|
Neonatal Aftercare
|
Facility
|
IP
|
$10,314.79
|
|
|
Service Code
|
APR-DRG 8632
|
| Hospital Charge Code |
APRDRG8632
|
| Min. Negotiated Rate |
$10,314.79 |
| Max. Negotiated Rate |
$10,314.79 |
| Rate for Payer: AHCCCS Medicaid |
$10,314.79
|
| Rate for Payer: Allwell Medicaid |
$10,314.79
|
| Rate for Payer: AZCH Complete Medicaid |
$10,314.79
|
| Rate for Payer: Banner UC Health Medicaid |
$10,314.79
|
| Rate for Payer: Mercy Care Medicaid |
$10,314.79
|
|
|
Neonatal Aftercare
|
Facility
|
IP
|
$3,680.25
|
|
|
Service Code
|
APR-DRG 8631
|
| Hospital Charge Code |
APRDRG8632
|
| Min. Negotiated Rate |
$3,680.25 |
| Max. Negotiated Rate |
$3,680.25 |
| Rate for Payer: AHCCCS Medicaid |
$3,680.25
|
| Rate for Payer: Allwell Medicaid |
$3,680.25
|
| Rate for Payer: AZCH Complete Medicaid |
$3,680.25
|
| Rate for Payer: Banner UC Health Medicaid |
$3,680.25
|
| Rate for Payer: Mercy Care Medicaid |
$3,680.25
|
|
|
Neonatal Aftercare
|
Facility
|
IP
|
$3,680.25
|
|
|
Service Code
|
APR-DRG 8631
|
| Hospital Charge Code |
APRDRG8634
|
| Min. Negotiated Rate |
$3,680.25 |
| Max. Negotiated Rate |
$3,680.25 |
| Rate for Payer: AHCCCS Medicaid |
$3,680.25
|
| Rate for Payer: Allwell Medicaid |
$3,680.25
|
| Rate for Payer: AZCH Complete Medicaid |
$3,680.25
|
| Rate for Payer: Banner UC Health Medicaid |
$3,680.25
|
| Rate for Payer: Mercy Care Medicaid |
$3,680.25
|
|
|
Neonatal Aftercare
|
Facility
|
IP
|
$3,680.25
|
|
|
Service Code
|
APR-DRG 8631
|
| Hospital Charge Code |
APRDRG8631
|
| Min. Negotiated Rate |
$3,680.25 |
| Max. Negotiated Rate |
$3,680.25 |
| Rate for Payer: AHCCCS Medicaid |
$3,680.25
|
| Rate for Payer: Allwell Medicaid |
$3,680.25
|
| Rate for Payer: AZCH Complete Medicaid |
$3,680.25
|
| Rate for Payer: Banner UC Health Medicaid |
$3,680.25
|
| Rate for Payer: Mercy Care Medicaid |
$3,680.25
|
|
|
Neonatal Aftercare
|
Facility
|
IP
|
$27,689.17
|
|
|
Service Code
|
APR-DRG 8633
|
| Hospital Charge Code |
APRDRG8632
|
| Min. Negotiated Rate |
$27,689.17 |
| Max. Negotiated Rate |
$27,689.17 |
| Rate for Payer: AHCCCS Medicaid |
$27,689.17
|
| Rate for Payer: Allwell Medicaid |
$27,689.17
|
| Rate for Payer: AZCH Complete Medicaid |
$27,689.17
|
| Rate for Payer: Banner UC Health Medicaid |
$27,689.17
|
| Rate for Payer: Mercy Care Medicaid |
$27,689.17
|
|
|
Neonatal Aftercare
|
Facility
|
IP
|
$10,314.79
|
|
|
Service Code
|
APR-DRG 8632
|
| Hospital Charge Code |
APRDRG8633
|
| Min. Negotiated Rate |
$10,314.79 |
| Max. Negotiated Rate |
$10,314.79 |
| Rate for Payer: AHCCCS Medicaid |
$10,314.79
|
| Rate for Payer: Allwell Medicaid |
$10,314.79
|
| Rate for Payer: AZCH Complete Medicaid |
$10,314.79
|
| Rate for Payer: Banner UC Health Medicaid |
$10,314.79
|
| Rate for Payer: Mercy Care Medicaid |
$10,314.79
|
|
|
Neonatal Bili
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
1019625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna of AZ Commercial |
$111.60
|
| Rate for Payer: Aetna of AZ Medicare |
$34.72
|
| Rate for Payer: Allwell Medicare |
$19.84
|
| Rate for Payer: Amerigroup Medicare |
$19.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$46.31
|
| Rate for Payer: AZCH Complete Medicare |
$19.84
|
| Rate for Payer: Banner UC Health Medicare |
$19.84
|
| Rate for Payer: Bisbee Police All Plans |
$32.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$84.32
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cigna of AZ Commercial |
$80.60
|
| Rate for Payer: Copperpoint Commercial |
$30.69
|
| Rate for Payer: Health Net of AZ Commercial |
$74.40
|
| Rate for Payer: Health Net of AZ Medicare |
$34.72
|
| Rate for Payer: Humana of AZ Medicare |
$19.84
|
| Rate for Payer: Self Pay Self Pay |
$99.20
|
| Rate for Payer: TriWest Medicare |
$19.84
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$72.29
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$22.32
|
|
|
Neonatal Bili
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
1019625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna of AZ Commercial |
$111.60
|
| Rate for Payer: Bisbee Police All Plans |
$32.24
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Self Pay Self Pay |
$99.20
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$18,202.03
|
|
|
Service Code
|
APR-DRG 6031
|
| Hospital Charge Code |
APRDRG6031
|
| Min. Negotiated Rate |
$18,202.03 |
| Max. Negotiated Rate |
$18,202.03 |
| Rate for Payer: AHCCCS Medicaid |
$18,202.03
|
| Rate for Payer: Allwell Medicaid |
$18,202.03
|
| Rate for Payer: AZCH Complete Medicaid |
$18,202.03
|
| Rate for Payer: Banner UC Health Medicaid |
$18,202.03
|
| Rate for Payer: Mercy Care Medicaid |
$18,202.03
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$52,950.79
|
|
|
Service Code
|
APR-DRG 6033
|
| Hospital Charge Code |
APRDRG6032
|
| Min. Negotiated Rate |
$52,950.79 |
| Max. Negotiated Rate |
$52,950.79 |
| Rate for Payer: AHCCCS Medicaid |
$52,950.79
|
| Rate for Payer: Allwell Medicaid |
$52,950.79
|
| Rate for Payer: AZCH Complete Medicaid |
$52,950.79
|
| Rate for Payer: Banner UC Health Medicaid |
$52,950.79
|
| Rate for Payer: Mercy Care Medicaid |
$52,950.79
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$109,833.63
|
|
|
Service Code
|
APR-DRG 6034
|
| Hospital Charge Code |
APRDRG6031
|
| Min. Negotiated Rate |
$109,833.63 |
| Max. Negotiated Rate |
$109,833.63 |
| Rate for Payer: AHCCCS Medicaid |
$109,833.63
|
| Rate for Payer: Allwell Medicaid |
$109,833.63
|
| Rate for Payer: AZCH Complete Medicaid |
$109,833.63
|
| Rate for Payer: Banner UC Health Medicaid |
$109,833.63
|
| Rate for Payer: Mercy Care Medicaid |
$109,833.63
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$109,833.63
|
|
|
Service Code
|
APR-DRG 6034
|
| Hospital Charge Code |
APRDRG6034
|
| Min. Negotiated Rate |
$109,833.63 |
| Max. Negotiated Rate |
$109,833.63 |
| Rate for Payer: AHCCCS Medicaid |
$109,833.63
|
| Rate for Payer: Allwell Medicaid |
$109,833.63
|
| Rate for Payer: AZCH Complete Medicaid |
$109,833.63
|
| Rate for Payer: Banner UC Health Medicaid |
$109,833.63
|
| Rate for Payer: Mercy Care Medicaid |
$109,833.63
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$52,950.79
|
|
|
Service Code
|
APR-DRG 6033
|
| Hospital Charge Code |
APRDRG6034
|
| Min. Negotiated Rate |
$52,950.79 |
| Max. Negotiated Rate |
$52,950.79 |
| Rate for Payer: AHCCCS Medicaid |
$52,950.79
|
| Rate for Payer: Allwell Medicaid |
$52,950.79
|
| Rate for Payer: AZCH Complete Medicaid |
$52,950.79
|
| Rate for Payer: Banner UC Health Medicaid |
$52,950.79
|
| Rate for Payer: Mercy Care Medicaid |
$52,950.79
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$109,833.63
|
|
|
Service Code
|
APR-DRG 6034
|
| Hospital Charge Code |
APRDRG6032
|
| Min. Negotiated Rate |
$109,833.63 |
| Max. Negotiated Rate |
$109,833.63 |
| Rate for Payer: AHCCCS Medicaid |
$109,833.63
|
| Rate for Payer: Allwell Medicaid |
$109,833.63
|
| Rate for Payer: AZCH Complete Medicaid |
$109,833.63
|
| Rate for Payer: Banner UC Health Medicaid |
$109,833.63
|
| Rate for Payer: Mercy Care Medicaid |
$109,833.63
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$34,533.43
|
|
|
Service Code
|
APR-DRG 6032
|
| Hospital Charge Code |
APRDRG6033
|
| Min. Negotiated Rate |
$34,533.43 |
| Max. Negotiated Rate |
$34,533.43 |
| Rate for Payer: AHCCCS Medicaid |
$34,533.43
|
| Rate for Payer: Allwell Medicaid |
$34,533.43
|
| Rate for Payer: AZCH Complete Medicaid |
$34,533.43
|
| Rate for Payer: Banner UC Health Medicaid |
$34,533.43
|
| Rate for Payer: Mercy Care Medicaid |
$34,533.43
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$34,533.43
|
|
|
Service Code
|
APR-DRG 6032
|
| Hospital Charge Code |
APRDRG6032
|
| Min. Negotiated Rate |
$34,533.43 |
| Max. Negotiated Rate |
$34,533.43 |
| Rate for Payer: AHCCCS Medicaid |
$34,533.43
|
| Rate for Payer: Allwell Medicaid |
$34,533.43
|
| Rate for Payer: AZCH Complete Medicaid |
$34,533.43
|
| Rate for Payer: Banner UC Health Medicaid |
$34,533.43
|
| Rate for Payer: Mercy Care Medicaid |
$34,533.43
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$18,202.03
|
|
|
Service Code
|
APR-DRG 6031
|
| Hospital Charge Code |
APRDRG6032
|
| Min. Negotiated Rate |
$18,202.03 |
| Max. Negotiated Rate |
$18,202.03 |
| Rate for Payer: AHCCCS Medicaid |
$18,202.03
|
| Rate for Payer: Allwell Medicaid |
$18,202.03
|
| Rate for Payer: AZCH Complete Medicaid |
$18,202.03
|
| Rate for Payer: Banner UC Health Medicaid |
$18,202.03
|
| Rate for Payer: Mercy Care Medicaid |
$18,202.03
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$52,950.79
|
|
|
Service Code
|
APR-DRG 6033
|
| Hospital Charge Code |
APRDRG6031
|
| Min. Negotiated Rate |
$52,950.79 |
| Max. Negotiated Rate |
$52,950.79 |
| Rate for Payer: AHCCCS Medicaid |
$52,950.79
|
| Rate for Payer: Allwell Medicaid |
$52,950.79
|
| Rate for Payer: AZCH Complete Medicaid |
$52,950.79
|
| Rate for Payer: Banner UC Health Medicaid |
$52,950.79
|
| Rate for Payer: Mercy Care Medicaid |
$52,950.79
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$109,833.63
|
|
|
Service Code
|
APR-DRG 6034
|
| Hospital Charge Code |
APRDRG6033
|
| Min. Negotiated Rate |
$109,833.63 |
| Max. Negotiated Rate |
$109,833.63 |
| Rate for Payer: AHCCCS Medicaid |
$109,833.63
|
| Rate for Payer: Allwell Medicaid |
$109,833.63
|
| Rate for Payer: AZCH Complete Medicaid |
$109,833.63
|
| Rate for Payer: Banner UC Health Medicaid |
$109,833.63
|
| Rate for Payer: Mercy Care Medicaid |
$109,833.63
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$34,533.43
|
|
|
Service Code
|
APR-DRG 6032
|
| Hospital Charge Code |
APRDRG6034
|
| Min. Negotiated Rate |
$34,533.43 |
| Max. Negotiated Rate |
$34,533.43 |
| Rate for Payer: AHCCCS Medicaid |
$34,533.43
|
| Rate for Payer: Allwell Medicaid |
$34,533.43
|
| Rate for Payer: AZCH Complete Medicaid |
$34,533.43
|
| Rate for Payer: Banner UC Health Medicaid |
$34,533.43
|
| Rate for Payer: Mercy Care Medicaid |
$34,533.43
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$34,533.43
|
|
|
Service Code
|
APR-DRG 6032
|
| Hospital Charge Code |
APRDRG6031
|
| Min. Negotiated Rate |
$34,533.43 |
| Max. Negotiated Rate |
$34,533.43 |
| Rate for Payer: AHCCCS Medicaid |
$34,533.43
|
| Rate for Payer: Allwell Medicaid |
$34,533.43
|
| Rate for Payer: AZCH Complete Medicaid |
$34,533.43
|
| Rate for Payer: Banner UC Health Medicaid |
$34,533.43
|
| Rate for Payer: Mercy Care Medicaid |
$34,533.43
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$18,202.03
|
|
|
Service Code
|
APR-DRG 6031
|
| Hospital Charge Code |
APRDRG6033
|
| Min. Negotiated Rate |
$18,202.03 |
| Max. Negotiated Rate |
$18,202.03 |
| Rate for Payer: AHCCCS Medicaid |
$18,202.03
|
| Rate for Payer: Allwell Medicaid |
$18,202.03
|
| Rate for Payer: AZCH Complete Medicaid |
$18,202.03
|
| Rate for Payer: Banner UC Health Medicaid |
$18,202.03
|
| Rate for Payer: Mercy Care Medicaid |
$18,202.03
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$18,202.03
|
|
|
Service Code
|
APR-DRG 6031
|
| Hospital Charge Code |
APRDRG6034
|
| Min. Negotiated Rate |
$18,202.03 |
| Max. Negotiated Rate |
$18,202.03 |
| Rate for Payer: AHCCCS Medicaid |
$18,202.03
|
| Rate for Payer: Allwell Medicaid |
$18,202.03
|
| Rate for Payer: AZCH Complete Medicaid |
$18,202.03
|
| Rate for Payer: Banner UC Health Medicaid |
$18,202.03
|
| Rate for Payer: Mercy Care Medicaid |
$18,202.03
|
|
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
Facility
|
IP
|
$52,950.79
|
|
|
Service Code
|
APR-DRG 6033
|
| Hospital Charge Code |
APRDRG6033
|
| Min. Negotiated Rate |
$52,950.79 |
| Max. Negotiated Rate |
$52,950.79 |
| Rate for Payer: AHCCCS Medicaid |
$52,950.79
|
| Rate for Payer: Allwell Medicaid |
$52,950.79
|
| Rate for Payer: AZCH Complete Medicaid |
$52,950.79
|
| Rate for Payer: Banner UC Health Medicaid |
$52,950.79
|
| Rate for Payer: Mercy Care Medicaid |
$52,950.79
|
|
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly
|
Facility
|
IP
|
$55,438.66
|
|
|
Service Code
|
APR-DRG 6022
|
| Hospital Charge Code |
APRDRG6021
|
| Min. Negotiated Rate |
$55,438.66 |
| Max. Negotiated Rate |
$55,438.66 |
| Rate for Payer: AHCCCS Medicaid |
$55,438.66
|
| Rate for Payer: Allwell Medicaid |
$55,438.66
|
| Rate for Payer: AZCH Complete Medicaid |
$55,438.66
|
| Rate for Payer: Banner UC Health Medicaid |
$55,438.66
|
| Rate for Payer: Mercy Care Medicaid |
$55,438.66
|
|
