SNFData - 135065 - 06/2000

409 - MOUNTAIN VALLEY CARE & REHAB
KELLOGG, ID 83837-

Medicare Provider Number: 135065

Cost report status: Settled Without Audit

[Record Code 155526 - 1996]

Excel

PDF

You are not logged in or you have not purchased this report. This report has had its actual values replaced with dummy text ('###').

If you would like to become a subscriber, please look at our subscription details.

If you are already a subscriber, please login.

RATIO OF COST TO CHARGES		PROVIDER NO: 135065	PERIOD: FROM 07/01/1999 TO 06/30/2000	WORKSHEET C
Cost Center		TOTAL (From Wkst B, Pt. I, Col. 18)	Total Charges	Ratio (col. 1 ÷ col. 2)
Cost Center		1	2	3
ANCILLARY SERVICE COST CENTERS
21	Radiology				21
22	Laboratory	###	###	###	22
23	Intravenous Therapy				23
24	Oxygen ( Inhalation ) Therapy	###			24
25	Physical Therapy	###	###	###	25
26	Occupational Therapy	###	###	###	26
27	Speech Pathology	###	###	###	27
28	Electrocardiology				28
29	Medical Supplies Charged	###	###	###	29
30	Drugs Charged to Patients	###	###	###	30
31	Dental Care - Title XIX only				31
32	Support Surfaces				32
33	Other Ancillary Service Cost	###	###	###	33
OUTPATIENT SERVICE COST CENTERS
34	Clinic				34
35	R H C				35
36	Other Outpatient Service Cost				36
48	Ambulance				48
75	Total	###	###		75

Worksheet C