/06 15 F 01 371 371 4 4 0 36,326.25 36,326.25 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 10/11/06 10/19/06 33 F 01 371 371 8 8 0 62,412.25 62,412.25 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 8 0.8416310001 09/27/06 10/01/06 21 F 01 371 371 4 4 0 28,897.06 28,897.06 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 11/12/06 11/15/06 38 F 01 371 371 3 3 0 22,368.92 22,368.92 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 12/29/06 01/01/07 33 F 01 371 371 3 3 0 20,948.35 20,948.35 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 09/19/06 09/23/06 28 F 01 371 371 4 4 0 31,213.64 31,213.64 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 12/05/06 12/09/06 27 F 01 371 371 4 4 0 30,574.09 30,574.09 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 08/24/06 08/28/06 27 F 01 371 371 4 4 0 26,824.03 26,824.03 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 12/18/06 12/22/06 33 F 01 371 371 4 4 0 27,905.44 27,905.44 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 08/18/06 08/22/06 20 F 01 371 371 4 4 0 28,098.20 28,098.20 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 08/15/06 08/18/06 24 F 01 371 371 3 3 0 20,990.11 20,990.11 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 11/02/06 11/05/06 32 F 01 371 371 3 3 0 21,205.94 21,205.94 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 12/18/06 12/22/06 26 F 01 371 371 4 4 0 26,825.28 26,825.28 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 4 0.8416310001 12/26/06 12/29/06 28 F 01 371 371 3 3 0 21,091.21 21,091.21 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 08/29/06 09/01/06 38 F 01 371 371 3 3 0 22,559.93 22,559.93 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 09/01/06 09/04/06 20 F 01 371 371 3 3 0 22,022.82 22,022.82 0.00 5,068.59 0.1754 0.00 0.00 5 0.00 0.8416 3 3 0.8416310001 02/01/06 02/04/06 40 F 01 372 372 3 3 0 23,217.03 23,217.03 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 01/19/06 01/23/06 29 F 01 372 372 4 4 0 28,804.00 28,804.00 0.00 3,244.91 0.1754 0.00 0.00 8 0.00 0.6571 3 4 0.6571310001 01/21/06 01/24/06 42 F 01 372 372 3 3 0 23,263.68 23,263.68 0.00 3,244.91 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 02/09/06 02/11/06 20 F 01 372 372 2 2 0 16,613.71 16,613.71 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 02/03/06 02/07/06 27 F 01 372 372 4 4 0 28,896.76 28,896.76 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 4 0.6571310001 02/28/06 03/03/06 28 F 01 372 372 3 3 0 23,132.90 23,132.90 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571



MedicareProvider

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DischargeStatus

PaidDRG

Version 24

AP-DRG

Lengthof

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SubAcuteDays Billed

AcuteBilled


Costto

ChargeRatio

MarginalCost

CostOutlierPaid

AWPDay

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AWPDay

OutlierPayment

Version24

Weight


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ofStay


310001 03/10/06 03/12/06 22 F 01 372 372 2 2 0 16,039.42 16,039.42 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 03/07/06 03/11/06 33 F 01 372 372 4 4 0 29,358.81 29,358.81 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 4 0.6571310001 03/10/06 03/12/06 38 F 01 372 372 2 2 0 16,568.95 16,568.95 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 03/27/06 03/30/06 22 F 01 372 372 3 3 0 22,296.40 22,296.40 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 03/23/06 03/26/06 35 F 01 372 372 3 3 0 22,780.73 22,780.73 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 04/08/06 04/10/06 21 F 01 372 372 2 2 0 17,360.43 17,360.43 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 01/31/06 02/02/06 16 F 01 372 372 2 2 0 16,322.84 16,322.84 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 04/21/06 04/24/06 31 F 01 372 372 3 3 0 22,609.19 22,609.19 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 04/28/06 05/01/06 21 F 01 372 372 3 3 0 23,536.64 23,536.64 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 05/05/06 05/08/06 36 F 01 372 372 3 3 0 23,136.73 23,136.73 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 03/29/06 03/31/06 34 F 01 372 372 2 2 0 16,828.73 16,828.73 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 04/30/06 05/03/06 29 F 01 372 372 3 3 0 22,640.05 22,640.05 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 01/30/06 02/02/06 22 F 01 372 372 3 3 0 23,072.68 23,072.68 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 01/30/06 02/01/06 32 F 01 372 372 2 2 0 16,090.29 16,090.29 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 05/26/06 05/28/06 21 F 01 372 372 2 2 0 16,819.66 16,819.66 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 05/04/06 05/06/06 33 F 01 372 372 2 2 0 17,705.43 17,705.43 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 05/25/06 05/29/06 32 F 01 372 372 4 4 0 31,180.58 31,180.58 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 4 0.6571310001 06/12/06 06/14/06 21 F 01 372 372 2 2 0 16,423.85 16,423.85 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 05/24/06 05/27/06 25 F 01 372 372 3 3 0 28,942.89 28,942.89 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 06/19/06 06/22/06 20 F 01 372 372 3 3 0 22,414.14 22,414.14 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 07/04/06 07/06/06 35 F 01 372 372 2 2 0 13,736.38 13,736.38 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 07/04/06 07/07/06 21 F 01 372 372 3 3 0 23,742.01 23,742.01 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 04/05/06 04/07/06 23 F 01 372 372 2 2 0 16,620.19 16,620.19 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 07/21/06 07/24/06 24 F 01 372 372 3 3 0 23,722.25 23,722.25 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 07/17/06 07/22/06 30 F 01 372 372 5 5 0 35,915.89 35,915.89 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 5 0.6571310001 07/27/06 07/29/06 40 F 01 372 372 2 2 0 16,771.00 16,771.00 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 05/01/06 05/03/06 23 F 01 372 372 2 2 0 16,696.64 16,696.64 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 08/10/06 08/13/06 29 F 01 372 372 3 3 0 23,425.66 23,425.66 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 08/11/06 08/13/06 33 F 01 372 372 2 2 0 17,823.09 17,823.09 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 05/01/06 05/04/06 24 F 01 372 372 3 3 0 25,351.35 25,351.35 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 08/28/06 08/31/06 21 F 01 372 372 3 3 0 21,995.93 21,995.93 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 05/25/06 05/28/06 25 F 01 372 372 3 3 0 22,958.27 22,958.27 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 10/10/06 10/13/06 26 F 01 372 372 3 3 0 21,686.49 21,686.49 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 08/21/06 08/23/06 37 F 01 372 372 2 2 0 17,424.99 17,424.99 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 09/25/06 09/27/06 31 F 01 372 372 2 2 0 16,252.52 16,252.52 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 09/16/06 09/20/06 22 F 01 372 372 4 4 0 30,328.06 30,328.06 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 4 0.6571310001 05/10/06 05/13/06 21 F 01 372 372 3 3 0 22,150.45 22,150.45 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 10/23/06 10/26/06 33 F 01 372 372 3 3 0 22,374.98 22,374.98 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 10/24/06 10/27/06 28 F 01 372 372 3 3 0 23,110.10 23,110.10 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 08/18/06 08/20/06 22 F 01 372 372 2 2 0 17,013.77 17,013.77 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 10/18/06 10/21/06 25 F 01 372 372 3 3 0 22,778.38 22,778.38 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 03/18/06 03/20/06 35 F 01 372 372 2 2 0 17,069.39 17,069.39 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 11/03/06 11/06/06 18 F 01 372 372 3 3 0 23,342.17 23,342.17 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 11/01/06 11/03/06 37 F 01 372 372 2 2 0 17,310.76 17,310.76 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 11/24/06 11/28/06 33 F 01 372 372 4 4 0 29,167.92 29,167.92 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 4 0.6571310001 11/29/06 12/01/06 31 F 01 372 372 2 2 0 16,604.40 16,604.40 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 12/04/06 12/07/06 23 F 01 372 372 3 3 0 22,273.26 22,273.26 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 09/09/06 09/12/06 23 F 01 372 372 3 3 0 24,667.44 24,667.44 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 07/15/06 07/20/06 26 F 01 372 372 5 5 0 36,274.18 36,274.18 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 5 0.6571310001 12/09/06 12/12/06 34 F 01 372 372 3 3 0 22,728.47 22,728.47 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 12/11/06 12/13/06 33 F 01 372 372 2 2 0 17,682.15 17,682.15 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 12/21/06 12/24/06 34 F 01 372 372 3 3 0 23,525.94 23,525.94 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 12/15/06 12/18/06 30 F 01 372 372 3 3 0 23,190.16 23,190.16 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 12/26/06 12/29/06 38 F 01 372 372 3 3 0 22,397.33 22,397.33 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 12/31/06 01/03/07 21 F 01 372 372 3 3 0 23,119.49 23,119.49 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 08/09/06 08/12/06 22 F 01 372 372 3 3 0 22,773.29 22,773.29 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 09/14/06 09/16/06 26 F 01 372 372 2 2 0 17,135.13 17,135.13 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 11/15/06 11/17/06 32 F 01 372 372 2 2 0 17,221.19 17,221.19 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 09/08/06 09/10/06 22 F 01 372 372 2 2 0 17,150.33 17,150.33 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 09/28/06 10/01/06 20 F 01 372 372 3 3 0 23,429.80 23,429.80 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 12/29/06 01/01/07 24 F 01 372 372 3 3 0 22,541.00 22,541.00 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 09/19/06 09/21/06 35 F 01 372 372 2 2 0 17,443.69 17,443.69 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 11/15/06 11/17/06 17 F 01 372 372 2 2 0 17,760.65 17,760.65 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 2 0.6571310001 05/24/06 05/27/06 21 F 01 372 372 3 3 0 23,044.45 23,044.45 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 08/15/06 08/18/06 33 F 01 372 372 3 3 0 24,358.69 24,358.69 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 11/01/06 11/04/06 22 F 01 372 372 3 3 0 26,552.23 26,552.23 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 08/10/06 08/13/06 20 F 01 372 372 3 3 0 23,850.63 23,850.63 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 09/07/06 09/10/06 26 F 01 372 372 3 3 0 25,728.21 25,728.21 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 11/06/06 11/09/06 37 F 01 372 372 3 3 0 29,508.51 29,508.51 0.00 3,362.17 0.1754 0.00 0.00 8 0.00 0.6571 3 3 0.6571310001 01/01/06 01/04/06 35 F 01 373 373 3 3 0 22,262.09 22,262.09 0.00 2,853.52 0.1754 0.00 0.00 3 0.00 0.5468 2 3 0.5468310001 01/08/06 01/11/06 39 F 01 373 373 3 3 0 22,586.25 22,586.25 0.00 2,853.52 0.1754 0.00 0.00 3 0.00 0.5468 2 3 0.5468310001 01/11/06 01/13/06 18 F 01 373 373 2 2 0 16,739.82 16,739.82 0.00 2,853.52 0.1754 0.00 0.00 3 0.00 0.5468 2 2 0.5468310001 01/10/06 01/12/06 28 F 01 373 373 2 2 0 16,355.53 16,355.53 0.00 2,853.52 0.1754 0.00 0.00 3 0.00 0.5468 2 2 0.5468310001 01/24/06 01/27/06 35 F 01 373 373 3 3 0 22,337.33 22,337.33 0.00 2,853.52 0.1754 0.00 0.00 3 0.00 0.5468 2 3 0.5468310001 01/24/06 01/27/06 35 F 01 373 373 3 3 0 22,006.33 22,006.33 0.00 2,853.52 0.1754 0.00 0.00 3 0.00 0.5468 2 3 0.5468



MedicareProvider

AdmitDate


DischargeStatus

PaidDRG

Version 24

AP-DRG

Lengthof

StayAcuteDays

SubAcuteDays Billed

AcuteBilled


Costto

ChargeRatio

MarginalCost

CostOutlierPaid

AWPDay

OutlierThreshold

AWPDay

OutlierPayment

Version24

Weight


TransferLength

ofStay


310001 01/23/06 01/25/06 29 F 01 373 373 2 2 0 15,861.01 15,861.01 0.00 2,853.52 0.1754 0.00 0.00 3 0.00 0.5468 2 2 0.5468310001 01/09/06 01/11/06 27 F 01 373 373 2 2 0 16,287.86 16,287.86 0.00 2,853.52 0.1754 0.00 0.00 3 0.00 0.5468 2 2 0.5468310001 01/31/06 02/02/06 24 F 01 373 373

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New Exhibit 10A Hospital Calendar Year 2006 Valid Claim Set (Part 1 … 2020. 10. 13. · Hospital...

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