NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
IP
|
$96,216.86
|
|
Service Code
|
APR-DRG 5912
|
Min. Negotiated Rate |
$73,808.46 |
Max. Negotiated Rate |
$96,216.86 |
Rate for Payer: IEHP Medi-Cal |
$73,808.46
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96,216.86
|
|
NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
IP
|
$2,613.64
|
|
Service Code
|
APR-DRG 5911
|
Min. Negotiated Rate |
$2,004.94 |
Max. Negotiated Rate |
$2,613.64 |
Rate for Payer: IEHP Medi-Cal |
$2,004.94
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,613.64
|
|
NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
IP
|
$444,447.52
|
|
Service Code
|
APR-DRG 5914
|
Min. Negotiated Rate |
$340,938.04 |
Max. Negotiated Rate |
$444,447.52 |
Rate for Payer: IEHP Medi-Cal |
$340,938.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444,447.52
|
|
NEONATE BIRTH WEIGHT < 500 GRAMS, OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS, OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION
|
Facility
IP
|
$1,931.29
|
|
Service Code
|
APR-DRG 5894
|
Min. Negotiated Rate |
$1,481.51 |
Max. Negotiated Rate |
$1,931.29 |
Rate for Payer: IEHP Medi-Cal |
$1,481.51
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,931.29
|
|
NEONATE BIRTH WEIGHT < 500 GRAMS, OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS, OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION
|
Facility
IP
|
$79,486.48
|
|
Service Code
|
APR-DRG 5892
|
Min. Negotiated Rate |
$60,974.50 |
Max. Negotiated Rate |
$79,486.48 |
Rate for Payer: IEHP Medi-Cal |
$60,974.50
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79,486.48
|
|
NEONATE BIRTH WEIGHT < 500 GRAMS, OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS, OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION
|
Facility
IP
|
$95,746.89
|
|
Service Code
|
APR-DRG 5891
|
Min. Negotiated Rate |
$73,447.94 |
Max. Negotiated Rate |
$95,746.89 |
Rate for Payer: IEHP Medi-Cal |
$73,447.94
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95,746.89
|
|
NEONATE BIRTH WEIGHT < 500 GRAMS, OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS, OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION
|
Facility
IP
|
$63,223.85
|
|
Service Code
|
APR-DRG 5893
|
Min. Negotiated Rate |
$48,499.35 |
Max. Negotiated Rate |
$63,223.85 |
Rate for Payer: IEHP Medi-Cal |
$48,499.35
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63,223.85
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
IP
|
$205,535.14
|
|
Service Code
|
APR-DRG 5933
|
Min. Negotiated Rate |
$157,667.09 |
Max. Negotiated Rate |
$205,535.14 |
Rate for Payer: IEHP Medi-Cal |
$157,667.09
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205,535.14
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
IP
|
$3,017.10
|
|
Service Code
|
APR-DRG 5931
|
Min. Negotiated Rate |
$2,314.44 |
Max. Negotiated Rate |
$3,017.10 |
Rate for Payer: IEHP Medi-Cal |
$2,314.44
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,017.10
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
IP
|
$460,249.05
|
|
Service Code
|
APR-DRG 5934
|
Min. Negotiated Rate |
$353,059.47 |
Max. Negotiated Rate |
$460,249.05 |
Rate for Payer: IEHP Medi-Cal |
$353,059.47
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$460,249.05
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
IP
|
$162,905.60
|
|
Service Code
|
APR-DRG 5932
|
Min. Negotiated Rate |
$124,965.74 |
Max. Negotiated Rate |
$162,905.60 |
Rate for Payer: IEHP Medi-Cal |
$124,965.74
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162,905.60
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE
|
Facility
IP
|
$11,345.18
|
|
Service Code
|
APR-DRG 5814
|
Min. Negotiated Rate |
$8,702.95 |
Max. Negotiated Rate |
$11,345.18 |
Rate for Payer: IEHP Medi-Cal |
$8,702.95
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,345.18
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE
|
Facility
IP
|
$2,050.56
|
|
Service Code
|
APR-DRG 5811
|
Min. Negotiated Rate |
$1,572.99 |
Max. Negotiated Rate |
$2,050.56 |
Rate for Payer: IEHP Medi-Cal |
$1,572.99
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,050.56
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE
|
Facility
IP
|
$4,708.54
|
|
Service Code
|
APR-DRG 5813
|
Min. Negotiated Rate |
$3,611.95 |
Max. Negotiated Rate |
$4,708.54 |
Rate for Payer: IEHP Medi-Cal |
$3,611.95
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,708.54
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE
|
Facility
IP
|
$3,070.30
|
|
Service Code
|
APR-DRG 5812
|
Min. Negotiated Rate |
$2,355.25 |
Max. Negotiated Rate |
$3,070.30 |
Rate for Payer: IEHP Medi-Cal |
$2,355.25
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,070.30
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE
|
Facility
IP
|
$12,352.15
|
|
Service Code
|
APR-DRG 5803
|
Min. Negotiated Rate |
$9,475.40 |
Max. Negotiated Rate |
$12,352.15 |
Rate for Payer: IEHP Medi-Cal |
$9,475.40
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,352.15
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE
|
Facility
IP
|
$7,528.33
|
|
Service Code
|
APR-DRG 5802
|
Min. Negotiated Rate |
$5,775.02 |
Max. Negotiated Rate |
$7,528.33 |
Rate for Payer: IEHP Medi-Cal |
$5,775.02
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,528.33
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE
|
Facility
IP
|
$29,164.20
|
|
Service Code
|
APR-DRG 5804
|
Min. Negotiated Rate |
$22,372.01 |
Max. Negotiated Rate |
$29,164.20 |
Rate for Payer: IEHP Medi-Cal |
$22,372.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,164.20
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE
|
Facility
IP
|
$5,887.89
|
|
Service Code
|
APR-DRG 5801
|
Min. Negotiated Rate |
$4,516.63 |
Max. Negotiated Rate |
$5,887.89 |
Rate for Payer: IEHP Medi-Cal |
$4,516.63
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,887.89
|
|
NEONATE WITH ECMO
|
Facility
IP
|
$473,187.95
|
|
Service Code
|
APR-DRG 5833
|
Min. Negotiated Rate |
$362,984.97 |
Max. Negotiated Rate |
$473,187.95 |
Rate for Payer: IEHP Medi-Cal |
$362,984.97
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473,187.95
|
|
NEONATE WITH ECMO
|
Facility
IP
|
$860,321.41
|
|
Service Code
|
APR-DRG 5834
|
Min. Negotiated Rate |
$659,957.08 |
Max. Negotiated Rate |
$860,321.41 |
Rate for Payer: IEHP Medi-Cal |
$659,957.08
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$860,321.41
|
|
NEONATE WITH ECMO
|
Facility
IP
|
$348,930.48
|
|
Service Code
|
APR-DRG 5832
|
Min. Negotiated Rate |
$267,666.41 |
Max. Negotiated Rate |
$348,930.48 |
Rate for Payer: IEHP Medi-Cal |
$267,666.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348,930.48
|
|
NEONATE WITH ECMO
|
Facility
IP
|
$301,539.20
|
|
Service Code
|
APR-DRG 5831
|
Min. Negotiated Rate |
$231,312.30 |
Max. Negotiated Rate |
$301,539.20 |
Rate for Payer: IEHP Medi-Cal |
$231,312.30
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301,539.20
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION SOLUTION. [4085490]
|
Facility
IP
|
$3.02
|
|
Service Code
|
CPT J2710
|
Hospital Charge Code |
NDG120692
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.72 |
Max. Negotiated Rate |
$2.57 |
Rate for Payer: Blue Shield of California Commercial |
$2.15
|
Rate for Payer: Blue Shield of California EPN |
$1.55
|
Rate for Payer: Cash Price |
$1.36
|
Rate for Payer: Cigna of CA HMO |
$2.11
|
Rate for Payer: Cigna of CA PPO |
$2.11
|
Rate for Payer: EPIC Health Plan Commercial |
$1.21
|
Rate for Payer: EPIC Health Plan Transplant |
$1.21
|
Rate for Payer: Galaxy Health WC |
$2.57
|
Rate for Payer: Global Benefits Group Commercial |
$1.81
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
Rate for Payer: Multiplan Commercial |
$2.42
|
Rate for Payer: Networks By Design Commercial |
$1.51
|
Rate for Payer: Prime Health Services Commercial |
$2.57
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION SOLUTION. [4085490]
|
Facility
OP
|
$3.02
|
|
Service Code
|
CPT J2710
|
Hospital Charge Code |
NDG120692
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.72 |
Max. Negotiated Rate |
$22.24 |
Rate for Payer: Aetna of CA HMO/PPO |
$4.98
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.57
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.66
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.24
|
Rate for Payer: BCBS Transplant Transplant |
$1.81
|
Rate for Payer: Blue Shield of California Commercial |
$2.23
|
Rate for Payer: Blue Shield of California EPN |
$2.08
|
Rate for Payer: Cash Price |
$1.36
|
Rate for Payer: Cash Price |
$1.36
|
Rate for Payer: Cigna of CA HMO |
$2.11
|
Rate for Payer: Cigna of CA PPO |
$2.11
|
Rate for Payer: Dignity Health Commercial/Exchange |
$2.57
|
Rate for Payer: Dignity Health Media |
$2.57
|
Rate for Payer: Dignity Health Medi-Cal |
$2.57
|
Rate for Payer: EPIC Health Plan Commercial |
$1.21
|
Rate for Payer: EPIC Health Plan Transplant |
$1.21
|
Rate for Payer: Galaxy Health WC |
$2.57
|
Rate for Payer: Global Benefits Group Commercial |
$1.81
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.26
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.49
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
Rate for Payer: Multiplan Commercial |
$2.42
|
Rate for Payer: Networks By Design Commercial |
$1.51
|
Rate for Payer: Prime Health Services Commercial |
$2.57
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.81
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.81
|
Rate for Payer: United Healthcare All Other Commercial |
$1.51
|
Rate for Payer: United Healthcare All Other HMO |
$1.51
|
Rate for Payer: United Healthcare HMO Rider |
$1.51
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$1.51
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.57
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$2.57
|
Rate for Payer: Vantage Medical Group Senior |
$2.57
|
|