Projected Annual Payment Change for Georgia Inpatient Facilities Estimated Impact of Moving from Tricare V30 to V33 Update Effective January 1, 2016 Payment Percent Hospital Name Change Change DeKalb Medical Center ($60,574) -0.16% Northside Hospital ($47,853) -0.13% Medical Center of Central Georgia ($41,485) -0.07% Eastside Medical Center ($9,046) -0.10% Medical Center of Columbus ($8,708) -0.03% Mayo Clinic - Waycross ($7,309) -0.09% Spalding Regional Hospital ($7,122) -0.08% Southeast Georgia Health System - Brunswick ($6,978) -0.06% Wellstar Cobb Hospital ($6,896) -0.02% Saint Mary's Hospital ($6,699) -0.10% Rockdale Medical Center ($5,400) -0.04% Atlanta Medical Center - South Campus ($4,941) -0.03% Phoebe Putney Memorial Hospital ($4,789) -0.01% Gwinnett Medical Center - Lawrenceville ($4,656) -0.02% Northside Hospital - Forsyth ($4,320) -0.04% Memorial Health University Medical Center ($3,665) -0.01% Clearview Regional Medical Center ($3,297) -0.09% Houston Medical Center ($3,267) -0.02% Phoebe North Hospital ($3,142) -0.14% Tanner Medical Center - Villa Rica ($2,866) -0.03% Doctor's Hospital - Augusta ($2,763) -0.02% Northeast Georgia Medical Center ($2,745) -0.01% Saint Francis Hospital ($2,660) -0.05% Saint Joseph's Hospital of Atlanta ($2,384) -0.06% Hughston Hospital ($1,823) -0.39% Upson Regional Medical Center ($1,795) -0.04% Floyd Medical Center ($1,714) -0.01% Colquitt Regional Medical Center ($1,651) -0.03% Cartersville Medical Center ($1,591) -0.02% Newton Medical Center ($1,521) -0.03% West Georgia Medical Center ($1,409) -0.02% Oconee Regional Medical Center ($1,319) -0.03% Piedmont Hospital ($1,319) -0.01% Ty Cobb Regional Hospital ($967) -0.06% Wellstar Douglas Hospital ($632) -0.01% Piedmont Newnan Hospital ($614) -0.01% Hutcheson Medical Center ($591) -0.01% Tift Regional Medical Center ($558) -0.01% Bacon County Hospital ($136) -0.01% Wesley Woods Center of Emory University $0 0.00% Barrow Regional Medical Center $0 0.00% Memorial Hospital - Bainbridge $0 0.00% Perry Hospital $0 0.00% Crisp Regional Hospital $0 0.00% Habersham County Medical Center $0 0.00% University Hospital McDuffie $0 0.00% Dorminy Medical Center $0 0.00% Phoebe Sumter Medical Center $0 0.00% Mitchell County Hospital $0 0.00% Wills Memorial Hospital $0 0.00% 11/17/2015 Projected Annual Payment Change for Georgia Inpatient Facilities Estimated Impact of Moving from Tricare V30 to V33 Update Effective January 1, 2016 Payment Percent Hospital Name Change Change Emanuel Medical Center $0 0.00% Taylor Regional Hospital $0 0.00% Wayne Memorial Hospital $0 0.00% Piedmont Mountainside Hospital $0 0.00% Dodge County Hospital $0 0.00% Putnam General Hospital $0 0.00% Southeast Georgia Health System - Camden $0 0.00% Liberty Regional Medical Center $0 0.00% Union General Hospital $0 0.00% Monroe County Hospital $0 0.00% North Georgia Medical Center $0 0.00% Appling Hospital $0 0.00% Berrien County Hospital $0 0.00% Bleckley Memorial Hospital $0 0.00% Brooks County Hospital $0 0.00% Burke Medical Center $0 0.00% Chatuge Regional Hospital $0 0.00% Chestatee Regional Hospital $0 0.00% Children's Hospital of Atlanta - Hughes Spalding $0 0.00% Clinch Memorial Hospital $0 0.00% Donalsonville Hospital $0 0.00% Early Memorial Hospital $0 0.00% Effingham County Hospital $0 0.00% Evans Memorial Hospital $0 0.00% Fannin Regional Hospital $0 0.00% Flint River Hospital $0 0.00% Georgia Rehabilitation Hospital $0 0.00% Good Samaritan Hospital $0 0.00% Higgins General Hospital $0 0.00% Jasper Memorial Hospital $0 0.00% Jefferson Hospital $0 0.00% Jenkins County Hospital $0 0.00% Louis Smith Memorial Hospital $0 0.00% Mountain Lakes Medical Center $0 0.00% Murray Medical Center $0 0.00% Polk Medical Center $0 0.00% Roosevelt Warm Springs Rehab Hospital $0 0.00% Screven County Hospital $0 0.00% Select Specialty Hospital - Atlanta $0 0.00% Shepherd Center $0 0.00% Stephens County Hospital $0 0.00% Warm Springs Medical Center $0 0.00% Wellstar Kennestone Windy Hill Hospital $0 0.00% Decatur Hospital $0 0.00% Northridge Medical Center $0 0.00% Cook Medical Center $0 0.00% Irwin County Hospital $0 0.00% Grady General Hospital $0 0.00% Jeff Davis Hospital $0 0.00% Southwest Georgia Regional Medical Center $0 0.00% 11/17/2015 Projected Annual Payment Change for Georgia Inpatient Facilities Estimated Impact of Moving from Tricare V30 to V33 Update Effective January 1, 2016 Payment Percent Hospital Name Change Change Sylvan Grove Hospital $0 0.00% Kindred Hospital Atlanta $0 0.00% Morgan Memorial Hospital $0 0.00% Wellstar Paulding Hospital $0 0.00% Washington County Regional Medical Center $0 0.00% Phoebe Worth Medical Center $0 0.00% Peach Regional Medical Center $0 0.00% Gordon Hospital $0 0.00% Elbert Memorial Hospital $0 0.00% North Fulton Hospital $0 0.00% Candler County Hospital $0 0.00% Coliseum Northside Hospital $0 0.00% Doctor's Hospital - Tattnall $0 0.00% Smith Northview Hospital $0 0.00% Hart County Hospital $0 0.00% Doctor's Hospital - Columbus $0 0.00% Piedmont Fayette Hospital $223 0.00% Emory Johns Creek Hospital $269 0.01% Gwinnett Medical Center - Duluth $513 0.02% Fairview Park Hospital $1,054 0.01% Candler Hospital $1,082 0.01% Piedmont Henry Hospital $1,223 0.01% Northside Hospital - Cherokee $1,403 0.03% Meadows Regional Medical Center $1,509 0.02% Emory Univeristy Hospital - Midtown $1,794 0.00% John D. Archbold Memorial Hospital $1,889 0.02% Trinity Hospital of Augusta $2,326 0.10% Tanner Medical Center - Carrollton $2,583 0.03% Coffee Regional Medical Center $2,812 0.04% Saint Joseph's Hospital Savannah $3,093 0.04% Hamilton Medical Center $3,333 0.03% East Georgia Regional Medical Center $3,955 0.04% South Georgia Medical Center $4,982 0.03% DeKalb Medical Center - Hillandale $5,232 0.11% Children's Hospital of Atlanta - Egleston $6,766 0.00% Coliseum Medical Center $6,934 0.05% Miller County Hospital $7,024 1.84% University Hospital $8,258 0.04% Southern Regional Medical Center $9,376 0.04% Atlanta Medical Center $10,021 0.02% Children's Hospital of Atlanta - Scottish Rite $12,108 0.02% Athens Regional Medical Center $16,197 0.07% Redmond Regional Medical Center $20,550 0.32% Wellstar Kennestone Hospital $21,303 0.07% Georgia Regents Medical Center $30,444 0.05% Emory University Hospital $36,188 0.09% Grady Memorial Hospital $46,797 0.05% 11/17/2015.