2009 Cost Center Setup Cross Reference Exhibit 3, 4, 11, 19, 20, 30, 31A, and 46. Exh 4, S & 31A Line

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1 Setup Cross Reference General Service Assignments (95) (38) Standard , , 033, , 095 (57)Variable , , , (Program Capabilities 200) Old Capital Related s-- Buildings and Fixtures Old Capital Related s-- Movable Equipment New Capital Related s-- Buildings and Fixtures New Capital Related s-- Movable Equipment Employee Benefits Inservice Education Day Care Maintenance and Repairs Operation of Plant Laundry and n Service Housekeeping Dietary--Raw Food Dietary--Other Cafeteria Maintenance of Personnel Medical Records & Medical Records Library Social Service Medical Supplies and Expense Central Services and Supply Pharmacy Nursing Administration Intensive Nursing Care General Nursing Service Supervising Physicians-- Other Transportation Activities Nonphysician Anesthetists Nursing School Intern & Res. Service-- Salary & Fringes (Appvd) Intern & Res. Other Program s (Appvd)

2 Setup Cross Reference Supervising Physicians - Teaching Paramedical Ed. Program (Specify) Nonpatient Telephones Data Processing Purchasing Receiving and Stores Admitting Cashiering/Accounts Receivable Other Administrative and General , 028, 031, 1119, 1132 to Variable Variable Any Additional General Service s 032, 034 to 1138, 1200 to 039, 048 to Ancillary Service Assignments (99) (66) Standard , , , (33) Variable 125, , (Program Capabilities 150 lines for Ancillary and Outpatient s) Operating Room Recovery Room Delivery Room & Labor Room Anesthesiology Radiology-Diagnostic Radiology-Therapeutic Radioisotope CAT Scan Laboratory Bio-Medical (Lab) (Engineering) PBP Clinical Lab Srvc-Program Only Whole Blood and Packed Red Blood Cells Blood Clotting Factors Admin s Blood Storing, Processing & Trans Intravenous Therapy Respiratory Therapy Physical Therapy Occupational Therapy Speech Pathology Electrocardiology Electroencephalography

3 Setup Cross Reference Med Supplies d to Patients Implantable Devices d to Patients Drugs d to Patients Renal Dialysis ASC (Non-Distinct) Blank - Not Used Audiology Shock Therapy Cardiopulmonary Cystoscopy Ultrasound Diagnostic Oncology Magnetic Resonance Imaging Mammography Nuclear Medicine - Diagnostic Nuclear Medicine - Therapeutic Cytology Cardiac Catherization Laboratory Vascular Lab Recreational Therapy Cardiology Echocardiography Pulmonary Function Testing Stress Test Urology Endoscopy Gastro Intestinal Services Ophthalmology Psychiatric/Psychological Services Dental Services Birthing Fee For Service - Cardiology Fee For Service - Emergency Service Fee For Service - Laboratory Fee For Service - Radiology Chemotherapy Asthma

4 Setup Cross Reference Cardiac Rehabilitation Diabetes Lithotripsy Nutritional Counseling Pain Management PET Scans Sleep Lab Wound Care Hyperbaric Oxygen Therapy Variable Variable Any Additional Ancillary s 125, 129 to 131, 159 to , 1175, 1178, 1180 to 1183, 1263 to 1287 Inpatient Service Assignments (99) (40) Standard 201, , , , , 268, , (59) Variable (Program Capabilities 50) 25 Adults and Pediatrics ( line comb. lines 25) Medical Surgical Inpatients Pediatric Unit Maternity Unit Alternate Level of Care Epilepsy Unit Psychiatric Rehabilitation Medicine Traumatic Brain Injury/Coma Tuberculosis H. I. V. Care Chemical Dependency - Drug Rehab Chemical Dependency - Drug Detox Chemical Dependency - Alcohol Rehab Chemical Dependency - Alcohol Detox Bone Marrow Unit Intensive Care Unit Pediatric ICU Cardiac ICU Coronary Care Unit

5 Setup Cross Reference Burn Intensive Care Unit Surgical Intensive Care Unit Neonatal Intensive Care Unit Neonatal Intermediate Care Neonatal Continuing Care See Below See List Other Special Care Units (specify) See Below See Below See Below Subprovider 1 - Psychiatric Long Term Psychiatric Unit Subprovider 2 Rehabilitation Traumatic Brain Injury/Coma Nursery Only (Comb. Prem. & Newborn) Nursery - Premature Nursery - Newborn Skilled Nursing Facility (Comb. for -96) Skilled Nursing Facility 1 (RHCF) Skilled Nursing Facility 2 (RHCF) SNF Head Injury Long Term Ventilator Dependent Behavioral Intervention Specialty Pediatric SNF Aids SNF Transitional Care Unit Other Long Term Care (Combined for -96) Other Long Term Care Other Long Term Care Variable Variable Variable Any Additional Inpatient Component Outpatient Service Assignment (98) (51) Standard 216, , 239, 240, , 253, 254, 260, 261, 263, , , (47) Variable (Program Capabilities for all Ancillary and Outpatient s is 150 possible lines) Clinic Alcohol Clinic Alcohol Day Rehab Clinic

6 Setup Cross Reference Chemotherapy Clinic Day Hospital Early Intervention Family Clinic Family Planning Head Injury Clinic H. I. V. Clinics Hyperbaric Clinic Intravenous Gamma Gobulin Pediatric Clinic - Discontinue beg 1/1/ Oncology Clinic Pediatric Clinic Rehabilitation Clinic Spina Bifada Clinic-Discontinue for reports beginning 1/1/09 and after Cardiac Rehabilitation Clinic Dental Clinic Diabetes Clinic PCAP Clinic Sleep Clinic Wound Care Clinic Mental Health Clinic Blank - Not Used Mental Health Continuing Day Treatment Mental Health Day Treatment Mental Health Intensive Psychiatric Rehab. Outpatient Mental Health Partial Hosp All Other OMH Programs O/P All Other OASAS Programs O/P Mental Health Outpatient ACT Programs Mental Health Outpatient ICM Programs Mental Health Outpatient SCM Programs Comprehensive PROS with Clinic Comprehensive PROS Limited License PROS PROS Rehabilitation and Support Adult Day Care Adult Day Care Ambulatory Surgical Service

7 Setup Cross Reference Referred Ambulatory Service Renal Dialysis Methadone Maintenance Treatment Program Birthing -Discontinue for reports beginning 1/1/09 and after Women and Infant Children Program (WIC) Emergency Service CPEP Poison Control Observation Beds (Non-Distinct Part) Observation Beds (Distinct Part) CPEP Observation Beds (Psychiatric) See 63 List Other Outpatient s Federally Qualified Health (FQHC) Not Applic. Not Applic. RPCH Not Applic. Not Applic. Other Reimbursable Assignments (50) (18) Standard , 234, 238, 243, 250, 255, 257, 259, , (32) Variable (Program Capabilities of 98 total lines for Other, Special Purpose and Non-reimbursable) Home Program Dialysis Ambulance Services Durable Medical Equip-Rented Durable Medical Equip-Sold See 68 List Other Reimbursable (specify) See Below See Below CORF CMHC OPT OOT OSP I&R Services -Non Apprvd Prgm Home Health Agency ( Only) HHA - Administrative & General HHA - Skilled Nursing Care HHA - Physical Therapy HHA - Occupational Therapy HHA - Speech Pathology

8 Setup Cross Reference HHA - Medical Social Services Home Health Aide Other HHA Services Variable Variable Additional Other Reimbursable s , Special Purpose Assignments (50) (14) Standard 241, 244, 245, 275, , 292, 293, (36) Variable 606 to 641 (Program Capabilities - See Other Reimbursable) Lung Acquisition Kidney Acquisition Liver Acquisition Heart Acquisition Pancreas Acquisition Intestinal Acquisition Islet Cell Acquisition Other Organ Acquisition (specify) Interest Expense Utilization Review -RHCF Other Capital Related s Ambulatory Surgical (Distinct Part) Hospice Inpatient Hospice -Home Care Variable Additional Special Purpose s Non Reimbursable Assignments (25) (6) Standard , 273, 274, 651 (19) Variable (Program Capabilities - See Outpatient) Gift, Flower, Coffee Shop, Canteen Research Physicians Private Offices Non - Paid Workers Appeal For Funds All Other Non- Reimbursable Expenses Variable Additional Non Reimbursable s TOTAL Expenses Worksheet A-All Services TOTAL Expenses Worksheet A-All Services n/a 36

9 Setup Cross Reference TOTAL s All Other Services n/a 124 TOTAL s Inpatient Service (Exh.1 Part 2) n/a 23 TOTAL s Outpatient Clinic n/a 123 TOTAL s Amb. Surg., Renal Dial., Emergency n/a 122 TOTAL s All Home Health Services n/a 125 9

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