|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]
|
Facility
|
IP
|
$3.81
|
|
|
Service Code
|
NDC 2420883060
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Central Health Plan Commercial |
$3.05
|
| Rate for Payer: Cigna of CA HMO |
$2.67
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.24
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 6131463006
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.51
|
| Rate for Payer: Blue Shield of California Commercial |
$2.74
|
| Rate for Payer: Blue Shield of California EPN |
$1.72
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Central Health Plan Commercial |
$3.46
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Senior |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: Riverside University Health System MISP |
$1.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 6131463006
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3.46
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Central Health Plan Commercial |
$3.46
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Senior |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]
|
Facility
|
OP
|
$3.81
|
|
|
Service Code
|
NDC 2420883060
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Central Health Plan Commercial |
$3.05
|
| Rate for Payer: Cigna of CA HMO |
$2.67
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.24
|
| Rate for Payer: Riverside University Health System MISP |
$1.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.24
|
| Rate for Payer: Vantage Medical Group Senior |
$3.24
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [28810]
|
Facility
|
OP
|
$10.07
|
|
|
Service Code
|
NDC 2420863562
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.86
|
| Rate for Payer: Blue Shield of California Commercial |
$6.38
|
| Rate for Payer: Blue Shield of California EPN |
$4.02
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Central Health Plan Commercial |
$8.06
|
| 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 Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: EPIC Health Plan Senior |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$4.03
|
| 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 2420863562
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Blue Shield of California Commercial |
$8.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.08
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Central Health Plan Commercial |
$8.06
|
| Rate for Payer: Cigna of CA HMO |
$7.05
|
| Rate for Payer: Cigna of CA PPO |
$7.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: EPIC Health Plan Senior |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
| 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 2420863110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Blue Shield of California Commercial |
$8.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.08
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Central Health Plan Commercial |
$8.06
|
| Rate for Payer: Cigna of CA HMO |
$7.05
|
| Rate for Payer: Cigna of CA PPO |
$7.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: EPIC Health Plan Senior |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
| 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 2420863110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.86
|
| Rate for Payer: Blue Shield of California Commercial |
$6.38
|
| Rate for Payer: Blue Shield of California EPN |
$4.02
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Central Health Plan Commercial |
$8.06
|
| 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 Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: EPIC Health Plan Senior |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$4.03
|
| 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
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$26,326.97
|
|
|
Service Code
|
APR-DRG 8631
|
| Min. Negotiated Rate |
$16,627.56 |
| Max. Negotiated Rate |
$26,326.97 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,627.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,814.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26,326.97
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$316,617.37
|
|
|
Service Code
|
APR-DRG 8634
|
| Min. Negotiated Rate |
$199,968.86 |
| Max. Negotiated Rate |
$316,617.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$199,968.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$238,296.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316,617.37
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$60,954.93
|
|
|
Service Code
|
APR-DRG 8632
|
| Min. Negotiated Rate |
$38,497.85 |
| Max. Negotiated Rate |
$60,954.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$38,497.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45,876.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60,954.93
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$122,138.97
|
|
|
Service Code
|
APR-DRG 8633
|
| Min. Negotiated Rate |
$77,140.40 |
| Max. Negotiated Rate |
$122,138.97 |
| Rate for Payer: Adventist Health Medi-Cal |
$77,140.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$91,925.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122,138.97
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$112,276.49
|
|
|
Service Code
|
APR-DRG 6032
|
| Min. Negotiated Rate |
$70,911.47 |
| Max. Negotiated Rate |
$112,276.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$70,911.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84,502.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112,276.49
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$7,532.57
|
|
|
Service Code
|
APR-DRG 6031
|
| Min. Negotiated Rate |
$4,757.41 |
| Max. Negotiated Rate |
$7,532.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,757.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,669.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,532.57
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$382,636.08
|
|
|
Service Code
|
APR-DRG 6034
|
| Min. Negotiated Rate |
$241,664.89 |
| Max. Negotiated Rate |
$382,636.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$241,664.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$287,984.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$382,636.08
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$130,499.87
|
|
|
Service Code
|
APR-DRG 6033
|
| Min. Negotiated Rate |
$82,420.97 |
| Max. Negotiated Rate |
$130,499.87 |
| Rate for Payer: Adventist Health Medi-Cal |
$82,420.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98,218.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130,499.87
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
|
IP
|
$224,662.25
|
|
|
Service Code
|
APR-DRG 6022
|
| Min. Negotiated Rate |
$141,891.95 |
| Max. Negotiated Rate |
$224,662.25 |
| Rate for Payer: Adventist Health Medi-Cal |
$141,891.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$169,087.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224,662.25
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
|
IP
|
$307,312.52
|
|
|
Service Code
|
APR-DRG 6023
|
| Min. Negotiated Rate |
$194,092.12 |
| Max. Negotiated Rate |
$307,312.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$194,092.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$231,293.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$307,312.52
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
|
IP
|
$529,042.12
|
|
|
Service Code
|
APR-DRG 6024
|
| Min. Negotiated Rate |
$334,131.86 |
| Max. Negotiated Rate |
$529,042.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$334,131.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$398,173.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$529,042.12
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
|
IP
|
$131,737.09
|
|
|
Service Code
|
APR-DRG 6021
|
| Min. Negotiated Rate |
$83,202.37 |
| Max. Negotiated Rate |
$131,737.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$83,202.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99,149.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131,737.09
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$160,700.63
|
|
|
Service Code
|
APR-DRG 6083
|
| Min. Negotiated Rate |
$101,495.14 |
| Max. Negotiated Rate |
$160,700.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$101,495.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$120,948.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160,700.63
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$192,840.77
|
|
|
Service Code
|
APR-DRG 6084
|
| Min. Negotiated Rate |
$121,794.17 |
| Max. Negotiated Rate |
$192,840.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$121,794.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145,138.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192,840.77
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$41,829.18
|
|
|
Service Code
|
APR-DRG 6081
|
| Min. Negotiated Rate |
$26,418.43 |
| Max. Negotiated Rate |
$41,829.18 |
| Rate for Payer: Adventist Health Medi-Cal |
$26,418.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31,481.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41,829.18
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$96,936.42
|
|
|
Service Code
|
APR-DRG 6082
|
| Min. Negotiated Rate |
$61,223.00 |
| Max. Negotiated Rate |
$96,936.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$61,223.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72,957.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96,936.42
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
|
IP
|
$230,460.60
|
|
|
Service Code
|
APR-DRG 6073
|
| Min. Negotiated Rate |
$145,554.06 |
| Max. Negotiated Rate |
$230,460.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$145,554.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$173,451.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$230,460.60
|
|
