|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
|
IP
|
$445,796.56
|
|
|
Service Code
|
APR-DRG 5933
|
| Min. Negotiated Rate |
$245,998.65 |
| Max. Negotiated Rate |
$445,796.56 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$245,998.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308,004.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$445,796.56
|
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
|
IP
|
$798,762.03
|
|
|
Service Code
|
APR-DRG 5934
|
| Min. Negotiated Rate |
$440,771.41 |
| Max. Negotiated Rate |
$798,762.03 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$440,771.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$551,871.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$798,762.03
|
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
|
IP
|
$346,615.25
|
|
|
Service Code
|
APR-DRG 5932
|
| Min. Negotiated Rate |
$191,268.60 |
| Max. Negotiated Rate |
$346,615.25 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191,268.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239,479.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$346,615.25
|
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
|
IP
|
$171,826.30
|
|
|
Service Code
|
APR-DRG 5931
|
| Min. Negotiated Rate |
$94,816.88 |
| Max. Negotiated Rate |
$171,826.30 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94,816.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118,716.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$171,826.30
|
|
|
NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY
|
Facility
|
IP
|
$111,229.34
|
|
|
Service Code
|
MSDRG 789
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$111,229.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54,635.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$111,229.34
|
| Rate for Payer: EPIC Health Plan Senior |
$74,152.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67,411.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94,376.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90,331.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,809.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,601.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE
|
Facility
|
IP
|
$16,563.42
|
|
|
Service Code
|
APR-DRG 5814
|
| Min. Negotiated Rate |
$9,139.99 |
| Max. Negotiated Rate |
$16,563.42 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,139.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,443.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,563.42
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE
|
Facility
|
IP
|
$4,351.05
|
|
|
Service Code
|
APR-DRG 5812
|
| Min. Negotiated Rate |
$2,400.99 |
| Max. Negotiated Rate |
$4,351.05 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,400.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,006.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,351.05
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE
|
Facility
|
IP
|
$7,477.69
|
|
|
Service Code
|
APR-DRG 5813
|
| Min. Negotiated Rate |
$4,126.33 |
| Max. Negotiated Rate |
$7,477.69 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,126.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,166.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,477.69
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE
|
Facility
|
IP
|
$3,006.38
|
|
|
Service Code
|
APR-DRG 5811
|
| Min. Negotiated Rate |
$1,658.98 |
| Max. Negotiated Rate |
$3,006.38 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,658.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,077.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,006.38
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE
|
Facility
|
IP
|
$8,344.99
|
|
|
Service Code
|
APR-DRG 5801
|
| Min. Negotiated Rate |
$4,604.91 |
| Max. Negotiated Rate |
$8,344.99 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,604.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,765.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,344.99
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE
|
Facility
|
IP
|
$42,231.83
|
|
|
Service Code
|
APR-DRG 5804
|
| Min. Negotiated Rate |
$23,304.29 |
| Max. Negotiated Rate |
$42,231.83 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23,304.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,178.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,231.83
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE
|
Facility
|
IP
|
$11,901.61
|
|
|
Service Code
|
APR-DRG 5802
|
| Min. Negotiated Rate |
$6,567.53 |
| Max. Negotiated Rate |
$11,901.61 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,567.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,222.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,901.61
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE
|
Facility
|
IP
|
$21,040.99
|
|
|
Service Code
|
APR-DRG 5803
|
| Min. Negotiated Rate |
$11,610.80 |
| Max. Negotiated Rate |
$21,040.99 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,610.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,537.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,040.99
|
|
|
NEONATE WITH ECMO
|
Facility
|
IP
|
$519,680.56
|
|
|
Service Code
|
APR-DRG 5831
|
| Min. Negotiated Rate |
$286,769.18 |
| Max. Negotiated Rate |
$519,680.56 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$286,769.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$359,052.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$519,680.56
|
|
|
NEONATE WITH ECMO
|
Facility
|
IP
|
$2,080,792.70
|
|
|
Service Code
|
APR-DRG 5834
|
| Min. Negotiated Rate |
$1,148,219.24 |
| Max. Negotiated Rate |
$2,080,792.70 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,148,219.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,437,638.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,080,792.70
|
|
|
NEONATE WITH ECMO
|
Facility
|
IP
|
$981,507.51
|
|
|
Service Code
|
APR-DRG 5833
|
| Min. Negotiated Rate |
$541,613.69 |
| Max. Negotiated Rate |
$981,507.51 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$541,613.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$678,132.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$981,507.51
|
|
|
NEONATE WITH ECMO
|
Facility
|
IP
|
$615,917.44
|
|
|
Service Code
|
APR-DRG 5832
|
| Min. Negotiated Rate |
$339,874.44 |
| Max. Negotiated Rate |
$615,917.44 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$339,874.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$425,542.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$615,917.44
|
|
|
NEONATE WITH OTHER SIGNIFICANT PROBLEMS
|
Facility
|
IP
|
$105,439.19
|
|
|
Service Code
|
MSDRG 794
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$105,439.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44,743.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$105,439.19
|
| Rate for Payer: EPIC Health Plan Senior |
$70,292.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,902.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89,463.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85,629.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,809.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,601.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
NEOSTIGMINE 5 MG/5 ML IN STERILE WATER INJECTION SYRINGE [215593]
|
Facility
|
IP
|
$3.61
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.53
|
| Rate for Payer: Cigna of CA HMO |
$2.40
|
| Rate for Payer: Cigna of CA PPO |
$2.40
|
| Rate for Payer: Cigna of CA PPO |
$2.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.37
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Galaxy Health WC |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.07
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
|
|
NEOSTIGMINE 5 MG/5 ML IN STERILE WATER INJECTION SYRINGE [215593]
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$26.66 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.53
|
| Rate for Payer: Cigna of CA HMO |
$2.40
|
| Rate for Payer: Cigna of CA PPO |
$2.53
|
| Rate for Payer: Cigna of CA PPO |
$2.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.37
|
| Rate for Payer: Galaxy Health WC |
$3.07
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.72
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$3.07
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION SOLUTION. [4085490]
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$26.66 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cigna of CA HMO |
$2.40
|
| Rate for Payer: Cigna of CA PPO |
$2.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.37
|
| Rate for Payer: EPIC Health Plan Senior |
$1.37
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: Networks By Design Commercial |
$1.72
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION SOLUTION. [4085490]
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cigna of CA HMO |
$2.40
|
| Rate for Payer: Cigna of CA PPO |
$2.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.37
|
| Rate for Payer: EPIC Health Plan Senior |
$1.37
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: Networks By Design Commercial |
$1.72
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
|
|
NEOSTIGMINE METHYLSULFATE 5 MG/5 ML (1 MG/ML) INTRAVENOUS SYRINGE [120692]
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$2.07
|
| Rate for Payer: Cigna of CA PPO |
$2.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.97
|
|
|
NEOSTIGMINE METHYLSULFATE 5 MG/5 ML (1 MG/ML) INTRAVENOUS SYRINGE [120692]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$26.66 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$2.07
|
| Rate for Payer: Cigna of CA PPO |
$2.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
NEPHRITIS AND NEPHROSIS
|
Facility
|
IP
|
$69,893.91
|
|
|
Service Code
|
APR-DRG 4624
|
| Min. Negotiated Rate |
$55,823.16 |
| Max. Negotiated Rate |
$69,893.91 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55,823.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69,893.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62,536.66
|
|
