PROGRAM: PSYCHIATRIC COMPUTATION OF PROFESSIONAL COMPONENT OF HOSPITAL BASED PHYSICIAN''''S REMUNERATION _part3 pdf

STATE OF CALIFORNIA SCHEDULE 7-1
PROGRAM: PSYCHIATRIC
Provider Name: Fiscal Period Ended:
CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008
Provider No:
HSM 30625F

PROFESSIONAL
SERVICE
COST CENTERS
40.00 Anesthesiology $ 0 $ 0 0.000000 $ $ 0
41.00 Radiology - Diagnostic 0 0 0.000000 0
43.00 Radioisotope 0 0 0.000000 0
44.00 Laboratory 0 0 0.000000 0
53.00 Electrocardiology 0 0 0.000000 0
54.00 Electroencephalography 0 0 0.000000 0
61.00 Emergency 0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0

0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
TOTAL $ 0 $ 0 $ 0 $ 0
(To Schedule 3-1)
COMPUTATION OF PROFESSIONAL
COMPONENT OF HOSPITAL BASED
PHYSICIAN'S REMUNERATION
(Adj )
TOTAL CHARGES
TO ALL PATIENTS
(Adj )
HBP
REMUNERATION
TO CHARGES

MEDI-CAL
CHARGES
MEDI-CAL
COSTREMUNERATION
RATIO OF
(Adj )
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STATE OF CALIFORNIA SCHEDULE 1-2
PROGRAM: REHABILITATION
Provider Name: Fiscal Period Ended:
CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008
Provider No:
HSC 30625F
REPORTED AUDITED
1. Net Cost of Covered Services Rendered to
Medi-Cal Patients (Schedule 3-2) $ 292,277 $ 0

2. Excess Reasonable Cost Over Charges (Schedule 2-2) $ 0 $ 0
3. Medi-Cal Inpatient Hospital Based Physician Services $ 0 $ 0
4. $ 0 $ 0
5. TOTAL COST - Reimbursable to Provider (Lines 1 through 4) $ 292,277 $ 0
6. Interim Payments (Adj 22) $ (292,277) $ 0
7. Balance Due Provider (State) $ 0 $ 0
8. Duplicate Payments (Adj ) $ 0 $ 0

9. $ 0 $ 0

10. $0 $0
11. TOTAL MEDI-CAL SETTLEMENT Due Provider (State) $ 0 $ 0

(To Summary of Findings)
COMPUTATION OF
MEDI-CAL REIMBURSEMENT SETTLEMENT
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STATE OF CALIFORNIA SCHEDULE 2-2
PROGRAM: REHABILITATION
Provider Name: Fiscal Period Ended:
CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008
Provider No:
HSC 30625F
REPORTED AUDITED
REASONABLE COST OF MEDI-CAL INPATIENT SERVICES
1. Cost of Covered Services (Schedule 3-2) $ 292,277 $ 0
CHARGES FOR MEDI-CAL INPATIENT SERVICES
2. Inpatient Routine Service Charges (Adj 21) $ 419,330 $ 0
3. Inpatient Ancillary Service Charges (Adj 21) $ 549,829 $ 0
4. Total Charges - Medi-Cal Inpatient Services $ 969,159 $ 0
5. Excess of Customary Charges Over Reasonable Cost
(Line 4 minus Line 1) * $ 676,882 $ 0
6. Excess of Reasonable Cost Over Customary Charges
(Line 1 minus Line 4) $ 0 $ 0
(To Schedule 1-2)
* If charges exceed reasonable cost, no further calculation necessary for this schedule.
COMPUTATION OF LESSER OF
MEDI-CAL REASONABLE COST OR CUSTOMARY CHARGES
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STATE OF CALIFORNIA SCHEDULE 3-2
PROGRAM: REHABILITATION

Provider Name: Fiscal Period Ended:
CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008
Provider No:
HSC 30625F
REPORTED AUDITED
1. Medi-Cal Inpatient Ancillary Services (Schedule 5-2) $ 107,260 $ 0
2. Medi-Cal Inpatient Routine Services (Schedule 4-2) $ 185,017 $ 0
3. Medi-Cal Inpatient Hospital Based Physician
for Intern and Resident Services (Sch ) $ 0 $ 0
4. $ 0 $ 0
5. $ 0 $ 0
6. SUBTOTAL (Sum of Lines 1 through 5) $ 292,277 $ 0
7. Medi-Cal Inpatient Hospital Based Physician
for Acute Care Services (Schedule 7-2) $ 0 $ 0
8. SUBTOTAL $ 292,277 $ 0
(To Schedule 2-2)
9. Coinsurance (Adj ) $ 0 $ 0
10. Patient and Third Party Liability (Adj ) $ 0 $ 0
11. Net Cost of Covered Services Rendered to Medi-Cal
Inpatients $ 292,277 $ 0
(To Schedule 1-2)
COMPUTATION OF
MEDI-CAL NET COSTS OF COVERED SERVICES
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STATE OF CALIFORNIA SCHEDULE 4-2
PROGRAM: REHABILITATION
Provider Name: Fiscal Period Ended:
CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008
Provider No:

HSC 30625F
GENERAL SERVICE UNIT NET OF SWING-BED COSTS REPORTED AUDITED
INPATIENT DAYS
1. Total Inpatient Days (include private & swing-bed) (Adj 7) 8,598 0
2. Inpatient Days (include private, exclude swing-bed) 8,598 0
3. Private Room Days (exclude swing-bed private room) (Adj ) 0 0
4. Semi-Private Room Days (exclude swing-bed) (Adj 7) 8,598 0
5. Medicare NF Swing-Bed Days through Dec 31 (Adj ) 0 0
6. Medicare NF Swing-Bed Days after Dec 31 (Adj ) 0 0
7. Medi-Cal NF Swing-Bed Days through July 31 (Adj ) 0 0
8. Medi-Cal NF Swing-Bed Days after July 31 (Adj ) 0 0
9. Medi-Cal Days (excluding swing-bed) (Adj 19) 146 0
SWING-BED ADJUSTMENT
17. Medicare NF Swing-Bed Rates through Dec 31 (Adj ) $ 0.00 $ 0.00
18. Medicare NF Swing-Bed Rates after Dec 31(Adj ) $ 0.00 $ 0.00
19. Medi-Cal NF Swing-Bed Rates through July 31(Adj ) $ 0.00 $ 0.00
20. Medi-Cal NF Swing-Bed Rates after July 31(Adj ) $ 0.00 $ 0.00
21. Total Routine Serv Cost (Sch 8, Part I, Line 31, Col 27) $ 10,895,759 $ 0
22. Medicare NF Swing-Bed Cost through Dec 31 (L 5 x L 17) $ 0 $ 0
23. Medicare NF Swing-Bed Cost after Dec 31 (L 6 x L 18) $ 0 $ 0
24. Medi-Cal NF Swing-Bed Cost through July 31 (L 7 x L 19) $ 0 $ 0
25. Medi-Cal NF Swing-Bed Cost after July 31 (L 8 x L 20) $ 0 $ 0
26. Total Swing-Bed Cost (Sum of Lines 22 to 25) $ 0 $ 0
27. Inpatient Routine Cost Net of Swing-Bed (L 21 minus L 26) $ 10,895,759 $ 0

PRIVATE ROOM DIFFERENTIAL ADJUSTMENT
28. Gen Inpatient Routine Serv Charges (excl swing-bed charges)(Adj 9) $ 24,816,770 $ 0
29. Private Room Charges (excluding swing-bed charges)(Adj ) $ 0 $ 0
30. Semi-Private Room Charges (excluding swing-bed charges)(Adj 9) $ 24,816,770 $ 0
31. Gen Inpatient Routine Service Cost/Charge Ratio (L 27 / L 28) $ 0.439048 $ 0.000000

32. Average Private Room Per Diem Charge (L 29 / L 3) $ 0.00 $ 0.00
33. Average Semi-Private Room Per Diem Charge (L 30 / L 4) $ 2,886.34 $ 0.00
34. Avg Per Diem Prvt Room Charge Differential (L 32 minus L 33) $ 0.00 $ 0.00
35. Average Per Diem Private Room Cost Differential (L 31 x L 34) $ 0.00 $ 0.00
36. Private Room Cost Differential Adjustment (L 35 x L 3) $ 0 $ 0
37. Inpatient Rout Cost Net of Swing-Bed & Prvt Rm (L 27 minus L 36) $ 10,895,759 $ 0
PROGRAM INPATIENT OPERATING COST
38. Adjusted General Inpatient Routine Cost Per Diem (L 37 / L 2) $ 1,267.24 $ 0.00
39. Program General Inpatient Routine Service Cost (L 9 x L 38) $ 185,017 $ 0
40. Cost Applicable to Medi-Cal (Schedule 4A-2) $ 0 $ 0
41. Cost Applicable to Medi-Cal (Schedule 4B-2) $ 0 $ 0
42. TOTAL MEDI-CAL ROUTINE COST (Sum of Lines 39, 40 & 41) $ 185,017 $ 0
(To Schedule 3-2)
COMPUTATION OF
MEDI-CAL INPATIENT ROUTINE SERVICE COST
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STATE OF CALIFORNIA SCHEDULE 4A-2
PROGRAM: REHABILITATION
Provider Name: Fiscal Period Ended:
CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008
Provider No:
HSC 30625F
SPECIAL CARE AND/OR NURSERY UNITS REPORTED AUDITED
NURSERY
1. Total Inpatient Routine Cost (Sch 8, Line 33, Col 27) $ 7,910,324 $ 7,910,329
2. Total Inpatient Days (Adj ) 16,584 16,584
3. Average Per Diem Cost $ 476.99 $ 476.99
4. Medi-Cal Inpatient Days (Adj ) 0 0
5. Cost Applicable to Medi-Cal $ 0 $ 0

INTENSIVE CARE UNIT
6. Total Inpatient Routine Cost (Sch 8, Line 26, Col 27) $ 34,664,749 $ 34,664,771
7. Total Inpatient Days (Adj ) 10,680 10,680
8. Average Per Diem Cost $ 3,245.76 $ 3,245.77
9. Medi-Cal Inpatient Days (Adj ) 0 0
10. Cost Applicable to Medi-Cal $ 0 $ 0
CORONARY CARE UNIT
11. Total Inpatient Routine Cost (Sch 8, Line 27, Col 27) $ 2,780,566 $ 2,780,568
12. Total Inpatient Days (Adj ) 890 890
13. Average Per Diem Cost $ 3,124.23 $ 3,124.23
14. Medi-Cal Inpatient Days (Adj ) 0 0
15. Cost Applicable to Medi-Cal $ 0 $ 0
SURGICAL INTENSIVE CARE UNIT
16. Total Inpatient Routine Cost (Sch 8, Line 29, Col 27) $ 23,895,533 $ 23,895,548
17. Total Inpatient Days (Adj ) 7,325 7,325
18. Average Per Diem Cost $ 3,262.19 $ 3,262.19
19. Medi-Cal Inpatient Days (Adj ) 0 0
20. Cost Applicable to Medi-Cal $ 0 $ 0
SURGICAL ICU-8
21. Total Inpatient Routine Cost (Sch 8, Line 29.01, Col 27) $ 22,082,665 $ 22,082,681
22. Total Inpatient Days (Adj ) 7,306 7,306
23. Average Per Diem Cost $ 3,022.54 $ 3,022.54
24. Medi-Cal Inpatient Days (Adj 20) 0 0
25. Cost Applicable to Medi-Cal $ 0 $ 0

ADMINISTRATIVE DAYS
26. Per Diem Rate (Adj ) $ 0.00 $ 0.00
27. Medi-Cal Inpatient Days (Adj ) 0 0
28. Cost Applicable to Medi-Cal $ 0 $ 0
ADMINISTRATIVE DAYS

29. Per Diem Rate (Adj ) $ 0.00 $ 0.00
30. Medi-Cal Inpatient Days (Adj ) 0 0
31. Cost Applicable to Medi-Cal $ 0 $ 0
32. Medi-Cal Routine Cost (Sum of Lines 5,10,15,20,25,28,31) $ 0 $ 0
(To Schedule 4-2)
COMPUTATION OF
MEDI-CAL INPATIENT ROUTINE SERVICE COST
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STATE OF CALIFORNIA SCHEDULE 4B-2
PROGRAM: REHABILITATION
Provider Name: Fiscal Period Ended:
CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008
Provider No:
HSC 30625F

SPECIAL CARE UNITS REPORTED AUDITED
PEDIATRIC INTENSIVE CARE UNIT
1. Total Inpatient Routine Cost (Sch 8, Line 29.03, Col 27) $ 7,410,985 $ 7,410,989
2. Total Inpatient Days (Adj ) 1,912 1,912
3. Average Per Diem Cost $ 3,876.04 $ 3,876.04
4. Medi-Cal Inpatient Days (Adj ) 0 0
5. Cost Applicable to Medi-Cal $ 0 $ 0

NEONATAL INTENSIVE CARE UNIT
6. Total Inpatient Routine Cost (Sch 8, Line 30, Col 27) $ 32,319,451 $ 32,319,475
7. Total Inpatient Days (Adj ) 14,302 14,302
8. Average Per Diem Cost $ 2,259.79 $ 2,259.79
9. Medi-Cal Inpatient Days (Adj ) 0 0
10. Cost Applicable to Medi-Cal $ 0 $ 0

N/A
11. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0
12. Total Inpatient Days (Adj ) 0 0
13. Average Per Diem Cost $ 0.00 $ 0.00
14. Medi-Cal Inpatient Days (Adj ) 0 0
15. Cost Applicable to Medi-Cal $ 0 $ 0
N/A
16. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0
17. Total Inpatient Days (Adj ) 0 0
18. Average Per Diem Cost $ 0.00 $ 0.00
19. Medi-Cal Inpatient Days (Adj ) 0 0
20. Cost Applicable to Medi-Cal $ 0 $ 0
N/A
21. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0
22. Total Inpatient Days (Adj ) 0 0
23. Average Per Diem Cost $ 0.00 $ 0.00
24. Medi-Cal Inpatient Days (Adj ) 0 0
25. Cost Applicable to Medi-Cal $ 0 $ 0
N/A
26. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0
27. Total Inpatient Days (Adj ) 0 0
28. Average Per Diem Cost $ 0.00 $ 0.00
29. Medi-Cal Inpatient Days (Adj ) 0 0
30. Cost Applicable to Medi-Cal $ 0 $ 0
31. Medi-Cal Routine Cost (Sum of Lines 5,10,15,20,25,30) $ 0 $ 0
(To Schedule 4-2)

COMPUTATION OF
MEDI-CAL INPATIENT ROUTINE SERVICE COST
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STATE OF CALIFORNIA SCHEDULE 5-2
PROGRAM: REHABILITATION
Provider Name: Fiscal Period Ended:
CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008
Provider No:
HSC 30625F
RATIO
COST TO
CHARGES
ANCILLARY COST CENTERS
37.00 Operating Room $ 95,710,199 $ 585,456,449 0.163480 $ 0 $ 0
39.00 Delivery Room and Labor Room 29,518,483 75,488,257 0.391034 0 0
40.00 Anesthesiology 55,602,856 446,285,096 0.124590 0 0
41.00 Radiology-Diagnostic 49,746,582 193,969,630 0.256466 0 0
43.01 Ultrasound 4,215,379 29,801,839 0.141447 0 0
43.02 CAT Scan 12,997,062 201,731,626 0.064427 0 0
44.00 Laboratory 81,858,827 694,170,211 0.117923 0 0
44.01 Laboratory-Pathological 25,512,941 62,236,846 0.409933 0 0
44.02 HLA Lab 4,969,551 11,666,069 0.425983 0 0
47.00 Blood Storing, Processing & Trans 25,970,759 39,817,972 0.652237 0 0
49.00 Respiratory Therapy 29,840,758 292,629,267 0.101975 0 0
50.00 Physical Therapy 11,777,981 41,779,821 0.281906 0 0
51.00 Occupational Therapy 4,439,833 22,511,543 0.197225 0 0
52.00 Speech Pathology 1,689,666 8,339,831 0.202602 0 0
53.00 Electrocardiology 13,588,420 98,869,613 0.137438 0 0
54.00 Electroencephalography 4,408,169 21,049,131 0.209423 0 0
54.01 Electromyography 166,799 1,342,237 0.124269 0 0
55.00 Medical Supplies Charged to Patients 125,543,810 522,478,410 0.240285 0 0
56.00 Drugs Charged to Patients 93,304,736 462,202,429 0.201870 0 0

57.00 Renal Dialysis 8,102,366 31,845,109 0.254430 0 0
59.00 Gastro Intestinal Services 17,677,073 51,780,517 0.341385 0 0
59.01 Eye Laboratory 116,474 643,684 0.180950 0 0
59.02 Cardiac Catheterization Laboratory 10,383,847 81,800,167 0.126942 0 0
59.03 Vascular Laboratory 4,491,186 49,819,261 0.090150 0 0
59.04 Psychiatric/Psychological Services 948,688 4,444,067 0.213473 0 0
59.05 Nuclear Medicine - Therapeutic 14,418,226 116,313,021 0.123961 0 0
59.06 Magnetic Resonance Imaging 15,976,382 140,454,524 0.113748 0 0
59.07 Pulmonary Function Testing 1,901,599 3,728,114 0.510070 0 0
59.08 Recreational Therapy 139,834 833,837 0.167700 0 0
60.00 Clinic 5,867,508 3,544,413 1.655425 0 0
60.01 Psychiatric Clinic 4,048,115 6,939,317 0.583359 0 0
60.02 Medical Oncology 101,988,606 315,812,474 0.322940 0 0
60.03 Psych - Partial Hospitalization 894,863 2,902,036 0.308357 0 0
60.04 Clinic 2 - Gen Risk Center 406,378 124,968 3.251855 0 0
60.05 Clinic 3 - Neuro Surgical Institute 5,137,193 1,367,847 3.755678 0 0
60.06 Clinic 4 - Prostate Cancer Program 463,111 194,947 2.375574 0 0
60.07 Clinic 5 -Endocrinology Center 1,082,093 973,406 1.111657 0 0
60.08 Clinic 6 - Spine Injury Institute 4,253,159 2,992,983 1.421044 0 0
60.09 Clinic 7 - Pediatric Center 2,929,172 1,490,379 1.965387 0 0
61.00 Emergency 38,372,548 260,197,483 0.147475 0 0
TOTAL $ 910,461,233 $ 4,890,028,831 $ 0 $ 0
(To Schedule 3-2)
* From Schedule 8, Column 27
(Schedule 6-2)
MEDI-CAL
COST *
TOTAL ANCILLARY
CHARGES
(Adj )

COST
SCHEDULE OF MEDI-CAL ANCILLARY COSTS
TOTAL
ANCILLARY
MEDI-CAL
CHARGES
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STATE OF CALIFORNIA SCHEDULE 6-2
PROGRAM: REHABILITATION
Provider Name: Fiscal Period Ended:
CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008
Provider No:
HSC 30625F
ANCILLARY CHARGES
37.00 Operating Room $ 10,034 $ (10,034) $ 0
39.00 Delivery Room and Labor Room 0 0
40.00 Anesthesiology 0 0
41.00 Radiology-Diagnostic 4,998 (4,998) 0
43.01 Ultrasound 0 0
43.02 CAT Scan 11,602 (11,602) 0
44.00 Laboratory 113,574 (113,574) 0
44.01 Laboratory-Pathological 0 0
44.02 HLA Lab 0 0
47.00 Blood Storing, Processing & Trans 1,573 (1,573) 0
49.00 Respiratory Therapy 17,756 (17,756) 0
50.00 Physical Therapy 95,372 (95,372) 0
51.00 Occupational Therapy 104,181 (104,181) 0
52.00 Speech Pathology 30,309 (30,309) 0
53.00 Electrocardiology 1,820 (1,820) 0

54.00 Electroencephalography 0 0
54.01 Electromyography 0 0
55.00 Medical Supplies Charged to Patients 20,031 (20,031) 0
56.00 Drugs Charged to Patients 56,206 (56,206) 0
57.00 Renal Dialysis 0 0
59.00 Gastro Intestinal Services 0 0
59.01 Eye Laboratory 0 0
59.02 Cardiac Catheterization Laboratory 0 0
59.03 Vascular Laboratory 12,999 (12,999) 0
59.04 Psychiatric/Psychological Services 0 0
59.05 Nuclear Medicine - Therapeutic 4,677 (4,677) 0
59.06 Magnetic Resonance Imaging 19,959 (19,959) 0
59.07 Pulmonary Function Testing 0 0
59.08 Recreational Therapy 7,035 (7,035) 0
60.00 Clinic 0 0 0
60.01 Psychiatric Clinic 0 0 0
60.02 Medical Oncology 37,703 (37,703) 0
60.03 Psych - Partial Hospitalization 0 0 0
60.04 Clinic 2 - Gen Risk Center 0 0 0
60.05 Clinic 3 - Neuro Surgical Institute 0 0 0
60.06 Clinic 4 - Prostate Cancer Program 0 0 0
60.07 Clinic 5 -Endocrinology Center 0 0 0
60.08 Clinic 6 - Spine Injury Institute 0 0 0
60.09 Clinic 7 - Pediatric Center 0 0 0
61.00 Emergency 0 0 0
TOTAL MEDI-CAL ANCILLARY CHARGES $ 549,829 $ (549,829) $ 0
(To Schedule 5-2)
ADJUSTMENTS TO MEDI-CAL CHARGES
REPORTED ADJUSTMENTS AUDITED
(Adj 20)

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STATE OF CALIFORNIA SCHEDULE 7-2
PROGRAM: REHABILITATION
Provider Name: Fiscal Period Ended:
CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008
Provider No:
HSC 30625F

HBP TOTAL CHARGES RATIO OF MEDI-CAL MEDI-CAL
PROFESSIONAL SERVICE REMUNERATION TO ALL PATIENTS CHARGES COST
COST CENTERS TO CHARGES
40.00 Anesthesiology $ 0 $ 0 0.000000 $ $ 0
41.00 Radiology - Diagnostic 0 0 0.000000 0
43.00 Radioisotope 0 0 0.000000 0
44.00 Laboratory 0 0 0.000000 0
53.00 Electrocardiology 0 0 0.000000 0
54.00 Electroencephalography 0 0 0.000000 0
61.00 Emergency 0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0

0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
TOTAL $ 0 $ 0 $ 0 $ 0
(To Schedule 3-2)
(Adj ) (Adj ) (Adj )
REMUNERATION
COMPUTATION OF PROFESSIONAL
COMPONENT OF HOSPITAL BASED
PHYSICIAN'S REMUNERATION
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STATE OF CALIFORNIA CONTRACT SCH 1
Provider Name: Fiscal Period Ended:
CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008
Provider No:
HSC 30625F
REPORTED AUDITED
1. Net Cost of Covered Services Rendered to
Medi-Cal Patients (Contract Sch 3) $ 113,981,887 $ 106,179,067

2. Excess Reasonable Cost Over Charges (Contract Sch 2) $ 0 $ 0
3. Medi-Cal Inpatient Hospital Based Physician Services $ 0 $ 0
4. $ 0 $ 0
5. Subtotal (Sum of Lines 1 through 4) $ 113,981,887 $ 106,179,067
6. $ 0 $ 0
7. $ 0 $ 0

8. Total Medi-Cal Cost (Sum of Lines 5 through 7) $ 113,981,887 $ 106,179,067
(To Summary of Findings)
9. Medi-Cal Overpayments (Adj ) $ 0 $ 0
10. Medi-Cal Credit Balances (Adj ) $ 0 $ 0
11. $ 0 $ 0
12. $ 0 $ 0
13. TOTAL MEDI-CAL SETTLEMENT Due Provider (State) $ 0 $ 0
(To Summary of Findings)
COMPUTATION OF MEDI-CAL CONTRACT COST
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