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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition

Facility

IP

$14,906.15

Service Code	APR-DRG 6222
Hospital Charge Code	APRDRG6223
Min. Negotiated Rate	$14,906.15
Max. Negotiated Rate	$14,906.15
Rate for Payer: AHCCCS Medicaid	$14,906.15
Rate for Payer: Allwell Medicaid	$14,906.15
Rate for Payer: AZCH Complete Medicaid	$14,906.15
Rate for Payer: Banner UC Health Medicaid	$14,906.15
Rate for Payer: Mercy Care Medicaid	$14,906.15

Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition

Facility

IP

$14,906.15

Service Code	APR-DRG 6222
Hospital Charge Code	APRDRG6222
Min. Negotiated Rate	$14,906.15
Max. Negotiated Rate	$14,906.15
Rate for Payer: AHCCCS Medicaid	$14,906.15
Rate for Payer: Allwell Medicaid	$14,906.15
Rate for Payer: AZCH Complete Medicaid	$14,906.15
Rate for Payer: Banner UC Health Medicaid	$14,906.15
Rate for Payer: Mercy Care Medicaid	$14,906.15

Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition

Facility

IP

$14,906.15

Service Code	APR-DRG 6222
Hospital Charge Code	APRDRG6221
Min. Negotiated Rate	$14,906.15
Max. Negotiated Rate	$14,906.15
Rate for Payer: AHCCCS Medicaid	$14,906.15
Rate for Payer: Allwell Medicaid	$14,906.15
Rate for Payer: AZCH Complete Medicaid	$14,906.15
Rate for Payer: Banner UC Health Medicaid	$14,906.15
Rate for Payer: Mercy Care Medicaid	$14,906.15

Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition

Facility

IP

$20,407.23

Service Code	APR-DRG 6223
Hospital Charge Code	APRDRG6224
Min. Negotiated Rate	$20,407.23
Max. Negotiated Rate	$20,407.23
Rate for Payer: AHCCCS Medicaid	$20,407.23
Rate for Payer: Allwell Medicaid	$20,407.23
Rate for Payer: AZCH Complete Medicaid	$20,407.23
Rate for Payer: Banner UC Health Medicaid	$20,407.23
Rate for Payer: Mercy Care Medicaid	$20,407.23

Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition

Facility

IP

$10,227.11

Service Code	APR-DRG 6221
Hospital Charge Code	APRDRG6221
Min. Negotiated Rate	$10,227.11
Max. Negotiated Rate	$10,227.11
Rate for Payer: AHCCCS Medicaid	$10,227.11
Rate for Payer: Allwell Medicaid	$10,227.11
Rate for Payer: AZCH Complete Medicaid	$10,227.11
Rate for Payer: Banner UC Health Medicaid	$10,227.11
Rate for Payer: Mercy Care Medicaid	$10,227.11

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$1,007.21

Service Code	APR-DRG 6402
Hospital Charge Code	APRDRG6403
Min. Negotiated Rate	$1,007.21
Max. Negotiated Rate	$1,007.21
Rate for Payer: AHCCCS Medicaid	$1,007.21
Rate for Payer: Allwell Medicaid	$1,007.21
Rate for Payer: AZCH Complete Medicaid	$1,007.21
Rate for Payer: Banner UC Health Medicaid	$1,007.21
Rate for Payer: Mercy Care Medicaid	$1,007.21

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$2,353.20

Service Code	APR-DRG 6403
Hospital Charge Code	APRDRG6403
Min. Negotiated Rate	$2,353.20
Max. Negotiated Rate	$2,353.20
Rate for Payer: AHCCCS Medicaid	$2,353.20
Rate for Payer: Allwell Medicaid	$2,353.20
Rate for Payer: AZCH Complete Medicaid	$2,353.20
Rate for Payer: Banner UC Health Medicaid	$2,353.20
Rate for Payer: Mercy Care Medicaid	$2,353.20

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$2,353.20

Service Code	APR-DRG 6403
Hospital Charge Code	APRDRG6404
Min. Negotiated Rate	$2,353.20
Max. Negotiated Rate	$2,353.20
Rate for Payer: AHCCCS Medicaid	$2,353.20
Rate for Payer: Allwell Medicaid	$2,353.20
Rate for Payer: AZCH Complete Medicaid	$2,353.20
Rate for Payer: Banner UC Health Medicaid	$2,353.20
Rate for Payer: Mercy Care Medicaid	$2,353.20

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$2,353.20

Service Code	APR-DRG 6403
Hospital Charge Code	APRDRG6402
Min. Negotiated Rate	$2,353.20
Max. Negotiated Rate	$2,353.20
Rate for Payer: AHCCCS Medicaid	$2,353.20
Rate for Payer: Allwell Medicaid	$2,353.20
Rate for Payer: AZCH Complete Medicaid	$2,353.20
Rate for Payer: Banner UC Health Medicaid	$2,353.20
Rate for Payer: Mercy Care Medicaid	$2,353.20

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$17,536.40

Service Code	APR-DRG 6404
Hospital Charge Code	APRDRG6404
Min. Negotiated Rate	$17,536.40
Max. Negotiated Rate	$17,536.40
Rate for Payer: AHCCCS Medicaid	$17,536.40
Rate for Payer: Allwell Medicaid	$17,536.40
Rate for Payer: AZCH Complete Medicaid	$17,536.40
Rate for Payer: Banner UC Health Medicaid	$17,536.40
Rate for Payer: Mercy Care Medicaid	$17,536.40

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$1,007.21

Service Code	APR-DRG 6402
Hospital Charge Code	APRDRG6404
Min. Negotiated Rate	$1,007.21
Max. Negotiated Rate	$1,007.21
Rate for Payer: AHCCCS Medicaid	$1,007.21
Rate for Payer: Allwell Medicaid	$1,007.21
Rate for Payer: AZCH Complete Medicaid	$1,007.21
Rate for Payer: Banner UC Health Medicaid	$1,007.21
Rate for Payer: Mercy Care Medicaid	$1,007.21

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$17,536.40

Service Code	APR-DRG 6404
Hospital Charge Code	APRDRG6401
Min. Negotiated Rate	$17,536.40
Max. Negotiated Rate	$17,536.40
Rate for Payer: AHCCCS Medicaid	$17,536.40
Rate for Payer: Allwell Medicaid	$17,536.40
Rate for Payer: AZCH Complete Medicaid	$17,536.40
Rate for Payer: Banner UC Health Medicaid	$17,536.40
Rate for Payer: Mercy Care Medicaid	$17,536.40

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$17,536.40

Service Code	APR-DRG 6404
Hospital Charge Code	APRDRG6402
Min. Negotiated Rate	$17,536.40
Max. Negotiated Rate	$17,536.40
Rate for Payer: AHCCCS Medicaid	$17,536.40
Rate for Payer: Allwell Medicaid	$17,536.40
Rate for Payer: AZCH Complete Medicaid	$17,536.40
Rate for Payer: Banner UC Health Medicaid	$17,536.40
Rate for Payer: Mercy Care Medicaid	$17,536.40

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$2,353.20

Service Code	APR-DRG 6403
Hospital Charge Code	APRDRG6401
Min. Negotiated Rate	$2,353.20
Max. Negotiated Rate	$2,353.20
Rate for Payer: AHCCCS Medicaid	$2,353.20
Rate for Payer: Allwell Medicaid	$2,353.20
Rate for Payer: AZCH Complete Medicaid	$2,353.20
Rate for Payer: Banner UC Health Medicaid	$2,353.20
Rate for Payer: Mercy Care Medicaid	$2,353.20

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$692.28

Service Code	APR-DRG 6401
Hospital Charge Code	APRDRG6403
Min. Negotiated Rate	$692.28
Max. Negotiated Rate	$692.28
Rate for Payer: AHCCCS Medicaid	$692.28
Rate for Payer: Allwell Medicaid	$692.28
Rate for Payer: AZCH Complete Medicaid	$692.28
Rate for Payer: Banner UC Health Medicaid	$692.28
Rate for Payer: Mercy Care Medicaid	$692.28

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$692.28

Service Code	APR-DRG 6401
Hospital Charge Code	APRDRG6404
Min. Negotiated Rate	$692.28
Max. Negotiated Rate	$692.28
Rate for Payer: AHCCCS Medicaid	$692.28
Rate for Payer: Allwell Medicaid	$692.28
Rate for Payer: AZCH Complete Medicaid	$692.28
Rate for Payer: Banner UC Health Medicaid	$692.28
Rate for Payer: Mercy Care Medicaid	$692.28

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$1,007.21

Service Code	APR-DRG 6402
Hospital Charge Code	APRDRG6401
Min. Negotiated Rate	$1,007.21
Max. Negotiated Rate	$1,007.21
Rate for Payer: AHCCCS Medicaid	$1,007.21
Rate for Payer: Allwell Medicaid	$1,007.21
Rate for Payer: AZCH Complete Medicaid	$1,007.21
Rate for Payer: Banner UC Health Medicaid	$1,007.21
Rate for Payer: Mercy Care Medicaid	$1,007.21

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$1,007.21

Service Code	APR-DRG 6402
Hospital Charge Code	APRDRG6402
Min. Negotiated Rate	$1,007.21
Max. Negotiated Rate	$1,007.21
Rate for Payer: AHCCCS Medicaid	$1,007.21
Rate for Payer: Allwell Medicaid	$1,007.21
Rate for Payer: AZCH Complete Medicaid	$1,007.21
Rate for Payer: Banner UC Health Medicaid	$1,007.21
Rate for Payer: Mercy Care Medicaid	$1,007.21

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$692.28

Service Code	APR-DRG 6401
Hospital Charge Code	APRDRG6402
Min. Negotiated Rate	$692.28
Max. Negotiated Rate	$692.28
Rate for Payer: AHCCCS Medicaid	$692.28
Rate for Payer: Allwell Medicaid	$692.28
Rate for Payer: AZCH Complete Medicaid	$692.28
Rate for Payer: Banner UC Health Medicaid	$692.28
Rate for Payer: Mercy Care Medicaid	$692.28

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$17,536.40

Service Code	APR-DRG 6404
Hospital Charge Code	APRDRG6403
Min. Negotiated Rate	$17,536.40
Max. Negotiated Rate	$17,536.40
Rate for Payer: AHCCCS Medicaid	$17,536.40
Rate for Payer: Allwell Medicaid	$17,536.40
Rate for Payer: AZCH Complete Medicaid	$17,536.40
Rate for Payer: Banner UC Health Medicaid	$17,536.40
Rate for Payer: Mercy Care Medicaid	$17,536.40

Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem

Facility

IP

$692.28

Service Code	APR-DRG 6401
Hospital Charge Code	APRDRG6401
Min. Negotiated Rate	$692.28
Max. Negotiated Rate	$692.28
Rate for Payer: AHCCCS Medicaid	$692.28
Rate for Payer: Allwell Medicaid	$692.28
Rate for Payer: AZCH Complete Medicaid	$692.28
Rate for Payer: Banner UC Health Medicaid	$692.28
Rate for Payer: Mercy Care Medicaid	$692.28

Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection

Facility

IP

$4,584.35

Service Code	APR-DRG 6361
Hospital Charge Code	APRDRG6364
Min. Negotiated Rate	$4,584.35
Max. Negotiated Rate	$4,584.35
Rate for Payer: AHCCCS Medicaid	$4,584.35
Rate for Payer: Allwell Medicaid	$4,584.35
Rate for Payer: AZCH Complete Medicaid	$4,584.35
Rate for Payer: Banner UC Health Medicaid	$4,584.35
Rate for Payer: Mercy Care Medicaid	$4,584.35

Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection

Facility

IP

$29,347.98

Service Code	APR-DRG 6364
Hospital Charge Code	APRDRG6361
Min. Negotiated Rate	$29,347.98
Max. Negotiated Rate	$29,347.98
Rate for Payer: AHCCCS Medicaid	$29,347.98
Rate for Payer: Allwell Medicaid	$29,347.98
Rate for Payer: AZCH Complete Medicaid	$29,347.98
Rate for Payer: Banner UC Health Medicaid	$29,347.98
Rate for Payer: Mercy Care Medicaid	$29,347.98

Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection

Facility

IP

$4,584.35

Service Code	APR-DRG 6361
Hospital Charge Code	APRDRG6361
Min. Negotiated Rate	$4,584.35
Max. Negotiated Rate	$4,584.35
Rate for Payer: AHCCCS Medicaid	$4,584.35
Rate for Payer: Allwell Medicaid	$4,584.35
Rate for Payer: AZCH Complete Medicaid	$4,584.35
Rate for Payer: Banner UC Health Medicaid	$4,584.35
Rate for Payer: Mercy Care Medicaid	$4,584.35

Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection

Facility

IP

$29,347.98

Service Code	APR-DRG 6364
Hospital Charge Code	APRDRG6363
Min. Negotiated Rate	$29,347.98
Max. Negotiated Rate	$29,347.98
Rate for Payer: AHCCCS Medicaid	$29,347.98
Rate for Payer: Allwell Medicaid	$29,347.98
Rate for Payer: AZCH Complete Medicaid	$29,347.98
Rate for Payer: Banner UC Health Medicaid	$29,347.98
Rate for Payer: Mercy Care Medicaid	$29,347.98

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