SALT LAKE COUNTY DIVISION OF SUBSTANCE ABUSE
RATE TABLE
Fiscal Year 2008
A g e n c y    N a m e :					Special Program Code:
P r o g r a m :
A  S  A M  :
Treatment Information		Units (I.e.	Current Contract			Proposed Contract			Net
	Treatment Activity	(M) Minutes, (S)ession,	Rate $	# of Units	Amount	Rate $	# of Units	Amount	Change
Description	HCPCS Code	(H)r,(D)ay)	(a)	(b)	(a*b)	(c)	(d)	(c*d)	(c*d)-(a*b)
		Total Contracted $ Amount
		Signatures:
				Agency's Director				Date Submitted
				SL County Program Director				Date Approved
									E:\collage\DocConv\transactions\1183144661432_4\upload\[9844_58169.xls]FY08 Rate Table Instructions
									6/29/2007 13:17