STATE OF CALIFORNIA SCHEDULE 4B PROGRAM: NONCONTRACT COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST Provider Name: CENTINELA HOSPITAL MEDICAL CENTER Fiscal Period Ended: DECEMBER 31, 2008 Provider No ZZT30240H SPECIAL CARE UNITS REPORTED Total Inpatient Routine Cost (Sch 8, Line _, Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj ) Cost Applicable to Medi-Cal $ 10 Total Inpatient Routine Cost (Sch 8, Line _, Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj ) Cost Applicable to Medi-Cal 11 12 13 14 15 Total Inpatient Routine Cost (Sch 8, Line _, Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj ) Cost Applicable to Medi-Cal 16 17 18 19 20 Total Inpatient Routine Cost (Sch 8, Line _, Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj ) Cost Applicable to Medi-Cal 21 22 23 24 25 Total Inpatient Routine Cost (Sch 8, Line _, Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj ) Cost Applicable to Medi-Cal 26 27 28 29 30 Total Inpatient Routine Cost (Sch 8, Line _, Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj ) Cost Applicable to Medi-Cal $ 31 Medi-Cal Routine Cost (Sum of Lines 5,10,15,20,25,30) $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ This is trial version www.adultpdf.com AUDITED $ 0.00 $ 0 $ 0 0.00 0 $ 0.00 $ 0 $ 0 0.00 0 $ 0.00 $ 0 $ 0 0.00 0 $ 0.00 $ 0 $ 0 0.00 0 $ 0.00 $ 0 $ 0 0.00 0 $ 0.00 $ 0 $ 0 0.00 0 $ (To Schedule 4) STATE OF CALIFORNIA SCHEDULE PROGRAM: NONCONTRACT SCHEDULE OF MEDI-CAL ANCILLARY COSTS Provider Name: CENTINELA HOSPITAL MEDICAL CENTER Fiscal Period Ended: DECEMBER 31, 2008 Provider No: ZZT30240H TOTAL ANCILLARY COST * ANCILLARY COST CENTERS 37.00 Operating Room 38.00 Recovery Room 39.00 Delivery Room and Labor Room 40.00 Anesthesiology 41.00 Radiology - Diagnostic 41.01 CAT Scan 41.02 Ultra Sound 41.03 Magnetic Resonance Imaging (MRI) 42.00 Radiology - Therapeutic 43.00 Radioisotope 44.00 Laboratory 44.01 Pathological Lab 46.00 Whole Blood 47.00 Blood Storing and Processing 49.00 Respiratory Therapy 50.00 Physical Therapy 51.00 Occupational Therapy 52.00 Speech Pathology 53.00 Electrocardiology 53.01 Cardiology 53.02 Cardiac Rehab 54.00 Electroencephalography 55.00 Medical Supplies Charged to Patients 56.00 Drugs Charged to Patients 57.00 Renal Dialysis 59.00 Lithotripsy 59.01 Pain Management 59.02 Rehab Nuero 60.00 Clinic 60.01 Other Clinic Services 61.00 Emergency 62.00 Observation Beds 71.00 82.00 83.00 84.00 85.00 86.00 TOTAL TOTAL ANCILLARY CHARGES (Adj 3) RATIO COST TO CHARGES MEDI-CAL CHARGES (From Schedule 6) $ 18,934,192 4,781,770 388,502 6,616,923 1,514,471 1,438,472 1,040,649 1,369,353 10,642,370 733,891 2,785,082 7,520,142 1,858,158 650,986 319,970 2,095,525 9,528,752 255,057 2,135,134 15,706,800 2,198,142 17,136 65,785 60,492 0 15,000,989 0 0 0 $ 107,341,144 8,964,037 22,301,238 32,512,124 57,470,248 16,361,285 13,178,801 11,432,966 162,889,960 1,211,146 2,563,444 53,903,767 4,641,624 1,594,903 406,182 40,462,624 29,275,216 1,579,673 234,412,470 241,708,950 17,837,132 190,845 541,722 610 0 86,098,626 0 0 0 0.176393 $ 0.000000 0.533439 0.017421 0.203522 0.026352 0.087919 0.078964 0.119772 0.000000 0.065335 0.605948 0.000000 1.086461 0.139511 0.400325 0.408166 0.787751 0.051789 0.325489 0.000000 0.161462 0.009108 0.064982 0.123234 0.089792 0.121437 99.167922 0.000000 0.000000 0.174230 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 $ 107,658,744 $ 1,148,880,737 $ * From Schedule 8, Column 27 This is trial version www.adultpdf.com MEDI-CAL COST $ 0 16,888 461 4,888 0 214,730 0 0 29,795 6,093 355 0 0 626,116 0 0 0 0 0 0 0 899,326 0 0 3,437 41 386 0 14,029 0 0 11,928 2,487 280 0 0 40,686 0 0 0 0 0 0 0 $ 73,274 (To Schedule 3) STATE OF CALIFORNIA SCHEDULE PROGRAM: NONCONTRACT ADJUSTMENTS TO MEDI-CAL CHARGES Provider Name: CENTINELA HOSPITAL MEDICAL CENTER Fiscal Period Ended: DECEMBER 31, 2008 Provider No: ZZT30240H REPORTED 37.00 38.00 39.00 40.00 41.00 41.01 41.02 41.03 42.00 43.00 44.00 44.01 46.00 47.00 49.00 50.00 51.00 52.00 53.00 53.01 53.02 54.00 55.00 56.00 57.00 59.00 59.01 59.02 60.00 60.01 61.00 62.00 71.00 82.00 83.00 84.00 85.00 86.00 ANCILLARY CHARGES Operating Room Recovery Room Delivery Room and Labor Room Anesthesiology Radiology - Diagnostic CAT Scan Ultra Sound Magnetic Resonance Imaging (MRI) Radiology - Therapeutic Radioisotope Laboratory Pathological Lab Whole Blood Blood Storing and Processing Respiratory Therapy Physical Therapy Occupational Therapy Speech Pathology Electrocardiology Cardiology ADJUSTMENTS (Adj 5) $ $ $ 0 0 16,888 461 4,888 0 214,730 0 0 29,795 6,093 355 0 0 626,116 0 0 0 0 0 0 0 16,888 0 461 4,888 214,730 0 29,795 6,093 355 626,116 $ 899,326 $ 899,326 (To Schedule 5) Cardiac Rehab Electroencephalography Medical Supplies Charged to Patients Drugs Charged to Patients Renal Dialysis Lithotripsy Pain Management Rehab Nuero Clinic Other Clinic Services Emergency Observation Beds TOTAL MEDI-CAL ANCILLARY CHARGES AUDITED $ This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE PROGRAM: NONCONTRACT COMPUTATION OF PROFESSIONAL COMPONENT OF HOSPITAL BASED PHYSICIAN'S REMUNERATION Provider Name: CENTINELA HOSPITAL MEDICAL CENTER Fiscal Period Ended: DECEMBER 31, 2008 Provider No: ZZT30240H PROFESSIONAL SERVICE COST CENTERS HBP REMUNERATION (Adj ) 40.00 41.00 43.00 44.00 53.00 54.00 61.00 Anesthesiology Radiology - Diagnostic Radioisotope Laboratory Electrocardiology Electroencephalography Emergency TOTAL $ $ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL CHARGES RATIO OF MEDI-CAL MEDI-CAL TO ALL PATIENTS REMUNERATION CHARGES COST TO CHARGES (Adj ) (Adj ) $ 0.000000 $ $ 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 0 0.000000 $ $ $ (To Schedule 3) This is trial version www.adultpdf.com STATE OF CALIFORNIA CONTRACT SCH COMPUTATION OF MEDI-CAL CONTRACT COST Provider Name: CENTINELA HOSPITAL MEDICAL CENTER Fiscal Period Ended: DECEMBER 31, 2008 Provider No: HSC30240H REPORTED AUDITED Net Cost of Covered Services Rendered to Medi-Cal Patients (Contract Sch 3) $ 39,169,928 $ 39,228,184 Excess Reasonable Cost Over Charges (Contract Sch 2) $ $ Medi-Cal Inpatient Hospital Based Physician Services $ $ $ $ $ 39,169,928 $ 39,228,184 $ $ $ $ Subtotal (Sum of Lines through 4) N/A Total Medi-Cal Cost (Sum of Lines through 7) $ Medi-Cal Overpayments (Adj ) $ $ 10 Medi-Cal Credit Balances (Adj ) $ $ 11 $ $ 12 $ $ 13 TOTAL MEDI-CAL SETTLEMENT Due Provider (State) $ This is trial version www.adultpdf.com 39,169,928 $ 39,228,184 (To Summary of Findings) $ (To Summary of Findings) STATE OF CALIFORNIA CONTRACT SCH COMPUTATION OF LESSER OF MEDI-CAL REASONABLE COST OR CUSTOMARY CHARGES Provider Name: CENTINELA HOSPITAL MEDICAL CENTER Fiscal Period Ended: DECEMBER 31, 2008 Provider No: HSC30240H REPORTED AUDITED REASONABLE COST OF MEDI-CAL INPATIENT SERVICES Cost of Covered Services (Contract Sch 3) $ 39,169,928 $ 39,904,252 CHARGES FOR MEDI-CAL INPATIENT SERVICES Inpatient Routine Service Charges (Adj 10) $ 118,181,100 $ 92,678,133 Inpatient Ancillary Service Charges (Adj 10) $ 217,292,074 $ 167,992,519 Total Charges - Medi-Cal Inpatient Services $ 335,473,174 $ 260,670,652 Excess of Customary Charges Over Reasonable Cost (Line minus Line 1) * $ 296,303,246 $ 220,766,401 Excess of Reasonable Cost Over Customary Charges (Line minus Line 4) $ * If charges exceed reasonable cost, no further calculation necessary for this schedule This is trial version www.adultpdf.com $ (To Contract Sch 1) STATE OF CALIFORNIA CONTRACT SCH COMPUTATION OF MEDI-CAL NET COST OF COVERED SERVICES Provider Name: CENTINELA HOSPITAL MEDICAL CENTER Fiscal Period Ended: DECEMBER 31, 2008 Provider No: HSC30240H REPORTED AUDITED Medi-Cal Inpatient Ancillary Services (Contract Sch 5) $ 19,714,567 $ 14,987,303 Medi-Cal Inpatient Routine Services (Contract Sch 4) $ 19,455,361 $ 24,916,949 Medi-Cal Inpatient Hospital Based Physician for Intern and Resident Services (Sch ) $ $ $ $ $ $ SUBTOTAL (Sum of Lines through 5) $ 39,169,928 $ 39,904,252 Medi-Cal Inpatient Hospital Based Physician for Acute Care Services (Contract Sch 7) $ ( See Contract Sch 1) $ SUBTOTAL $ Coinsurance (Adj 11) $ $ (659,039) 10 Patient and Third Party Liability (Adj 11) $ $ (17,029) 11 Net Cost of Covered Services Rendered to Medi-Cal Inpatients $ This is trial version www.adultpdf.com 39,169,928 $ 39,904,252 (To Contract Sch 2) 39,169,928 $ 39,228,184 (To Contract Sch 1) STATE OF CALIFORNIA CONTRACT SCH COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST Provider Name: CENTINELA HOSPITAL MEDICAL CENTER Fiscal Period Ended: DECEMBER 31, 2008 Provider No: HSC30240H GENERAL SERVICE UNIT NET OF SWING-BEDS COSTS REPORTED INPATIENT DAYS Total Inpatient Days (include private & swing-bed) (Adj ) Inpatient Days (include private, exclude swing-bed) Private Room Days (exclude swing-bed private room) (Adj ) Semi-Private Room Days (exclude swing-bed) (Adj ) Medicare NF Swing-Bed Days through Dec 31 (Adj ) Medicare NF Swing-Bed Days after Dec 31 (Adj ) Medi-Cal NF Swing-Bed Days through July 31 (Adj ) Medi-Cal NF Swing-Bed Days after July 31 (Adj ) Medi-Cal Days (excluding swing-bed) (Adj 8) AUDITED 62,121 62,121 62,121 0 0 13,474 62,121 62,121 62,121 0 0 5,666 SWING-BED ADJUSTMENT 17 Medicare NF Swing-Bed Rates through Dec 31 (Adj ) 18 Medicare NF Swing-Bed Rates after Dec 31(Adj ) 19 Medi-Cal NF Swing-Bed Rates through July 31(Adj ) 20 Medi-Cal NF Swing-Bed Rates after July 31(Adj ) 21 Total Routine Serv Cost (Sch 8, Part I, Line 25, Col 27) 22 Medicare NF Swing-Bed Cost through Dec 31 (L x L 17) 23 Medicare NF Swing-Bed Cost after Dec 31 (L x L 18) 24 Medi-Cal NF Swing-Bed Cost through July 31 (L x L 19) 25 Medi-Cal NF Swing-Bed Cost after July 31 (L x L 20) 26 Total Swing-Bed Cost (Sum of Lines 22 to 25) 27 Inpatient Routine Cost Net of Swing-Bed (L 21 minus L 26) $ $ $ $ $ $ $ $ $ $ $ 0.00 0.00 0.00 0.00 64,008,208 0 0 64,008,208 $ $ $ $ $ $ $ $ $ $ $ 0.00 0.00 0.00 0.00 63,347,793 0 0 63,347,793 PRIVATE ROOM DIFFERENTIAL ADJUSTMENT 28 Gen Inpatient Routine Serv Charges (excl swing-bed charges)(Adj ) 29 Private Room Charges (excluding swing-bed charges)(Adj ) 30 Semi-Private Room Charges (excluding swing-bed charges)(Adj ) 31 Gen Inpatient Routine Service Cost/Charge Ratio (L 27 / L 28) 32 Average Private Room Per Diem Charge (L 29 / L 3) 33 Average Semi-Private Room Per Diem Charge (L 30 / L 4) 34 Avg Per Diem Prvt Room Charge Differential (L 32 minus L 33) 35 Average Per Diem Private Room Cost Differential (L 31 x L 34) 36 Private Room Cost Differential Adjustment (L 35 x L 3) 37 Inpatient Rout Cost Net of Swing-Bed & Prvt Rm (L 27 minus L 36) $ $ $ $ $ $ $ $ $ $ 369,411,300 369,411,300 0.173271 0.00 5,946.64 0.00 0.00 64,008,208 $ $ $ $ $ $ $ $ $ $ 369,411,300 369,411,300 0.171483 0.00 5,946.64 0.00 0.00 63,347,793 PROGRAM INPATIENT OPERATING COST 38 Adjusted General Inpatient Routine Cost Per Diem (L 37 / L 2) 39 Program General Inpatient Routine Service Cost (L x L 38) $ $ 1,030.38 $ 13,883,340 $ 1,019.75 5,777,904 40 41 Cost Applicable to Medi-Cal (Contract Sch 4A) Cost Applicable to Medi-Cal (Contract Sch 4B) $ $ 5,572,021 $ $ 19,139,045 42 TOTAL MEDI-CAL ROUTINE COST (Sum of Lines 39, 40 & 41) $ This is trial version www.adultpdf.com 19,455,361 $ 24,916,949 (To Contract Sch 3) STATE OF CALIFORNIA CONTRACT SCH 4A COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST Provider Name: CENTINELA HOSPITAL MEDICAL CENTER Fiscal Period Ended: DECEMBER 31, 2008 Provider No: HSC30240H SPECIAL CARE AND/OR NURSERY UNITS NURSERY Total Inpatient Routine Cost (Sch 8, Line 33, Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj 8) Cost Applicable to Medi-Cal INTENSIVE CARE UNIT Total Inpatient Routine Cost (Sch 8, Line 26, Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj 8) 10 Cost Applicable to Medi-Cal CORONARY CARE UNIT 11 Total Inpatient Routine Cost (Sch 8, Line 27, Col 27) 12 Total Inpatient Days (Adj ) 13 Average Per Diem Cost 14 Medi-Cal Inpatient Days (Adj ) 15 Cost Applicable to Medi-Cal NEONATAL INTENSIVE CARE UNIT 16 Total Inpatient Routine Cost (Sch 8, Line 30, Col 27) 17 Total Inpatient Days (Adj ) 18 Average Per Diem Cost 19 Medi-Cal Inpatient Days (Adj 8) 20 Cost Applicable to Medi-Cal SURGICAL INTENSIVE CARE UNIT 21 Total Inpatient Routine Cost (Sch 8, Line 29, Col 27) 22 Total Inpatient Days (Adj ) 23 Average Per Diem Cost 24 Medi-Cal Inpatient Days (Adj ) 25 Cost Applicable to Medi-Cal REPORTED $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ AUDITED 1,244,249 $ 4,391 283.36 $ 2,358 668,163 $ 1,231,396 4,391 280.44 3,113 873,010 17,992,564 $ 9,258 1,943.46 $ 1,036 2,013,425 $ 17,806,741 9,258 1,923.39 9,109 17,520,160 $ 0.00 $ 0 $ 0 0.00 0 3,892,517 $ 2,789 1,395.67 $ 2,071 2,890,433 $ 3,852,313 2,789 1,381.25 540 745,875 $ 0.00 $ 0 $ 0 0.00 0 0 0.00 0 26 27 28 29 30 Total Inpatient Routine Cost (Sch 8, Line , Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj ) Cost Applicable to Medi-Cal $ $ 0.00 $ $ $ 31 Medi-Cal Routine Cost (Sum of Lines 5,10,15,20,25,30) $ This is trial version www.adultpdf.com 5,572,021 $ 19,139,045 (To Contract Sch 4) STATE OF CALIFORNIA CONTRACT SCH 4B COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST Provider Name: CENTINELA HOSPITAL MEDICAL CENTER Fiscal Period Ended: DECEMBER 31, 2008 Provider No: HSC30240H SPECIAL CARE UNITS REPORTED Total Inpatient Routine Cost (Sch 8, Line _, Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj ) Cost Applicable to Medi-Cal $ 10 Total Inpatient Routine Cost (Sch 8, Line _, Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj ) Cost Applicable to Medi-Cal 11 12 13 14 15 Total Inpatient Routine Cost (Sch 8, Line _, Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj ) Cost Applicable to Medi-Cal 16 17 18 19 20 Total Inpatient Routine Cost (Sch 8, Line _, Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj ) Cost Applicable to Medi-Cal 21 22 23 24 25 Total Inpatient Routine Cost (Sch 8, Line _, Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj ) Cost Applicable to Medi-Cal 26 27 28 29 30 Total Inpatient Routine Cost (Sch 8, Line _, Col 27) Total Inpatient Days (Adj ) Average Per Diem Cost Medi-Cal Inpatient Days (Adj ) Cost Applicable to Medi-Cal $ 31 Medi-Cal Routine Cost (Sum of Lines 5,10,15,20,25,30) $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ This is trial version www.adultpdf.com AUDITED $ 0.00 $ 0 $ 0 0.00 0 $ 0.00 $ 0 $ 0 0.00 0 $ 0.00 $ 0 $ 0 0.00 0 $ 0.00 $ 0 $ 0 0.00 0 $ 0.00 $ 0 $ 0 0.00 0 $ 0.00 $ 0 $ 0 0.00 0 $ (To Contract Sch 4) STATE OF CALIFORNIA CONTRACT SCH SCHEDULE OF MEDI-CAL ANCILLARY COSTS Provider Name: CENTINELA HOSPITAL MEDICAL CENTER Fiscal Period Ended: DECEMBER 31, 2008 Provider No: HSC30240H TOTAL ANCILLARY COST* ANCILLARY COST CENTERS 37.00 Operating Room 38.00 Recovery Room 39.00 Delivery Room and Labor Room 40.00 Anesthesiology 41.00 Radiology - Diagnostic 41.01 CAT Scan 41.02 Ultra Sound 41.03 Magnetic Resonance Imaging (MRI) 42.00 Radiology - Therapeutic 43.00 Radioisotope 44.00 Laboratory 44.01 Pathological Lab 46.00 Whole Blood 47.00 Blood Storing and Processing 49.00 Respiratory Therapy 50.00 Physical Therapy 51.00 Occupational Therapy 52.00 Speech Pathology 53.00 Electrocardiology 53.01 Cardiology 53.02 Cardiac Rehab 54.00 Electroencephalography 55.00 Medical Supplies Charged to Patients 56.00 Drugs Charged to Patients 57.00 Renal Dialysis 59.00 Lithotripsy 59.01 Pain Management 59.02 Rehab Nuero 60.00 Clinic 60.01 Other Clinic Services 61.00 Emergency 62.00 Observation Beds 71.00 82.00 83.00 84.00 85.00 86.00 TOTAL $ $ TOTAL ANCILLARY CHARGES (Adj 3) 18,934,192 $ 4,781,770 388,502 6,616,923 1,514,471 1,438,472 1,040,649 1,369,353 10,642,370 733,891 2,785,082 7,520,142 1,858,158 650,986 319,970 2,095,525 9,528,752 255,057 2,135,134 15,706,800 2,198,142 17,136 65,785 60,492 0 15,000,989 0 0 0 107,658,744 $ RATIO COST TO CHARGES 107,341,144 8,964,037 22,301,238 32,512,124 57,470,248 16,361,285 13,178,801 11,432,966 162,889,960 1,211,146 2,563,444 53,903,767 4,641,624 1,594,903 406,182 40,462,624 29,275,216 1,579,673 234,412,470 241,708,950 17,837,132 190,845 541,722 610 0 86,098,626 0 0 0 0.176393 $ 0.000000 0.533439 0.017421 0.203522 0.026352 0.087919 0.078964 0.119772 0.000000 0.065335 0.605948 0.000000 1.086461 0.139511 0.400325 0.408166 0.787751 0.051789 0.325489 0.000000 0.161462 0.009108 0.064982 0.123234 0.089792 0.121437 99.167922 0.000000 0.000000 0.174230 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 1,148,880,737 $ * From Schedule 8, Column 27 This is trial version www.adultpdf.com MEDI-CAL COST MEDI-CAL CHARGES (Contract Sch 6) 10,870,227 $ 2,808,700 3,582,170 4,199,349 5,744,943 1,495,478 1,375,731 1,402,881 29,216,590 160,952 500,511 7,078,803 591,294 180,749 61,051 3,906,558 1,998,419 917,862 34,162,549 45,503,632 3,959,772 0 0 8,274,298 0 0 0 167,992,519 1,917,428 1,498,271 62,404 854,659 151,392 131,481 108,633 168,026 1,908,858 97,529 543,786 987,567 236,710 73,776 48,093 202,317 650,463 148,200 311,168 2,956,930 487,979 0 0 1,441,633 0 0 0 $ 14,987,303 (To Contract Sch 3) ... COMPUTATION OF LESSER OF MEDI-CAL REASONABLE COST OR CUSTOMARY CHARGES Provider Name: CENTINELA HOSPITAL MEDICAL CENTER Fiscal Period Ended: DECEMBER 31, 2008 Provider No: HSC30240H REPORTED... (To Contract Sch 4) STATE OF CALIFORNIA CONTRACT SCH SCHEDULE OF MEDI-CAL ANCILLARY COSTS Provider Name: CENTINELA HOSPITAL MEDICAL CENTER Fiscal Period Ended: DECEMBER 31, 2008 Provider No: HSC30240H. .. OF CALIFORNIA SCHEDULE PROGRAM: NONCONTRACT SCHEDULE OF MEDI-CAL ANCILLARY COSTS Provider Name: CENTINELA HOSPITAL MEDICAL CENTER Fiscal Period Ended: DECEMBER 31, 2008 Provider No: ZZT30240H TOTAL