STATE OF CALIFORNIA SCHEDULE 5 PROGRAM: NONCONTRACT SCHEDULE OF MEDI-CAL ANCILLARY COSTS part1 pot
STATE OF CALIFORNIASCHEDULE 5 PROGRAM: NONCONTRACT SCHEDULE OF MEDI-CAL ANCILLARY COSTSProvider ppt
... (From Schedule 6)
MEDI-CAL
CHARGES
MEDI-CAL
SCHEDULE OF MEDI-CAL ANCILLARY COSTS
TOTAL ANCILLARY
CHARGES
TOTAL
COST *
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STATE OF CALIFORNIA SCHEDULE 4A-1
PROGRAM: ... 140, 454 ,52 4 0.113748 0 0
59 .07 Pulmonary Function Testing 1,901 ,59 9 3,728,114 0 .51 0070 0 0
59 .08 Recreational Therapy 139,834 833,837 0.167700 0 0
60.00...
SCHEDULE 5 PROGRAM: NON CONTRACT SCHEDULE OF MEDICAL ANCILLARY COSTS_PART2 potx
... Pathology 81, 955 2 45, 3 75 0.334000 8,772 2,930
53 .00 Electrocardiology 999,870 8, 750 ,091 0.114270 5, 262,779 601,376
54 .00 Electroencephalography 317,877 1,347,672 0.2 358 71 65, 952 15, 556
55 .00 Medical ... 8 ,57 3,772 71,377,030 0.120119 0 0
50 .00 Physical Therapy 1,463,732 4,003,812 0.3 655 85 70,914 25, 9 25
51.00 Occupational Therapy 156 ,122 306,981 0 .50 857 1 4,274 2...
SCHEDULE 5 PROGRAM: NON CONTRACT SCHEDULE OF MEDICAL ANCILLARY COSTS_PART3 pot
... 00
0
6, 358 ,52 5
83,131
59 1 ,50 2
4 85, 639
0
0
0
0
0
38,668,001
5, 101, 858
0 2,086 ,51 6 20,689 157 , 953 129,6830000011,978,720 1 ,58 0,473
0000000000 00
0 1,016,638 21,2 35 83,400 68,4740000 05, 934,8 35 783,042
0000000000 ... 18.00
COMPUTATION OF COST ALLOCATION (W/S B)
454 ,329
53 ,734
17,048
64,217
20,374
0
159 ,711
50 ,671
0
95, 083
183,742
58 ,2 95
0
109,441
0
0
0
0
0...
SCHEDULE 5 PROGRAM: NON CONTRACT SCHEDULE OF MEDICAL ANCILLARY COSTS_PART4 docx
... 3 25, 660 241 ,55 5 124,728 0 122,429 10,119,4 35 9,473,614 847,407,934 0 0
2,996,762 1 ,58 1,328 5, 553 ,236 3,6 25, 274 1,1 85, 728 0 3,271,0 45 2,381,360 6,374,876 5, 630,813 0 0
9.087292 0.824038 17. 052 252 ... 23,061
0
5, 416,880 676,186 50 ,9 35, 422 50 ,9 35, 422 9, 450 ,264 52 ,56 2
0
3,914 ,54 2 1, 058 ,122 103,024,136 103,024,136 7,249,602 11 ,59 0
0
0
0
394,922 308,8 65 4...
SCHEDULE 5 PROGRAM: NON CONTRACT SCHEDULE OF MEDICAL ANCILLARY COSTS_PART5 docx
... Private Offices $5, 258 , 056 $679 ,53 1 $5, 937 ,58 7
10A A 99.01 7 Community Benefits * 3, 355 ,072 1,198 3, 356 ,270
10A A 99.02 7 Marketing * 714 ,55 9 982 7 15, 541
10A A 2.00 7 Old Capital Related Costs - Movable ... $52 ,806 ,53 6
5, Contract 5 C I 53 .00 8 Electrocardiology 8, 650 ,091 100,000 8, 750 ,091
5, Contract 5 C I 55 .00 8 Medical Supplies Charged to Patients 91,497...
SCHEDULE 5 PROGRAM: NON CONTRACT SCHEDULE OF MEDICAL ANCILLARY COSTS_part2 docx
... Therapy 2 ,53 2,287 19, 155 ,59 0 0.132196 0 0
50 .00 Physical Therapy 699,6 85 3, 958 ,002 0.176777 0 0
51 .00 Occupational Therapy 0 0 0.000000 0 0
52 .00 Speech Pathology 77,916 53 0 ,59 3 0.146847 0 0
53 .00 ... *
MEDI-CAL
(Schedule 6-1)(Adj )
CHARGES
TOTAL ANCILLARY
SCHEDULE OF MEDI-CAL ANCILLARY COSTS
TOTAL
This is trial version
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STATE OF CALIFO...
SCHEDULE 5 PROGRAM: NON CONTRACT SCHEDULE OF MEDICAL ANCILLARY COSTS_part3 pdf
... $0
5. Subtotal (Sum of Lines 1 through 4) $ 6, 256 ,4 65 $ 7,1 45, 013
6. $0 $0
7. $0 $0
8. Total Medi-Cal Cost (Sum of Lines 5 through 7) $ 6, 256 ,4 65 $ 7,1 45, 013
(To Summary of Findings)
9. Medi-Cal ... 2 ,53 2,287 19, 155 ,59 0 0.132196 3,1 75, 810 419,828
50 .00 Physical Therapy 699,6 85 3, 958 ,002 0.176777 214,804 37,972
51 .00 Occupational Therapy 0 0 0.000...
SCHEDULE 5 PROGRAM: NON CONTRACT SCHEDULE OF MEDICAL ANCILLARY COSTS_part4 ppt
... Respiratory Therapy 2 ,53 2,287 19, 155 ,59 0 0.132196 5, 319, 759 703,249
50 .00 Physical Therapy 699,6 85 3, 958 ,002 0.176777 45, 027 7,960
52 .00
Speech Pathology 77,916 53 0 ,59 3 0.146847 15, 960 2,344
53 .00 Electrocardiology ... Electrocardiology 7 35, 1 25 4,110,438 0.178843 0 0
54 .00 Electroencephalography 75, 249 1 05, 813 0.711 151 0 0
55 .00 Med Supply Charged to Patien...
SCHEDULE 5 PROGRAM: NON CONTRACT SCHEDULE OF MEDICAL ANCILLARY COSTS_part5 pdf
... 381
1,304 1,304 1 ,53 5 3
2,319 2,319 1,0 25
0
15, 092
3 85, 244
15, 092
40 ,52 3
9,8 15
4,160
8,738
34,1 05, 250
3,838
5, 268 95, 602 5, 268 3,180 2,324 2,080 5, 478 8,674 ,50 0 158
8,804 91,730 8,804 9 ,58 4 2,873 2,080 ... 2,164
117,691 9 35, 510 1 15, 499 56 ,827 34,922 0 10,400 1,721, 855 2,1 95, 398 172, 254 ,56 3 6,711 0
3,421,172 346, 753 158 ,870 1,039,400 883,887 0 1,370,7...
SCHEDULE 5 PROGRAM: NON CONTRACT SCHEDULE OF MEDICAL ANCILLARY COSTS_part6 doc
... 3, 958 ,002 3, 958 ,002
9 B-1 52 .00 17 Speech Pathology 0 53 0 ,59 3 53 0 ,59 3
9 B-1 53 .00 17 Electrocardiology 92,3 25 4,018,113 4,110,438
9 B-1 54 .00 17 Electroencephalography 0 1 05, 813 1 05, 813
9 B-1 55 .00 17 ... 6,182 ,53 7 6,182 ,53 7
9 B-1 56 .00 17 Drugs Charged to Patients 0 28, 451 ,429 28, 451 ,429
9 B-1 57 .00 17 Renal Dialysis 0 1,789,364 1,789,364
9 B-1 61.00 17...
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