|
NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
IP
|
$249,331.28
|
|
|
Service Code
|
APR-DRG 5914
|
| Min. Negotiated Rate |
$249,331.28 |
| Max. Negotiated Rate |
$249,331.28 |
| Rate for Payer: IEHP Medi-Cal |
$249,331.28
|
|
|
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
|
$1,083.45
|
|
|
Service Code
|
APR-DRG 5894
|
| Min. Negotiated Rate |
$1,083.45 |
| Max. Negotiated Rate |
$1,083.45 |
| Rate for Payer: IEHP Medi-Cal |
$1,083.45
|
|
|
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
|
$53,713.20
|
|
|
Service Code
|
APR-DRG 5891
|
| Min. Negotiated Rate |
$53,713.20 |
| Max. Negotiated Rate |
$53,713.20 |
| Rate for Payer: IEHP Medi-Cal |
$53,713.20
|
|
|
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
|
$44,591.23
|
|
|
Service Code
|
APR-DRG 5892
|
| Min. Negotiated Rate |
$44,591.23 |
| Max. Negotiated Rate |
$44,591.23 |
| Rate for Payer: IEHP Medi-Cal |
$44,591.23
|
|
|
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
|
$35,468.04
|
|
|
Service Code
|
APR-DRG 5893
|
| Min. Negotiated Rate |
$35,468.04 |
| Max. Negotiated Rate |
$35,468.04 |
| Rate for Payer: IEHP Medi-Cal |
$35,468.04
|
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
IP
|
$1,692.57
|
|
|
Service Code
|
APR-DRG 5931
|
| Min. Negotiated Rate |
$1,692.57 |
| Max. Negotiated Rate |
$1,692.57 |
| Rate for Payer: IEHP Medi-Cal |
$1,692.57
|
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
IP
|
$115,303.47
|
|
|
Service Code
|
APR-DRG 5933
|
| Min. Negotiated Rate |
$115,303.47 |
| Max. Negotiated Rate |
$115,303.47 |
| Rate for Payer: IEHP Medi-Cal |
$115,303.47
|
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
IP
|
$258,195.81
|
|
|
Service Code
|
APR-DRG 5934
|
| Min. Negotiated Rate |
$258,195.81 |
| Max. Negotiated Rate |
$258,195.81 |
| Rate for Payer: IEHP Medi-Cal |
$258,195.81
|
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
IP
|
$91,388.66
|
|
|
Service Code
|
APR-DRG 5932
|
| Min. Negotiated Rate |
$91,388.66 |
| Max. Negotiated Rate |
$91,388.66 |
| Rate for Payer: IEHP Medi-Cal |
$91,388.66
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE
|
Facility
IP
|
$1,150.35
|
|
|
Service Code
|
APR-DRG 5811
|
| Min. Negotiated Rate |
$1,150.35 |
| Max. Negotiated Rate |
$1,150.35 |
| Rate for Payer: IEHP Medi-Cal |
$1,150.35
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE
|
Facility
IP
|
$1,722.42
|
|
|
Service Code
|
APR-DRG 5812
|
| Min. Negotiated Rate |
$1,722.42 |
| Max. Negotiated Rate |
$1,722.42 |
| Rate for Payer: IEHP Medi-Cal |
$1,722.42
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE
|
Facility
IP
|
$6,364.55
|
|
|
Service Code
|
APR-DRG 5814
|
| Min. Negotiated Rate |
$6,364.55 |
| Max. Negotiated Rate |
$6,364.55 |
| Rate for Payer: IEHP Medi-Cal |
$6,364.55
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE
|
Facility
IP
|
$2,641.45
|
|
|
Service Code
|
APR-DRG 5813
|
| Min. Negotiated Rate |
$2,641.45 |
| Max. Negotiated Rate |
$2,641.45 |
| Rate for Payer: IEHP Medi-Cal |
$2,641.45
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE
|
Facility
IP
|
$6,929.45
|
|
|
Service Code
|
APR-DRG 5803
|
| Min. Negotiated Rate |
$6,929.45 |
| Max. Negotiated Rate |
$6,929.45 |
| Rate for Payer: IEHP Medi-Cal |
$6,929.45
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE
|
Facility
IP
|
$3,303.05
|
|
|
Service Code
|
APR-DRG 5801
|
| Min. Negotiated Rate |
$3,303.05 |
| Max. Negotiated Rate |
$3,303.05 |
| Rate for Payer: IEHP Medi-Cal |
$3,303.05
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE
|
Facility
IP
|
$16,360.87
|
|
|
Service Code
|
APR-DRG 5804
|
| Min. Negotiated Rate |
$16,360.87 |
| Max. Negotiated Rate |
$16,360.87 |
| Rate for Payer: IEHP Medi-Cal |
$16,360.87
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE
|
Facility
IP
|
$4,223.33
|
|
|
Service Code
|
APR-DRG 5802
|
| Min. Negotiated Rate |
$4,223.33 |
| Max. Negotiated Rate |
$4,223.33 |
| Rate for Payer: IEHP Medi-Cal |
$4,223.33
|
|
|
NEONATE WITH ECMO
|
Facility
IP
|
$195,747.03
|
|
|
Service Code
|
APR-DRG 5832
|
| Min. Negotiated Rate |
$195,747.03 |
| Max. Negotiated Rate |
$195,747.03 |
| Rate for Payer: IEHP Medi-Cal |
$195,747.03
|
|
|
NEONATE WITH ECMO
|
Facility
IP
|
$169,160.92
|
|
|
Service Code
|
APR-DRG 5831
|
| Min. Negotiated Rate |
$169,160.92 |
| Max. Negotiated Rate |
$169,160.92 |
| Rate for Payer: IEHP Medi-Cal |
$169,160.92
|
|
|
NEONATE WITH ECMO
|
Facility
IP
|
$482,633.00
|
|
|
Service Code
|
APR-DRG 5834
|
| Min. Negotiated Rate |
$482,633.00 |
| Max. Negotiated Rate |
$482,633.00 |
| Rate for Payer: IEHP Medi-Cal |
$482,633.00
|
|
|
NEONATE WITH ECMO
|
Facility
IP
|
$265,454.42
|
|
|
Service Code
|
APR-DRG 5833
|
| Min. Negotiated Rate |
$265,454.42 |
| Max. Negotiated Rate |
$265,454.42 |
| Rate for Payer: IEHP Medi-Cal |
$265,454.42
|
|
|
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 |
$0.55 |
| Max. Negotiated Rate |
$22.30 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.07
|
| 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 |
$2.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.57
|
| Rate for Payer: Dignity Health Senior |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1.40
|
| Rate for Payer: IEHP Medi-Cal |
$8.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.57
|
| Rate for Payer: Vantage Medical Group Senior |
$2.57
|
|
|
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 |
$0.55 |
| Max. Negotiated Rate |
$2.26 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.07
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.04
|
| Rate for Payer: Heritage Provider Network Senior |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.01
|
|
|
NEOSTIGMINE METHYLSULFATE 5 MG/5 ML (1 MG/ML) INTRAVENOUS SYRINGE [120692]
|
Facility
OP
|
$3.02
|
|
|
Service Code
|
CPT J2710
|
| Hospital Charge Code |
NDG120692
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$22.30 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.07
|
| 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 |
$2.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.57
|
| Rate for Payer: Dignity Health Senior |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1.40
|
| Rate for Payer: IEHP Medi-Cal |
$8.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.57
|
| Rate for Payer: Vantage Medical Group Senior |
$2.57
|
|
|
NEOSTIGMINE METHYLSULFATE 5 MG/5 ML (1 MG/ML) INTRAVENOUS SYRINGE [120692]
|
Facility
IP
|
$3.02
|
|
|
Service Code
|
CPT J2710
|
| Hospital Charge Code |
NDG120692
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.26 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.07
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.04
|
| Rate for Payer: Heritage Provider Network Senior |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.01
|
|
