|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]
|
Facility
IP
|
$4.32
|
|
|
Service Code
|
NDC 61314-630-06
|
| Hospital Charge Code |
1740080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Blue Shield of California Commercial |
$3.08
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [28810]
|
Facility
OP
|
$10.07
|
|
|
Service Code
|
NDC 24208-635-62
|
| Hospital Charge Code |
1740060
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.00
|
| Rate for Payer: BCBS Transplant Transplant |
$6.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7.42
|
| Rate for Payer: Blue Shield of California EPN |
$5.88
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna of CA HMO |
$7.05
|
| Rate for Payer: Cigna of CA PPO |
$7.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.56
|
| Rate for Payer: Dignity Health Media |
$8.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$8.06
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare HMO Rider |
$5.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$8.56
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [28810]
|
Facility
IP
|
$10.07
|
|
|
Service Code
|
NDC 24208-635-62
|
| Hospital Charge Code |
1740060
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Blue Shield of California Commercial |
$7.17
|
| Rate for Payer: Blue Shield of California EPN |
$5.16
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna of CA HMO |
$7.05
|
| Rate for Payer: Cigna of CA PPO |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$8.06
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.56
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]
|
Facility
IP
|
$10.07
|
|
|
Service Code
|
NDC 61314-646-10
|
| Hospital Charge Code |
1740064
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Blue Shield of California Commercial |
$7.17
|
| Rate for Payer: Blue Shield of California EPN |
$5.16
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna of CA HMO |
$7.05
|
| Rate for Payer: Cigna of CA PPO |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$8.06
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.56
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]
|
Facility
OP
|
$10.07
|
|
|
Service Code
|
NDC 61314-646-10
|
| Hospital Charge Code |
1740064
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: BCBS Transplant Transplant |
$6.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7.42
|
| Rate for Payer: Blue Shield of California EPN |
$5.88
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna of CA HMO |
$7.05
|
| Rate for Payer: Cigna of CA PPO |
$7.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.56
|
| Rate for Payer: Dignity Health Media |
$8.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$8.06
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare HMO Rider |
$5.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$8.56
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]
|
Facility
OP
|
$10.07
|
|
|
Service Code
|
NDC 24208-631-10
|
| Hospital Charge Code |
1740064
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.00
|
| Rate for Payer: BCBS Transplant Transplant |
$6.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7.42
|
| Rate for Payer: Blue Shield of California EPN |
$5.88
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna of CA HMO |
$7.05
|
| Rate for Payer: Cigna of CA PPO |
$7.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.56
|
| Rate for Payer: Dignity Health Media |
$8.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$8.06
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare HMO Rider |
$5.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$8.56
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]
|
Facility
IP
|
$10.07
|
|
|
Service Code
|
NDC 24208-631-10
|
| Hospital Charge Code |
1740064
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Blue Shield of California Commercial |
$7.17
|
| Rate for Payer: Blue Shield of California EPN |
$5.16
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna of CA HMO |
$7.05
|
| Rate for Payer: Cigna of CA PPO |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$8.06
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.56
|
|
|
NEONATAL AFTERCARE
|
Facility
IP
|
$84,117.43
|
|
|
Service Code
|
APR-DRG 8633
|
| Min. Negotiated Rate |
$64,526.92 |
| Max. Negotiated Rate |
$84,117.43 |
| Rate for Payer: IEHP Medi-Cal |
$64,526.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84,117.43
|
|
|
NEONATAL AFTERCARE
|
Facility
IP
|
$188,781.99
|
|
|
Service Code
|
APR-DRG 8634
|
| Min. Negotiated Rate |
$144,815.66 |
| Max. Negotiated Rate |
$188,781.99 |
| Rate for Payer: IEHP Medi-Cal |
$144,815.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188,781.99
|
|
|
NEONATAL AFTERCARE
|
Facility
IP
|
$16,965.37
|
|
|
Service Code
|
APR-DRG 8631
|
| Min. Negotiated Rate |
$13,014.22 |
| Max. Negotiated Rate |
$16,965.37 |
| Rate for Payer: IEHP Medi-Cal |
$13,014.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,965.37
|
|
|
NEONATAL AFTERCARE
|
Facility
IP
|
$43,159.37
|
|
|
Service Code
|
APR-DRG 8632
|
| Min. Negotiated Rate |
$33,107.78 |
| Max. Negotiated Rate |
$43,159.37 |
| Rate for Payer: IEHP Medi-Cal |
$33,107.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43,159.37
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$125,024.50
|
|
|
Service Code
|
APR-DRG 6033
|
| Min. Negotiated Rate |
$95,906.95 |
| Max. Negotiated Rate |
$125,024.50 |
| Rate for Payer: IEHP Medi-Cal |
$95,906.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125,024.50
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$2,994.93
|
|
|
Service Code
|
APR-DRG 6031
|
| Min. Negotiated Rate |
$2,297.43 |
| Max. Negotiated Rate |
$2,994.93 |
| Rate for Payer: IEHP Medi-Cal |
$2,297.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,994.93
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$369,963.27
|
|
|
Service Code
|
APR-DRG 6034
|
| Min. Negotiated Rate |
$283,800.77 |
| Max. Negotiated Rate |
$369,963.27 |
| Rate for Payer: IEHP Medi-Cal |
$283,800.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369,963.27
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$61,685.38
|
|
|
Service Code
|
APR-DRG 6032
|
| Min. Negotiated Rate |
$47,319.18 |
| Max. Negotiated Rate |
$61,685.38 |
| Rate for Payer: IEHP Medi-Cal |
$47,319.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61,685.38
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$137,842.19
|
|
|
Service Code
|
APR-DRG 6022
|
| Min. Negotiated Rate |
$105,739.47 |
| Max. Negotiated Rate |
$137,842.19 |
| Rate for Payer: IEHP Medi-Cal |
$105,739.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137,842.19
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$27,105.12
|
|
|
Service Code
|
APR-DRG 6021
|
| Min. Negotiated Rate |
$20,792.48 |
| Max. Negotiated Rate |
$27,105.12 |
| Rate for Payer: IEHP Medi-Cal |
$20,792.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,105.12
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$180,653.50
|
|
|
Service Code
|
APR-DRG 6023
|
| Min. Negotiated Rate |
$138,580.25 |
| Max. Negotiated Rate |
$180,653.50 |
| Rate for Payer: IEHP Medi-Cal |
$138,580.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180,653.50
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$329,907.18
|
|
|
Service Code
|
APR-DRG 6024
|
| Min. Negotiated Rate |
$253,073.54 |
| Max. Negotiated Rate |
$329,907.18 |
| Rate for Payer: IEHP Medi-Cal |
$253,073.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329,907.18
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$160,441.38
|
|
|
Service Code
|
APR-DRG 6084
|
| Min. Negotiated Rate |
$123,075.42 |
| Max. Negotiated Rate |
$160,441.38 |
| Rate for Payer: IEHP Medi-Cal |
$123,075.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160,441.38
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$10,611.94
|
|
|
Service Code
|
APR-DRG 6081
|
| Min. Negotiated Rate |
$8,140.47 |
| Max. Negotiated Rate |
$10,611.94 |
| Rate for Payer: IEHP Medi-Cal |
$8,140.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,611.94
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$78,333.73
|
|
|
Service Code
|
APR-DRG 6082
|
| Min. Negotiated Rate |
$60,090.22 |
| Max. Negotiated Rate |
$78,333.73 |
| Rate for Payer: IEHP Medi-Cal |
$60,090.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78,333.73
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$106,112.76
|
|
|
Service Code
|
APR-DRG 6083
|
| Min. Negotiated Rate |
$81,399.66 |
| Max. Negotiated Rate |
$106,112.76 |
| Rate for Payer: IEHP Medi-Cal |
$81,399.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106,112.76
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$43,875.41
|
|
|
Service Code
|
APR-DRG 6071
|
| Min. Negotiated Rate |
$33,657.06 |
| Max. Negotiated Rate |
$43,875.41 |
| Rate for Payer: IEHP Medi-Cal |
$33,657.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43,875.41
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$253,395.88
|
|
|
Service Code
|
APR-DRG 6074
|
| Min. Negotiated Rate |
$194,381.31 |
| Max. Negotiated Rate |
$253,395.88 |
| Rate for Payer: IEHP Medi-Cal |
$194,381.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253,395.88
|
|
