Cal. Code Regs. Tit. 8, div. 1, ch. 4.5, subch. 1, art. 5.5, app A

Current through Register 2024 Notice Reg. No. 41, October 11, 2024
Appendix A - Hospital Composite Factors and Cost to Charge Rations

Provider NumberHospital NameComposite Factor (2001 Payment Impact File Data)Capital Cost-to- Charge RatioOperating Cost-to- Charge RatioTotal Cost-to- Charge RatioHospital Specific Outlier Factor
50002ST. ROSE HOSPITAL7626.10.0180.3720.390$ 19,640
50006ST. JOSEPH HOSPITAL, EUREKA4303.80.0360.3590.395$ 14,357
50007MILLS PENINSULA MEDICAL CENTER5732.90.0350.3640.399$ 18,837
50008DAVIES MEDICAL CENTER6366.30.0390.3170.356$ 18,840
50009QUEEN OF THE VALLEY5214.80.0410.3570.398$ 16,820
50013ST. HELENA HOSPITAL5286.90.0240.4300.454$ 16,828
50014SUTTER AMADOR HOSPITAL4303.80.0200.3530.373$ 14,357
50015NORTHERN INYO HOSPITAL4346.00.0280.7010.729$ 14,357
50016ARROYO GRANDE COMMUNITY HOSPITAL4553.80.1080.3940.502$ 15,187
50017MERCY GENERAL HOSPITAL5765.80.0220.2410.263$ 16,548
50018PACIFIC ALLIANCE MEDICAL CNTR.8999.40.0430.3930.436$ 16,631
50022RIVERSIDE COMMUNITY5171.40.0440.3370.381$ 15,697
50024PARADISE VALLEY HOSPITAL7440.00.0240.3600.384$ 16,363
50025UCSD MEDICAL CENTER8430.00.0570.3210.378$ 16,395
50026GROSSMONT HOSPITAL5834.50.0430.3180.361$ 16,384
50028MAD RIVER COMMUNITY HOSPITAL4303.80.0260.4180.444$ 14,357
50029ST.LUKE MEDICAL CENTER6514.70.0310.2380.269$ 16,637
50030OROVILLE HOSPITAL5185.60.0480.4950.543$ 14,416
50032WARRACK HOSPITAL5159.20.0330.5000.533$ 17,216
50033MOUNT ZION MEDICAL CENTER OF UCSF8623.80.0420.4070.449$ 18,838
50036MEMORIAL HOSPITAL4314.70.0550.3580.413$ 14,357
50038SANTA CLARA VALLEY MEDICAL CENTER9378.90.0450.5380.583$ 18,192
50039ENLOE MEDICAL CENTER4630.00.0260.4340.460$ 14,416
50040LAC OLIVE VIEW/UCLA MEDICAL CENTER10003.10.0330.3290.362$ 16,628
50042ST. ELIZABETH COMMUNITY HOSPITAL4346.00.0300.4130.443$ 14,357
50043SUMMIT MEDICAL CENTER7556.70.0160.3400.356$ 19,640
50045EL CENTRO REGIONAL MED. CTR.5940.40.0210.3570.378$ 14,381
50046OJAI VALLEY COMMUNITY HOSPITAL4494.10.0590.6750.734$ 14,992
50047CALIFORNIA PACIFIC MEDICAL CENTER7124.80.0290.3730.402$ 18,834
50051ALTA DISTRICT HOSPITAL4303.80.0360.5860.622$ 14,357
50054SAN GORGONIO MEMORIAL HOSPITAL4981.70.0240.3300.354$ 15,677
50055ST. LUKES HOSPITAL8503.50.0260.3600.386$ 18,834
50056ANTELOPE VALLEY HOSPITAL6281.40.0430.3130.356$ 16,639
50057KAWEAH DELTA HEALTH CARE DISTRICT5269.10.0310.4300.461$ 14,357
50058GLENDALE MEMORIAL HOSPITAL & HLTH CT7144.10.0310.2780.309$ 16,632
50060FRESNO COMMUNITY HOSP & MED CENTER5731.00.0290.3370.366$ 14,607
50061ST. FRANCIS MEDICAL CENTER4530.40.0570.3560.413$ 15,112
50063QUEEN OF ANGELS - HLLYWD PRES MC8430.20.0330.2960.329$ 16,632
50065WMC SANTA ANA7039.70.0570.3140.371$ 16,015
50066BAY HARBOR HOSPITAL5818.70.0160.3020.318$ 16,614
50067OAK VALLEY DISTRICT HOSPITAL4468.60.0290.3590.388$ 14,907
50068LINDSAY DISTRICT HOSPITAL4494.20.0140.4870.501$ 14,357
50069ST. JOSEPH HOSPITAL5069.00.0290.2840.313$ 16,629
50070KFH - SSF5729.50.0390.3610.400$ 18,838
50071KFH - SANTA CLARA7040.90.0390.3610.400$ 19,643
50072KFH - WALNUT CREEK6149.70.0390.3610.400$ 19,643
50073KFH - VALLEJO5946.20.0390.3610.400$ 19,587
50075KFH - OAKLAND7131.20.0390.3610.400$ 19,643
50076KFH - SAN FRANCISCO7132.40.0390.3610.400$ 19,643
50077MERCY HOSPITAL6346.80.0340.3000.334$ 16,377
50078SAN PEDRO PENINSULA5498.40.0280.2680.296$ 16,630
50079DOCTORS MEDICAL CENTER-SAN PABLO7288.60.0210.2890.310$ 19,641
50082ST. JOHN'S REGIONAL MEDICAL CENTER5247.30.0740.3430.417$ 14,990
50084ST. JOSEPH'S MEDICAL CENTER5020.20.0220.2600.282$ 15,146
50088SAN LUIS OBISPO GENERAL HOSPITAL4755.30.0250.7350.760$ 15,193
50089COMMUNITY HOSPITAL OF SAN BERNARDINO7291.20.0460.3150.361$ 15,701
50090SONOMA VALLEY HEALTH CARE DIST.5159.20.0550.4370.492$ 17,206
50091COMMUNITY HOSPITALS OF HUNTINGTON PK9079.10.0320.2770.309$ 16,633
50092GLENN MEDICAL CENTER4730.90.0500.7470.797$ 14,357
50093SAINT AGNES MEDICAL CENTER4603.70.0430.3530.396$ 14,607
50096DR'S HOSPITAL OF WEST COVINA5406.70.0390.3040.343$ 16,636
50097GENERAL HOSPITAL4303.80.0330.3670.400$ 14,357
50099SAN ANTONIO COMMUNITY HOSPITAL5661.20.0310.2930.324$ 15,688
50100SHARP MEMORIAL HOSPITAL5783.90.0410.3590.400$ 16,377
50101SUTTER SOLANO MEDICAL CENTER6430.30.0250.2900.315$ 16,823
50102PARKVIEW COMMUNITY HOSPITAL5928.80.0240.3400.364$ 15,676
50103WHITE MEMORIAL MEDICAL CENTER8308.70.0440.3350.379$ 16,637
50104ST. FRANCIS MEDICAL CENTER7922.80.0220.2710.293$ 16,623
50107MARIAN MEDICAL CENTER5215.20.0580.3780.436$ 15,112
50108SUTTER COMMUNITY HOSPITAL5789.30.0360.2780.314$ 16,559
50110LOMPOC DISTRICT HOSPITAL4530.40.0420.4360.478$ 15,113
50111TEMPLE COMMUNITY HOSPITAL7509.10.0160.2850.301$ 16,615
50112SANTA MONICA HOSPITAL5570.30.0390.3550.394$ 16,631
50113SAN MATEO COUNTY GENERAL HOSPITAL6178.80.0280.8860.914$ 18,828
50114SHERMAN OAKS HOSP AND HLTH CENTER5268.70.0470.4300.477$ 16,631
50115PALOMAR MEDICAL CENTER5573.10.0440.3420.386$ 16,382
50116NORTHRIDGE HOSPITAL MEDICAL CENTER5974.70.0290.2750.304$ 16,630
50117MERCY HOSPITAL & HEALTH SYSTEM4954.20.0210.3080.329$ 14,357
50118DOCTORS HOSPITAL OF MANTECA4540.30.0290.2250.254$ 15,145
50121HANFORD COMMUNITY MEDICAL CENTER4303.80.0210.3910.412$ 14,357
50122DAMERON HOSPITAL5554.00.0150.2800.295$ 15,147
50124VERDUGO HILLS HOSPITAL5057.30.0530.3100.363$ 16,648
50125ALEXIAN BROS. HOSPITAL7865.20.0320.2800.312$ 18,198
50126VALLEY PRESBYTERIAN HOSPITAL6606.00.0470.3120.359$ 16,643
50127WOODLAND MEMORIAL HOSPITAL4896.10.0460.4760.522$ 14,704
50128TRI-CITY MEDICAL CENTER5188.60.0430.3090.352$ 16,385
50129ST. BERNARDINE MEDICAL CENTER6071.70.0720.3920.464$ 15,713
50131NOVATO COMMUNITY HOSPITAL5729.50.0260.4640.490$ 18,831
50132SAN GABRIEL VALLEY MEDICAL CENTER5928.30.0380.2510.289$ 16,643
50133RIDEOUT MEMORIAL HOSPITAL5334.90.0440.4430.487$ 15,225
50135HOLLYWOOD COMM. HOSP OF HOLLYWOOD6497.70.0270.3770.404$ 16,620
50136PETALUMA VALLEY HOSPITAL5159.20.0360.4890.525$ 17,214
50137KAISER FOUNDATION HOSPITALS-PANORAMA5088.30.0390.3610.400$ 16,631
50138KAISER FOUNDATION HOSPITALS - SUNSET5938.50.0390.3610.400$ 16,631
50139KAISER FOUND. HOSPITALS - BELLFLOWER5118.50.0390.3610.400$ 16,631
50140KAISER FOUND. HOSPITALS - FONTANA5082.30.0390.3610.400$ 15,689
50144BROTMAN MEDICAL CENTER6207.80.0500.3180.368$ 16,644
50145COMMUNITY HOSP. MONTEREY PENINSULA5869.70.0320.4630.495$ 19,113
50148PLUMAS DISTRICT HOSPITAL MCARE RPT4346.00.0340.4660.500$ 14,357
50149CALIFORNIA HOSPITAL MEDICAL CENTER8562.60.0350.3530.388$ 16,628
50150SIERRA NEVADA MEMORIAL HOSPITAL4948.00.0730.4590.532$ 16,500
50152SAINT FRANCIS MEMORIAL HOSPITAL7135.70.0320.2920.324$ 18,839
50153O'CONNOR HOSPITAL5991.80.0360.3630.399$ 18,195
50155MONROVIA COMMUNITY HOSPITAL5408.90.0390.3140.353$ 16,635
50158ENCINO-TARZANA REG MED CENTER5071.90.0380.3610.399$ 16,630
50159VENTURA COUNTY MEDICAL CENTER7638.60.0240.5040.528$ 14,993
50167SAN JOAQUIN GENERAL HOSPITAL7581.00.0480.4510.499$ 15,146
50168ST. JUDE MEDICAL CENTER4875.00.0220.2820.304$ 15,983
50169PRESBYTERIAN INTERCOMMUNITY5662.70.0410.2900.331$ 16,640
50170LONG BEACH COMMUNITY MEDICAL CENTER5651.60.0320.3330.365$ 16,627
50172REDWOOD MEMORIAL HOSPITAL4303.80.0360.4280.464$ 14,357
50173ANAHEIM GENERAL HOSPITAL6486.40.0130.2750.288$ 15,972
50174SANTA ROSA MEMORIAL HOSPITAL5179.20.0390.4620.501$ 17,212
50175WHITTIER HOSPITAL MEDICAL CENTER6697.30.0390.2910.330$ 16,638
50177SANTA PAULA MEMORIAL HOSPITAL4693.00.0280.5460.574$ 14,993
50179EMANUEL MEDICAL CENTER5133.30.0380.3530.391$ 14,907
50180JOHN MUIR MEDICAL CENTER5985.20.0360.3050.341$ 19,644
50186SCRIPPS HOSPITAL - EAST COUNTY5747.00.0510.3700.421$ 16,384
50188COMM HOSP.& REHAB- LOS GATOS5534.00.0450.2530.298$ 18,209
50189GEORGE L. MEE MEMORIAL HOSPITAL6039.30.0360.4930.529$ 19,112
50191ST MARY MEDICAL CENTER7071.60.0390.2550.294$ 16,643
50192SIERRA KINGS DISTRICT HOSPITAL4572.40.0380.5200.558$ 14,607
50193SOUTH COAST MEDICAL CENTER4867.80.0270.2680.295$ 15,991
50194WATSONVILLE COMMUNITY HOSPITAL6816.00.0300.3870.417$ 18,694
50195WASHINGTON HOSPITAL DISTRICT6805.60.0240.3360.360$ 19,641
50196CENTRAL VALLEY GENERAL HOSP4456.10.0210.3820.403$ 14,357
50197SEQUOIA HEALTH SERVICES5739.10.0300.4490.479$ 18,833
50204LANCASTER HOSPITAL5201.40.0220.2510.273$ 16,625
50205HUNTINGTON EAST VALLEY HOSPITAL7228.20.0440.4190.463$ 16,630
50207FREMONT MEDICAL CENTER5423.30.0300.4940.524$ 15,226
50211ALAMEDA HOSPITAL6385.20.0140.2500.264$ 19,641
50213UNIVERSITY MEDICAL CENTER7604.50.0210.4390.460$ 14,607
50214GRANADA HILLS COMMUNITY HOSPITAL6473.80.0220.3030.325$ 16,620
50215SAN JOSE MEDICAL CENTER7139.90.1300.4250.555$ 18,227
50217FAIRCHILD MEDICAL CENTER4346.00.0450.6160.661$ 14,357
50219COAST PLAZA DOCTORS HOSPITAL6698.90.0230.2880.311$ 16,622
50222SHARP CHULA VISTA MEDICAL CTR6376.70.0440.3260.370$ 16,384
50224HOAG MEMORIAL HOSPITAL PRESBYTERIAN4869.00.0360.3800.416$ 15,989
50225FEATHER RIVER HOSPITAL4510.50.0470.4500.497$ 14,416
50226ANAHEIM MEMORIAL MEDICAL CENTER5034.20.0520.2990.351$ 16,013
50228SAN FRANCISCO GENERAL HOSPITAL10776.10.0160.5350.551$ 18,827
50230GARDEN GROVE MEDICAL CENTER6972.40.0290.2620.291$ 15,994
50231POMONA VALLEY HOSPITAL MED CTR6615.40.0240.2640.288$ 16,626
50232FRENCH HOSPITAL MEDICAL CENTER4562.20.0330.2620.295$ 15,190
50234SHARP CORONADO HOSPITAL4979.70.0350.4640.499$ 16,365
50235PROVIDENCE SAINT JOSEPH MED CTR5361.50.0460.4030.449$ 16,632
50236SIMI VALLEY HOSPITAL5177.00.0360.3260.362$ 16,582
50238METHODIST HOSPITAL OF SOUTHERN CA5065.00.0420.3530.395$ 16,634
50239GLENDALE ADVENTIST MEDICAL CENTER7355.80.0520.6070.659$ 16,624
50240CENTINELA HOSPITAL MEDICAL CENTER6795.90.0490.2980.347$ 16,646
50242DOMINICAN SANTA CRUZ HOSPITAL6176.10.0340.3310.365$ 18,686
50243DESERT HOSPITAL5437.40.0440.2600.304$ 15,708
50245ARROWHEAD REGIONAL MEDICAL CENTER8153.00.0150.4760.491$ 15,662
50248NATIVIDAD MEDICAL CENTER8830.30.0160.3930.409$ 19,124
50251LASSEN COMMUNITY HOSPITAL4730.90.0390.4760.515$ 14,357
50253LINCOLN LLC6066.40.0280.3010.329$ 15,988
50254MARSHALL HOSPITAL5033.60.0850.4310.516$ 16,577
50256ORTHOPAEDIC HOSPITAL6853.00.0460.4470.493$ 16,629
50257GOOD SAMARITAN HOSPITAL4494.20.0800.3200.400$ 14,358
50260MOUNTAINS COMMUNITY HOSPITAL4770.80.0420.4600.502$ 15,684
50261SIERRA VIEW DISTRICT HOSPITAL5092.20.0640.3900.454$ 14,357
50262UCLA MEDICAL CENTER7975.20.0390.3870.426$ 16,629
50264SAN LEANDRO HOSPITAL5974.60.0390.3370.376$ 19,644
50267DANIEL FREEMAN MEMORIAL HOSP6571.30.0230.2480.271$ 16,626
50270SMH - CHULA VISTA6795.50.0360.3050.341$ 16,379
50272REDLANDS COMMUNITY HOSPITAL4783.70.0350.2920.327$ 15,693
50276CONTRA COSTA REGIONAL MEDICAL CNTR9454.00.0170.6660.683$ 19,639
50277PACIFIC HOSPITAL OF LONG BEACH7263.80.0240.3870.411$ 16,617
50278PROVIDENCE HOLY CROSS MEDICAL CENTER5769.40.0390.2820.321$ 16,639
50279HI - DESERT MEDICAL CENTER4817.50.0540.4910.545$ 15,690
50280MERCY MEDICAL CENTER5635.00.0290.2960.325$ 16,206
50281ALHAMBRA HOSPITAL7401.60.0390.3200.359$ 16,635
50282MARTIN LUTHER HOSPITAL5945.20.0380.3210.359$ 15,996
50283VALLEY MEMORIAL HOSPITAL5974.60.0350.2690.304$ 19,644
50289SETON MEDICAL CENTER6749.30.0360.3570.393$ 18,837
50290SAINT JOHN'S HOSPITAL5063.80.0270.3070.334$ 16,625
50291SUTTER COMMUNITY HOSPITAL SANTA ROSA8312.90.0390.4990.538$ 17,213
50292RIVERSIDE COUNTY REGIONAL MED CENTER7310.50.0180.4800.498$ 15,664
50293PACIFIC COAST HOSPITAL7084.40.1120.8350.947$ 18,842
50295MERCY HOSPITAL4464.20.0550.3140.369$ 14,358
50296HAZEL HAWKINS MEM. HOSPITAL5541.70.0360.4420.478$ 18,491
50298BARSTOW COMMUNITY HOSPITAL4770.80.0360.2820.318$ 15,696
50299NHMC-SHERMAN WAY CAMPUS7150.00.0420.3510.393$ 16,634
50300ST. MARY REGIONAL5606.90.0400.3250.365$ 15,694
50301UKIAH VALLEY MEDICAL CENTER5263.30.0340.4860.520$ 16,961
50305ALTA BATES MEDICAL CENTER7233.90.0280.2780.306$ 19,643
50308EL CAMINO HOSPITAL5542.80.0310.3350.366$ 18,194
50309SUTTER ROSEVILLE MEDICAL CENTER5237.10.0350.2870.322$ 16,557
50312REDDING MEDICAL CENTER5071.60.0150.3610.376$ 16,211
50313SUTTER TRACY COMMUNITY HOSPITAL4540.30.0580.3010.359$ 15,144
50315KERN MEDICAL CENTER7908.40.0300.5740.604$ 14,357
50320ALAMEDA COUNTY MEDICAL CENTER10196.10.0170.6080.625$ 19,639
50324SCRIPPS MEMORIAL HOSPITAL - LA JOLLA4990.50.0340.2800.314$ 16,380
50325TUOLUMNE GENERAL HOSPITAL4303.80.0220.4190.441$ 14,357
50327LOMA LINDA UNIVERSITY MEDICAL CTR.7076.60.0360.2890.325$ 15,695
50329CORONA REGIONAL MEDICAL CENTER5574.60.0280.2740.302$ 15,687
50331HEALDSBURG GENERAL HOSPITAL5159.20.0240.4590.483$ 17,218
50333SENECA DISTRICT HOSPITAL4346.00.0210.5320.553$ 14,357
50334SALINAS VALLEY MEMORIAL HOSPITAL6197.30.0230.4420.465$ 19,120
50335SONORA COMMUNITY HOSPITAL4303.80.0390.4600.499$ 14,357
50336LODI MEMORIAL HOSPITAL4748.40.0300.3120.342$ 15,146
50337DESERT PALMS COMMUNITY HOSPITAL5057.30.0420.3940.436$ 16,630
50342PIONEERS MEM. HOSPITAL4456.10.0330.4260.459$ 14,357
50345HOSPITAL NAME NOT AVAILABLE4781.90.0510.4970.548$ 15,687
50348UCI MEDICAL CENTER8187.60.0270.3220.349$ 15,985
50349CORCORAN DISTRICT HOSPITAL4456.10.0300.4290.459$ 14,357
50350BEVERLY COMMUNITY HOSPITAL6431.80.0230.3050.328$ 16,621
50351TORRANCE MEMORIAL MEDICAL CENTER5063.40.0310.3230.354$ 16,627
50352BARTON MEMORIAL HOSPITAL5083.00.0700.5160.586$ 16,561
50353LITTLE COMPANY OF MARY HOSPITAL5067.10.0330.2950.328$ 16,632
50355SIERRA VALLEY DISTRICT HOSPITAL4346.00.1110.6400.751$ 14,358
50357GOLETA VALLEY COTTAGE HOSPITAL4540.50.0360.3510.387$ 15,113
50359TULARE DISTRICT HOSPITAL5249.70.0410.4300.471$ 14,357
50360MARIN GENERAL HOSPITAL5875.40.0500.4250.475$ 18,840
50366MARK TWAIN ST. JOSEPH'S HOSPITAL4346.00.0220.3460.368$ 14,357
50367NORTHBAY MEDICAL CENTER6561.20.0340.2330.267$ 16,816
50369QUEEN OF THE VALLEY HOSPITAL6821.20.0230.3560.379$ 16,618
50373LAC+USC MEDICAL CENTER9863.60.0160.3470.363$ 16,612
50376HARBOR-UCLA MEDICAL CENTER10439.60.0390.2960.335$ 16,637
50377CHOWCHILLA DISTRICT MEMORIAL HOSP4378.70.0320.6420.674$ 14,607
50378PACIFICA OF THE VALLEY8053.40.0590.4760.535$ 16,635
50379WEST SIDE DISTRICT HOSPITAL4346.00.1270.8320.959$ 14,357
50380GOOD SAMARITAN HOSPITAL5539.00.1060.5560.662$ 18,211
50382INTER-COMMUNITY MEDICAL CENTER6123.90.0260.3400.366$ 16,621
50385PALM DRIVE HOSPITAL5159.20.0300.4940.524$ 17,216
50388SOUTHERN INYO HOSPITAL4346.00.0550.7530.808$ 14,357
50390HEMET VALLEY MEDICAL CENTER5342.10.0290.3080.337$ 15,685
50391SANTA TERESITA HOSPITAL5281.00.0260.4100.436$ 16,617
50392TRINITY HOSPITAL4730.90.0150.6100.625$ 14,357
50393DOWNEY COMMUNITY HOSPITAL5960.70.0870.7160.803$ 16,635
50394COMM MEM HOSP OF SAN BUENAVENTURA4498.90.0260.4060.432$ 14,993
50396SANTA BARBARA COTTAGE HOSPITAL5094.90.0220.2450.267$ 15,113
50397COALINGA REGIONAL MEDICAL CENTER4421.60.0850.4830.568$ 14,607
50401WASHINGTON MEDICAL CENTER5057.30.0420.2900.332$ 16,641
50404BIGGS-GRIDLEY MEMORIAL HOSP.-CARE4321.40.0150.4240.439$ 14,416
50406MAYERS MEMORIAL HOSPITAL MCARE RPT4905.90.0400.5240.564$ 16,208
50407CHINESE HOSPITAL5983.10.0340.5130.547$ 18,833
50410SANGER GENERAL HOSPITAL4572.40.0320.4430.475$ 14,607
50411KAISER FOUNDATION HOSPITALS -HARBOR5104.80.0390.3610.400$ 16,631
50414MERCY HOSPITAL OF FOLSOM5033.60.0720.3260.398$ 16,583
50417SUTTER COAST HOSPITAL4346.00.0680.4390.507$ 14,357
50419MERCY MEDICAL CENTER MT. SHASTA4905.90.0530.5170.570$ 16,206
50420ROBERT F. KENNEDY MEDICAL CENTER7318.80.0360.3920.428$ 16,626
50423PALO VERDE HOSPITAL5030.70.0530.3900.443$ 15,698
50424GREEN HOSPITAL OF SCRIPPS CLINIC5539.00.0420.4080.450$ 16,374
50425KFH - SACRAMENTO5398.60.0390.3610.400$ 16,553
50426WEST ANAHEIM MEDICAL CENTER5079.20.0240.2420.266$ 15,990
50427AVALON MUNICIPAL HOSPITAL5106.90.0390.6100.649$ 16,617
50430MODOC MEDICAL CENTER4730.90.0190.5570.576$ 14,357
50432GARFIELD MEDICAL CTR.8463.20.0160.3610.377$ 16,611
50433INDIAN VALLEY HOSPITAL4346.00.0200.5630.583$ 14,357
50434COLUSA COMMUNITY HOSPITAL4730.90.0390.5960.635$ 14,357
50435FALLBROOK DISTRICT HOSPITAL5028.50.0240.3740.398$ 16,362
50438HUNTINGTON MEMORIAL HOSPITAL6155.80.0280.3320.360$ 16,624
50440HOWARD MEMORIAL HOSPITAL4303.80.0490.4330.482$ 14,357
50441STANFORD UNIVERSITY HOSPITAL8212.00.0320.3270.359$ 18,195
50443JOHN C. FREMONT HOSPITAL4346.00.0270.5180.545$ 14,357
50444SUTTER MERCED MEDICAL CENTER6086.40.0330.3400.373$ 14,357
50446TEHACHAPI VALLEY HOSP. DIST.4346.00.0510.9741.025$ 14,357
50447VILLA VIEW COMMUNITY HOSPITAL7531.80.0680.3740.442$ 16,397
50448RIDGECREST REGIONAL HOSPITAL4346.00.0450.4420.487$ 14,357
50449VALLEY COMMUNITY HOSPITAL4530.40.0590.2400.299$ 15,110
50454UC SAN FRANCISCO MEDICAL CENTER9962.80.0330.3240.357$ 18,838
50455SAN JOAQUIN COMMUNITY HOSPITAL5021.50.0220.3520.374$ 14,357
50456GARDENA PHYSICIANS HOSP. INC.5057.30.0480.6940.742$ 16,619
50457ST. MARY MEDICAL CENTER6681.90.0330.2720.305$ 18,840
50464DOCTORS MEDICAL CENTER OF MODESTO5775.50.0180.3610.379$ 14,907
50468MEMORIAL HOSPITAL OF GARDENA6576.10.0220.3100.332$ 16,620
50469COLORADO RIVER MEDICAL CENTER4817.50.0220.7770.799$ 15,661
50470SELMA DISTRICT HOSPITAL4618.30.0220.6150.637$ 14,607
50471GOOD SAMARITAN HOSPITAL6314.20.0160.2930.309$ 16,614
50476SUTTER LAKESIDE HOSPITAL4346.00.0400.4180.458$ 14,357
50477MIDWAY HOSPITAL MEDICAL CENTER5687.70.0520.2340.286$ 16,661
50478SANTA YNEZ VALLEY COTTAGE HOSPITAL4574.90.0530.4240.477$ 15,112
50481WEST HILLS REG MEDICAL CENTER5065.20.0250.2490.274$ 16,628
50482JEROLD PHELPS COMMUNITY HOSPITAL4730.90.0290.6610.690$ 14,357
50485LONG BEACH MEMORIAL MEDICAL CENTER6475.20.0380.4010.439$ 16,627
50488EDEN MEDICAL CENTER6177.80.0260.3270.353$ 19,642
50491SANTA ANA HOSPITAL MEDICAL CENTER5078.20.1290.3710.500$ 16,056
50492CLOVIS COMMUNITY HOSPITAL4663.90.0870.4000.487$ 14,606
50494TAHOE FOREST HOSPITAL4996.60.0500.5390.589$ 16,507
50496MT. DIABLO MEDICAL CENTER6186.00.0320.2650.297$ 19,644
50497DOS PALOS MEMORIAL HOSPITAL4303.80.0390.3650.404$ 14,357
50498SUTTER AUBURN FAITH HOSPITAL5033.60.0260.3200.346$ 16,545
50502ST. VINCENT MEDICAL CENTER6665.50.0310.2970.328$ 16,630
50503SCRIPPS MEMORIAL HOSPITAL-ENCINITAS4979.70.0310.3020.333$ 16,374
50506SIERRA VISTA REGIONAL MED CTR4935.50.0270.2530.280$ 15,191
50510KFH - SAN RAFAEL5977.40.0390.3610.400$ 19,643
50512KFH - HAYWARD6050.00.0390.3610.400$ 19,643
50515KAISER FOUND. HOSPITALS -SAN DIEGO5093.30.0390.3610.400$ 16,376
50516MERCY SAN JUAN HOSPITAL5633.10.0250.2430.268$ 16,551
50517VICTOR VALLEY COMMUNITY HOSPITAL5987.70.0300.2810.311$ 15,689
50522DOCTORS HOSPITAL OF PINOLE5974.60.0230.2610.284$ 19,642
50523SUTTER DELTA MEDICAL CENTER7027.70.0290.3030.332$ 19,643
50526HUNTINGTON BEACH MEDICAL CENTER5932.90.0330.2480.281$ 16,001
50528MEMORIAL HOSPITAL-LOS BANOS4538.50.0310.2920.323$ 14,357
50531BELLFLOWER MEDICAL CENTER7475.70.0150.2580.273$ 16,616
50534JOHN F. KENNEDY MEMORIAL HOSP.6752.00.0250.2120.237$ 15,692
50535COASTAL COMMUNITIES HOSPITAL7877.00.0380.3200.358$ 15,996
50537SUTTER DAVIS HOSPITAL4407.90.0800.2840.364$ 14,703
50539REDBUD COMMUNITY HOSPITAL4346.00.0360.3590.395$ 14,357
50541KFH - REDWOOD CITY5976.10.0390.3610.400$ 19,643
50542KERN VALLEY HOSPITAL DISTRICT4346.00.0830.4470.530$ 14,358
50543COLLEGE HOSPITAL COSTA MESA7210.10.0260.2600.286$ 15,990
50545LANTERMAN DEVELOPMENTAL CENTER5281.00.0390.6870.726$ 16,615
50546PORTERVILLE DEVELOPMENTAL CENTER4303.80.0140.3650.379$ 14,357
50547SONOMA DEVELOPMENTAL CENTER5387.60.0390.7820.821$ 17,218
50549LOS ROBLES MEDICAL CENTER4977.90.0290.3890.418$ 16,586
50550CHAPMAN MEDICAL CENTER5626.90.0400.3150.355$ 15,999
50551LOS ALAMITOS MEDICAL CTR.4875.40.0270.2550.282$ 15,992
50552MOTION PICTURE AND TELEVISION FUND5057.30.0820.9461.028$ 16,624
50557MEMORIAL HOSPITAL MODESTO5018.90.0170.2110.228$ 14,907
50559DANIEL FREEMAN MARINA HOSPITAL5069.80.0350.2910.326$ 16,634
50561KAISER FOUND. HOSPITAL - WEST LA5088.70.0390.3610.400$ 16,631
50564PACIFICA HOSPITAL4863.30.0640.4460.510$ 16,004
50566EASTERN PLUMAS DISTRICT HOSP4346.00.0320.3870.419$ 14,357
50567MISSION HOSP REGIONAL MEDICAL CTR4873.40.0350.2740.309$ 15,999
50568MADERA COMMUNITY HOSPITAL5863.20.0200.4700.490$ 14,607
50569MENDOCINO COAST DISTRICT HOSPITAL5133.10.0530.5980.651$ 16,958
50570FOUNTAIN VALLEY REG MEDICAL CENTER6380.70.0130.2730.286$ 15,973
50571SUBURBAN MEDICAL CENTER8142.00.0380.2300.268$ 16,647
50573EISENHOWER MEMORIAL HOSPITAL4779.70.0640.3280.392$ 15,716
50575TRI-CITY REGIONAL MEDICAL CENTER6475.10.0390.3650.404$ 16,630
50577SANTA MARTA HOSPITAL7722.80.0230.4580.481$ 16,613
50578MARTIN LUTHER KING, JR./DREW MEDICAL10471.70.0190.3380.357$ 16,615
50579CENTURY CITY HOSP5317.20.0550.2350.290$ 16,664
50580LAPALMA INTERCOMMUNITY HOSPITAL5889.60.0330.2570.290$ 15,999
50581LAKEWOOD REGIONAL MED. CTR.5585.00.0310.2500.281$ 16,635
50583ALVARADO COMMUNITY HOSPITAL5628.40.0350.2450.280$ 16,386
50584US FAMILYCARE MEDICAL CENTER5954.80.0430.2390.282$ 15,712
50585SAN CLEMENTE HOSPITAL4863.30.0940.5100.604$ 16,016
50586CHINO VALLEY MEDICAL CENTER5966.50.0350.3290.364$ 15,689
50588SAN DIMAS COMMUNITY HOSPITAL5057.30.0280.2350.263$ 16,634
50589PLACENTIA LINDA COMMUNITY HOSPITAL4872.50.0410.3110.352$ 16,000
50590METHODIST HOSPITAL OF SACRAMENTO6464.50.0280.3560.384$ 16,544
50591MONTEREY PARK HOSPITAL7802.90.0360.2220.258$ 16,646
50592BREA COMMUNITY HOSPITAL4876.00.0290.2850.314$ 15,991
50594WESTERN MEDICAL CENTER ANAHEIM6282.60.0620.3020.364$ 16,022
50597FOOTHILL PRESBYTERIAN HOSPITAL5389.10.0310.3980.429$ 16,622
50598MISSION BAY MEMORIAL HOSPITAL4979.70.0270.3520.379$ 16,366
50599UC DAVIS MEDICAL CENTER9301.90.0390.3610.400$ 16,553
50601TARZANA ENCINO REGIONAL MED CTR5670.20.0280.3610.389$ 16,622
50603SADDLEBACK MEMORIAL MEDICAL CENTER4871.20.0260.3870.413$ 15,979
50604KFH - SANTA TERESA5536.50.0390.3610.400$ 18,196
50608DELANO REGIONAL MEDICAL CNT.6006.50.0290.2660.295$ 14,357
50609KAISER FOUNDATION HOSPITALS -ANAHEIM5468.50.0390.3610.400$ 16,631
50613SETON COASTSIDE HOSPITAL5729.50.0390.3650.404$ 18,838
50615GREATER EL MONTE COMMUNITY HOSPITAL8024.60.0480.2440.292$ 16,655
50616ST. JOHN'S PLEASANT VALLEY HOSPITAL4494.10.0270.3470.374$ 14,992
50618BEAR VALLEY COMMUNITY HOSPITAL4817.50.0420.6450.687$ 15,674
50623HIGH DESERT HOSPITAL5281.00.0270.4860.513$ 16,615
50624HENRY MAYO NEWHALL MEMORIAL HOSPITAL5067.00.0510.3020.353$ 16,647
50625CEDARS-SINAI MEDICAL CENTER6622.90.0250.2750.300$ 16,626
50630INLAND VALLEY REGIONAL MEDICAL CENTER4770.80.0470.3580.405$ 15,697
50633TWIN CITIES COMMUNITY HOSPITAL4553.80.0240.2350.259$ 15,191
50636POMERADO HOSPITAL4979.70.0430.3470.390$ 16,380
50638SOUTHERN MONO HEALTH CARE DISTRICT4346.00.0980.8630.961$ 14,357
50641EAST LA DOCTOR'S HOSPITAL7814.30.0410.3890.430$ 16,630
50643HOSPITAL NAME NOT AVAILABLE5710.00.0360.6060.642$ 3,953
50644LOS ANGELES METROPOLITAN MED CNTR8106.80.0390.2340.273$ 16,647
50662AGNEWS DEVELOPMENTAL CENTER5778.90.0390.9060.945$ 18,184
50663LOS ANGELES COMMUNITY HOSPITAL8162.80.0180.3270.345$ 16,615
50667NELSON M. HOLDERMAN5042.80.0241.1821.206$ 16,833
50668LAGUNA HONDA HOSPITAL5729.50.0220.9981.020$ 18,826
50670NORTH COAST HEALTH CARE CENTERS5159.20.0580.3710.429$ 17,201
50674KFH - SOUTH SACRAMENTO5474.70.0390.3610.400$ 16,553
50676SURPRISE VALLEY COMM HOSPITAL4346.00.0620.8040.866$ 14,357
50677KAISER FOUND. HOSP. - WOODLAND HILLS5392.00.0390.3610.400$ 16,631
50678ORANGE COAST MEMORIAL MEDICAL CENTER4867.40.0330.4520.485$ 15,981
50680VACAVALLEY HOSPITAL5042.80.0340.2180.252$ 16,815
50682KINGSBURG MEDICAL CENTER4572.40.0860.3610.447$ 14,606
50684MENIFEE VALLEY MEDICAL CENTER4770.80.0480.2650.313$ 15,712
50685SOUTH VALLEY HOSPITAL5534.00.0270.4270.454$ 18,188
50686KAISER FOUND. HOSPITALS - RIVERSIDE5140.10.0390.3610.400$ 15,993
50688SAINT LOUISE HOSPITAL5534.00.0890.4170.506$ 18,214
50689SAN RAMON REG. MEDICAL CENTER5981.90.0870.3080.395$ 19,651
50690KFH - SANTA ROSA5161.20.0390.3610.400$ 17,208
50693IRVINE MEDICAL CENTER5021.50.1290.3000.429$ 16,073
50694MORENO VALLEY COMMUNITY HOSPITAL4981.70.0630.2780.341$ 15,725
50695ST. DOMINIC'S HOSPITAL4540.30.0720.3800.452$ 15,144
50696USC UNIVERSITY HOSPITAL6232.70.0710.2780.349$ 16,669
50697PATIENT'S HOSPITAL OF REDDING4858.20.0760.4860.562$ 16,202
50699REDDING SPECIALTY HOSPITAL4858.20.0600.5330.593$ 16,205
50701SHARP HEALTHCARE MURRIETA4979.70.0450.3700.415$ 16,380
50704MISSION COMMUNITY HOSPITAL7949.10.0300.3690.399$ 16,623
50707RECOVERY INN OF MENLO PARK5729.50.1130.7490.862$ 18,844
50708FRESNO SURGERY CENTER4378.70.1000.4980.598$ 14,607
50709DESERT VALLEY HOSPITAL4770.80.0570.3120.369$ 15,712
50710KFH - FRESNO4379.70.0360.3610.397$ 14,607
50713LINCOLN HOSPITAL MEDICAL CENTER5281.00.0360.4910.527$ 16,621
50714SUTTER MATERNITY & SURGERY CENTER5726.40.0390.7760.815$ 19,120
50717RANCHO LOS AMIGOS NATL. REHAB. CTR.7608.20.0400.4050.445$ 16,628
50718VALLEY PLAZA DOCTORS HOSPITAL4981.70.0360.3610.397$ 15,687
50719THE HEART HOSPITAL4770.80.0390.3650.404$ 15,689
50720TUSTIN HOSPITAL & MEDICAL CENTER5078.20.0390.3610.400$ 15,993
50721HOSPITAL NAME NOT AVAILABLE5057.30.0360.3820.418$ 16,627
50722HOSPITAL NAME NOT AVAILABLE4979.70.0360.3650.401$ 16,373
50723HOSPITAL NAME NOT AVAILABLE5057.30.0360.3650.401$ 16,628

Cal. Code Regs. Tit. 8, div. 1, ch. 4.5, subch. 1, art. 5.5, app A