Exhibit 4.1 Costs for the Most Frequent Diagnoses Top 20 Inpatient Hospital Principal Diagnoses with the Highest Aggregate Costs, 1997, 2004, and 2005, Ordered by Rank for 2005
CCS Principal Diagnosis Category and Name Total Inflation-adjusted* Hospital Costs in Millions Percent of Total Costs Rank
1997 2004 2005 1997 2004 2005 1997 2004 2005
All diagnoses $209,240.6332 $303,515.0317 $310,916.1910 100.0 100.0 100.0      
101 Coronary atherosclerosis (coronary artery disease) $13,983.3517 $16,260.6633 $15,452.8920 6.7 5.4 5.0 1 1 1
100 Acute myocardial infarction (heart attack) $8,738.1129 $11,601.5299 $10,903.3520 4.2 3.8 3.5 2 2 2
122 Pneumonia (except that caused by tuberculosis or sexually transmitted disease) $8,512.6203 $10,103.6277 $10,685.9790 4.1 3.3 3.4 3 5 3
108 Congestive heart failure, nonhypertensive $6,361.9484 $10,741.4909 $10,466.9020 3.0 3.5 3.4 5 3 4
218 Liveborn (newborn infant) $7,582.4233 $10,562.0491 $9,817.9980 3.6 3.5 3.2 4 4 5
203 Osteoarthritis (degenerative joint disease) $4,487.5632 $8,744.5241 $9,686.0780 2.1 2.9 3.1 8 6 6
237 Complication of medical device, implant or graft $5,288.5931 $8,402.7643 $8,870.2610 2.5 2.8 2.9 6 7 7
2 Septicemia (blood infection) $3,880.1969 $6,685.7440 $8,367.1750 1.9 2.2 2.7 9 8 8
205 Spondylosis, intervertebral disc disorders, other back problems (disorders of intervertebral discs and bones on spinal column) $3,274.1988 $6,507.1386 $7,094.6680 1.6 2.1 2.3 12 9 9
131 Adult respiratory failure, insufficiency, or arrest $3,150.6168 $5,402.6515 $7,019.6980 1.5 1.8 2.3 15 12 10
106 Cardiac dysrhythmias (irregular heart beat) $3,380.1640 $6,228.2545 $5,985.0090 1.6 2.1 1.9 11 11 11
109 Acute cerebrovascular disease (stroke) $5,163.7597 $6,238.4473 $5,853.9840 2.5 2.1 1.9 7 10 12
254 Rehabilitation care, fitting of prostheses, and adjustment of devices $3,572.5144 $5,077.2538 $5,066.7370 1.7 1.7 1.6 10 13 13
238 Complications of surgical procedures or medical care $2,761.5632 $4,592.5188 $4,715.9000 1.3 1.5 1.5 18 14 14
127 Chronic obstructive pulmonary disease and bronchiectasis (chronic obstructive lung disease) $3,167.2664 $3,784.0214 $4,152.5490 1.5 1.2 1.3 14 17 15
149 Biliary tract disease (gall bladder disease) $3,171.6540 $4,081.3313 $4,100.2820 1.5 1.3 1.3 13 15 16
50 Diabetes mellitus with complications $2,618.9522 $3,974.9278 $3,917.3620 1.3 1.3 1.3 19 16 17
226 Fracture of neck of femur (hip fracture) $3,046.3596 $3,779.3019 $3,864.6420 1.5 1.2 1.2 16 18 18
102 Non-specific chest pain $1,593.8139 $3,562.9529 $3,459.9390 0.8 1.2 1.1 36 20 19
657 Mood disorders (depression and bipolar disorder) $2,964.9681 $3,637.9504 $3,393.5020 1.4 1.2 1.1 17 19 20
Total for top 20 conditions $96,700.6407 $139,969.1434 $142,874.9080 46.2 46.1 46.0      
Standard Errors
All diagnoses $6,379.257922 $7,523.368449 $8,017.870192            
101 Coronary atherosclerosis (coronary artery disease) 823.809453 928.738253 885.351869            
100 Acute myocardial infarction (heart attack) 394.173158 519.687862 486.743156            
122 Pneumonia (except that caused by tuberculosis or sexually transmitted disease) 335.761925 220.526095 274.896883            
108 Congestive heart failure, nonhypertensive 278.402660 336.277748 344.321756            
218 Liveborn (newborn infant) 488.356029 623.588943 594.049538            
203 Osteoarthritis (degenerative joint disease) 167.015306 430.971265 396.785992            
237 Complication of medical device, implant or graft 268.176235 377.944255 415.802266            
2 Septicemia (blood infection) 136.116755 202.007563 302.062172            
205 Spondylosis, intervertebral disc disorders, other back problems (disorders of intervertebral discs and bones on spinal column) 142.112031 314.124029 377.745597            
131 Adult respiratory failure, insufficiency, or arrest 115.008168 179.800948 257.341537            
106 Cardiac dysrhythmias (irregular heart beat) 139.336749 244.020104 246.149746            
109 Acute cerebrovascular disease (stroke) 191.406237 241.784658 206.937759            
254 Rehabilitation care, fitting of prostheses, and adjustment of devices 316.673837 486.497039 382.514574            
238 Complications of surgical procedures or medical care 140.705833 167.947703 180.692630            
127 Chronic obstructive pulmonary disease and bronchiectasis (chronic obstructive lung disease) 99.661254 97.522933 104.795673            
149 Biliary tract disease (gall bladder disease) 85.046076 96.855055 100.565098            
50 Diabetes mellitus with complications 127.049299 113.416806 118.424943            
226 Fracture of neck of femur (hip fracture) 89.566960 85.846761 99.333691            
102 Non-specific chest pain 57.740391 112.822836 141.417811            
657 Mood disorders (depression and bipolar disorder) 173.735160 244.700897 222.837210            
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1997, 2004, and 2005.
*Adjusted for inflation using the GDP deflator (http://www.bea.gov/national/nipaweb/TableView.asp#Mid, Table 1.1.4. Price Indexes for Gross Domestic Product).

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