|
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 |
$1.82 |
| Max. Negotiated Rate |
$7.55 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.92
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.82
|
| Rate for Payer: Heritage Provider Network Senior |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
|
|
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 |
$1.82 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.92
|
| 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 |
$7.55
|
| Rate for Payer: Blue Shield of California Commercial |
$6.25
|
| Rate for Payer: Blue Shield of California EPN |
$5.91
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Senior |
$8.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.23
|
| Rate for Payer: Heritage Provider Network Senior |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
| 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 |
$1.82 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.92
|
| 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 |
$7.55
|
| Rate for Payer: Blue Shield of California Commercial |
$6.25
|
| Rate for Payer: Blue Shield of California EPN |
$5.91
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Senior |
$8.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.23
|
| Rate for Payer: Heritage Provider Network Senior |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
| 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 |
$1.82 |
| Max. Negotiated Rate |
$7.55 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.92
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.82
|
| Rate for Payer: Heritage Provider Network Senior |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
|
|
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 |
$1.82 |
| Max. Negotiated Rate |
$7.55 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.92
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.82
|
| Rate for Payer: Heritage Provider Network Senior |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
|
|
NEONATAL AFTERCARE
|
Facility
IP
|
$105,905.09
|
|
|
Service Code
|
APR-DRG 8634
|
| Min. Negotiated Rate |
$105,905.09 |
| Max. Negotiated Rate |
$105,905.09 |
| Rate for Payer: IEHP Medi-Cal |
$105,905.09
|
|
|
NEONATAL AFTERCARE
|
Facility
IP
|
$24,212.03
|
|
|
Service Code
|
APR-DRG 8632
|
| Min. Negotiated Rate |
$24,212.03 |
| Max. Negotiated Rate |
$24,212.03 |
| Rate for Payer: IEHP Medi-Cal |
$24,212.03
|
|
|
NEONATAL AFTERCARE
|
Facility
IP
|
$47,189.16
|
|
|
Service Code
|
APR-DRG 8633
|
| Min. Negotiated Rate |
$47,189.16 |
| Max. Negotiated Rate |
$47,189.16 |
| Rate for Payer: IEHP Medi-Cal |
$47,189.16
|
|
|
NEONATAL AFTERCARE
|
Facility
IP
|
$9,517.42
|
|
|
Service Code
|
APR-DRG 8631
|
| Min. Negotiated Rate |
$9,517.42 |
| Max. Negotiated Rate |
$9,517.42 |
| Rate for Payer: IEHP Medi-Cal |
$9,517.42
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$34,604.97
|
|
|
Service Code
|
APR-DRG 6032
|
| Min. Negotiated Rate |
$34,604.97 |
| Max. Negotiated Rate |
$34,604.97 |
| Rate for Payer: IEHP Medi-Cal |
$34,604.97
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$1,680.13
|
|
|
Service Code
|
APR-DRG 6031
|
| Min. Negotiated Rate |
$1,680.13 |
| Max. Negotiated Rate |
$1,680.13 |
| Rate for Payer: IEHP Medi-Cal |
$1,680.13
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$207,546.25
|
|
|
Service Code
|
APR-DRG 6034
|
| Min. Negotiated Rate |
$207,546.25 |
| Max. Negotiated Rate |
$207,546.25 |
| Rate for Payer: IEHP Medi-Cal |
$207,546.25
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$70,137.68
|
|
|
Service Code
|
APR-DRG 6033
|
| Min. Negotiated Rate |
$70,137.68 |
| Max. Negotiated Rate |
$70,137.68 |
| Rate for Payer: IEHP Medi-Cal |
$70,137.68
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$77,328.29
|
|
|
Service Code
|
APR-DRG 6022
|
| Min. Negotiated Rate |
$77,328.29 |
| Max. Negotiated Rate |
$77,328.29 |
| Rate for Payer: IEHP Medi-Cal |
$77,328.29
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$185,075.13
|
|
|
Service Code
|
APR-DRG 6024
|
| Min. Negotiated Rate |
$185,075.13 |
| Max. Negotiated Rate |
$185,075.13 |
| Rate for Payer: IEHP Medi-Cal |
$185,075.13
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$101,345.08
|
|
|
Service Code
|
APR-DRG 6023
|
| Min. Negotiated Rate |
$101,345.08 |
| Max. Negotiated Rate |
$101,345.08 |
| Rate for Payer: IEHP Medi-Cal |
$101,345.08
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$15,205.74
|
|
|
Service Code
|
APR-DRG 6021
|
| Min. Negotiated Rate |
$15,205.74 |
| Max. Negotiated Rate |
$15,205.74 |
| Rate for Payer: IEHP Medi-Cal |
$15,205.74
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$5,953.21
|
|
|
Service Code
|
APR-DRG 6081
|
| Min. Negotiated Rate |
$5,953.21 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: IEHP Medi-Cal |
$5,953.21
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$43,944.55
|
|
|
Service Code
|
APR-DRG 6082
|
| Min. Negotiated Rate |
$43,944.55 |
| Max. Negotiated Rate |
$43,944.55 |
| Rate for Payer: IEHP Medi-Cal |
$43,944.55
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$90,006.25
|
|
|
Service Code
|
APR-DRG 6084
|
| Min. Negotiated Rate |
$90,006.25 |
| Max. Negotiated Rate |
$90,006.25 |
| Rate for Payer: IEHP Medi-Cal |
$90,006.25
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$59,528.36
|
|
|
Service Code
|
APR-DRG 6083
|
| Min. Negotiated Rate |
$59,528.36 |
| Max. Negotiated Rate |
$59,528.36 |
| Rate for Payer: IEHP Medi-Cal |
$59,528.36
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$76,797.27
|
|
|
Service Code
|
APR-DRG 6073
|
| Min. Negotiated Rate |
$76,797.27 |
| Max. Negotiated Rate |
$76,797.27 |
| Rate for Payer: IEHP Medi-Cal |
$76,797.27
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$59,466.18
|
|
|
Service Code
|
APR-DRG 6072
|
| Min. Negotiated Rate |
$59,466.18 |
| Max. Negotiated Rate |
$59,466.18 |
| Rate for Payer: IEHP Medi-Cal |
$59,466.18
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$24,613.73
|
|
|
Service Code
|
APR-DRG 6071
|
| Min. Negotiated Rate |
$24,613.73 |
| Max. Negotiated Rate |
$24,613.73 |
| Rate for Payer: IEHP Medi-Cal |
$24,613.73
|
|
|
NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$142,152.93
|
|
|
Service Code
|
APR-DRG 6074
|
| Min. Negotiated Rate |
$142,152.93 |
| Max. Negotiated Rate |
$142,152.93 |
| Rate for Payer: IEHP Medi-Cal |
$142,152.93
|
|
