Nhà cung cấp: Alhambra BỆNH VIỆN Y TẾ TRUNG TÂM cung cấp số: ZZT 30281H CHI PHÍ phụ trợ TỔNG * phụ trợ CHI PHÍ TRUNG TÂM 37,00 38,00 phòng điều hành phục hồi Phòng 39,00 Giao hàng tận nơi trong phòng và Phòng Lao động - 40,00 Gây Mê 41,00 X Quang - Chẩn đoán 41,01 41,02 42,00 X Quang | SCHEDULE 5 PROGRAM NONCONTRACT STATE OF CALIFORNIA SCHEDULE OF MEDI-CAL ANCILLARY COSTS Provider Name ALHAMBRA HOSPITAL MEDICAL CENTER Fiscal Period Ended JUNE 30 2007 Provider No ZZT 30281H TOTAL ANCILLARY COST TOTAL ANCILLARY CHARGES Adj RATIO COST TO CHARGES MEDI-CAL CHARGES From Schedule 6 MEDI-CAL COST ANCILLARY COST CENTERS Operating Room 3 167 973 15 068 745 0 0 Recovery Room 0 0 0 0 Delivery Room and Labor Room 0 0 0 0 Anesthesiology 0 0 0 0 Radiology - Diagnostic 2 434 853 10 756 349 230 52 0 0 0 0 0 0 0 0 Radiology - Therapeutic 0 0 0 0 Radioisotope 431 248 1 854 743 0 0 Laboratory 3 175 765 21 740 181 2 798 409 Pathological Lab 0 0 0 0 Whole Blood 873 403 623 641 0 0 Blood Storing and Processing 0 0 0 0 Intravenous Therapy 0 0 0 0 Respiratory Therapy 2 532 287 19 155 590 0 0 Physical Therapy 699 685 3 958 002 129 23 Occupational Therapy 0 0 0 0 Speech Pathology 77 916 530 593 0 0 Electrocardiology 735 125 4 110 438 0 0 Electroencephalography 75 249 105 813 0 0 Medical Supplies Charged to Patients 3 159 034 6 182 537 0 0 Drugs Charged to Patients 4 077 315 28 451 429 9 616 1 378 Renal Dialysis 447 219 1 789 364 0 0 ASC Non-Distinct Part 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Clinic 0 0 0 0 Other Clinic Services 0 0 0 0 Emergency 3 003 592 6 232 588 0 0 Observation Beds 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL 24 890 663 120 560 013 12 773 1 862 To Schedule 3 From Schedule 8
