|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
Facility
|
IP
|
$20,400.92
|
|
|
Service Code
|
APR-DRG 6301
|
| Hospital Charge Code |
APRDRG6302
|
| Min. Negotiated Rate |
$20,400.92 |
| Max. Negotiated Rate |
$20,400.92 |
| Rate for Payer: AHCCCS Medicaid |
$20,400.92
|
| Rate for Payer: Allwell Medicaid |
$20,400.92
|
| Rate for Payer: AZCH Complete Medicaid |
$20,400.92
|
| Rate for Payer: Banner UC Health Medicaid |
$20,400.92
|
| Rate for Payer: Mercy Care Medicaid |
$20,400.92
|
|
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
Facility
|
IP
|
$118,789.10
|
|
|
Service Code
|
APR-DRG 6304
|
| Hospital Charge Code |
APRDRG6301
|
| Min. Negotiated Rate |
$118,789.10 |
| Max. Negotiated Rate |
$118,789.10 |
| Rate for Payer: AHCCCS Medicaid |
$118,789.10
|
| Rate for Payer: Allwell Medicaid |
$118,789.10
|
| Rate for Payer: AZCH Complete Medicaid |
$118,789.10
|
| Rate for Payer: Banner UC Health Medicaid |
$118,789.10
|
| Rate for Payer: Mercy Care Medicaid |
$118,789.10
|
|
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
Facility
|
IP
|
$59,310.38
|
|
|
Service Code
|
APR-DRG 6303
|
| Hospital Charge Code |
APRDRG6302
|
| Min. Negotiated Rate |
$59,310.38 |
| Max. Negotiated Rate |
$59,310.38 |
| Rate for Payer: AHCCCS Medicaid |
$59,310.38
|
| Rate for Payer: Allwell Medicaid |
$59,310.38
|
| Rate for Payer: AZCH Complete Medicaid |
$59,310.38
|
| Rate for Payer: Banner UC Health Medicaid |
$59,310.38
|
| Rate for Payer: Mercy Care Medicaid |
$59,310.38
|
|
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
Facility
|
IP
|
$20,400.92
|
|
|
Service Code
|
APR-DRG 6301
|
| Hospital Charge Code |
APRDRG6304
|
| Min. Negotiated Rate |
$20,400.92 |
| Max. Negotiated Rate |
$20,400.92 |
| Rate for Payer: AHCCCS Medicaid |
$20,400.92
|
| Rate for Payer: Allwell Medicaid |
$20,400.92
|
| Rate for Payer: AZCH Complete Medicaid |
$20,400.92
|
| Rate for Payer: Banner UC Health Medicaid |
$20,400.92
|
| Rate for Payer: Mercy Care Medicaid |
$20,400.92
|
|
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
Facility
|
IP
|
$118,789.10
|
|
|
Service Code
|
APR-DRG 6304
|
| Hospital Charge Code |
APRDRG6303
|
| Min. Negotiated Rate |
$118,789.10 |
| Max. Negotiated Rate |
$118,789.10 |
| Rate for Payer: AHCCCS Medicaid |
$118,789.10
|
| Rate for Payer: Allwell Medicaid |
$118,789.10
|
| Rate for Payer: AZCH Complete Medicaid |
$118,789.10
|
| Rate for Payer: Banner UC Health Medicaid |
$118,789.10
|
| Rate for Payer: Mercy Care Medicaid |
$118,789.10
|
|
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
Facility
|
IP
|
$118,789.10
|
|
|
Service Code
|
APR-DRG 6304
|
| Hospital Charge Code |
APRDRG6302
|
| Min. Negotiated Rate |
$118,789.10 |
| Max. Negotiated Rate |
$118,789.10 |
| Rate for Payer: AHCCCS Medicaid |
$118,789.10
|
| Rate for Payer: Allwell Medicaid |
$118,789.10
|
| Rate for Payer: AZCH Complete Medicaid |
$118,789.10
|
| Rate for Payer: Banner UC Health Medicaid |
$118,789.10
|
| Rate for Payer: Mercy Care Medicaid |
$118,789.10
|
|
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
Facility
|
IP
|
$59,310.38
|
|
|
Service Code
|
APR-DRG 6303
|
| Hospital Charge Code |
APRDRG6304
|
| Min. Negotiated Rate |
$59,310.38 |
| Max. Negotiated Rate |
$59,310.38 |
| Rate for Payer: AHCCCS Medicaid |
$59,310.38
|
| Rate for Payer: Allwell Medicaid |
$59,310.38
|
| Rate for Payer: AZCH Complete Medicaid |
$59,310.38
|
| Rate for Payer: Banner UC Health Medicaid |
$59,310.38
|
| Rate for Payer: Mercy Care Medicaid |
$59,310.38
|
|
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
Facility
|
IP
|
$20,400.92
|
|
|
Service Code
|
APR-DRG 6301
|
| Hospital Charge Code |
APRDRG6301
|
| Min. Negotiated Rate |
$20,400.92 |
| Max. Negotiated Rate |
$20,400.92 |
| Rate for Payer: AHCCCS Medicaid |
$20,400.92
|
| Rate for Payer: Allwell Medicaid |
$20,400.92
|
| Rate for Payer: AZCH Complete Medicaid |
$20,400.92
|
| Rate for Payer: Banner UC Health Medicaid |
$20,400.92
|
| Rate for Payer: Mercy Care Medicaid |
$20,400.92
|
|
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
Facility
|
IP
|
$59,310.38
|
|
|
Service Code
|
APR-DRG 6303
|
| Hospital Charge Code |
APRDRG6303
|
| Min. Negotiated Rate |
$59,310.38 |
| Max. Negotiated Rate |
$59,310.38 |
| Rate for Payer: AHCCCS Medicaid |
$59,310.38
|
| Rate for Payer: Allwell Medicaid |
$59,310.38
|
| Rate for Payer: AZCH Complete Medicaid |
$59,310.38
|
| Rate for Payer: Banner UC Health Medicaid |
$59,310.38
|
| Rate for Payer: Mercy Care Medicaid |
$59,310.38
|
|
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
Facility
|
IP
|
$33,012.09
|
|
|
Service Code
|
APR-DRG 6302
|
| Hospital Charge Code |
APRDRG6303
|
| Min. Negotiated Rate |
$33,012.09 |
| Max. Negotiated Rate |
$33,012.09 |
| Rate for Payer: AHCCCS Medicaid |
$33,012.09
|
| Rate for Payer: Allwell Medicaid |
$33,012.09
|
| Rate for Payer: AZCH Complete Medicaid |
$33,012.09
|
| Rate for Payer: Banner UC Health Medicaid |
$33,012.09
|
| Rate for Payer: Mercy Care Medicaid |
$33,012.09
|
|
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
Facility
|
IP
|
$33,012.09
|
|
|
Service Code
|
APR-DRG 6302
|
| Hospital Charge Code |
APRDRG6304
|
| Min. Negotiated Rate |
$33,012.09 |
| Max. Negotiated Rate |
$33,012.09 |
| Rate for Payer: AHCCCS Medicaid |
$33,012.09
|
| Rate for Payer: Allwell Medicaid |
$33,012.09
|
| Rate for Payer: AZCH Complete Medicaid |
$33,012.09
|
| Rate for Payer: Banner UC Health Medicaid |
$33,012.09
|
| Rate for Payer: Mercy Care Medicaid |
$33,012.09
|
|
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
Facility
|
IP
|
$33,012.09
|
|
|
Service Code
|
APR-DRG 6302
|
| Hospital Charge Code |
APRDRG6302
|
| Min. Negotiated Rate |
$33,012.09 |
| Max. Negotiated Rate |
$33,012.09 |
| Rate for Payer: AHCCCS Medicaid |
$33,012.09
|
| Rate for Payer: Allwell Medicaid |
$33,012.09
|
| Rate for Payer: AZCH Complete Medicaid |
$33,012.09
|
| Rate for Payer: Banner UC Health Medicaid |
$33,012.09
|
| Rate for Payer: Mercy Care Medicaid |
$33,012.09
|
|
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
Facility
|
IP
|
$41,104.14
|
|
|
Service Code
|
APR-DRG 6313
|
| Hospital Charge Code |
APRDRG6314
|
| Min. Negotiated Rate |
$41,104.14 |
| Max. Negotiated Rate |
$41,104.14 |
| Rate for Payer: AHCCCS Medicaid |
$41,104.14
|
| Rate for Payer: Allwell Medicaid |
$41,104.14
|
| Rate for Payer: AZCH Complete Medicaid |
$41,104.14
|
| Rate for Payer: Banner UC Health Medicaid |
$41,104.14
|
| Rate for Payer: Mercy Care Medicaid |
$41,104.14
|
|
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
Facility
|
IP
|
$22,038.69
|
|
|
Service Code
|
APR-DRG 6312
|
| Hospital Charge Code |
APRDRG6311
|
| Min. Negotiated Rate |
$22,038.69 |
| Max. Negotiated Rate |
$22,038.69 |
| Rate for Payer: AHCCCS Medicaid |
$22,038.69
|
| Rate for Payer: Allwell Medicaid |
$22,038.69
|
| Rate for Payer: AZCH Complete Medicaid |
$22,038.69
|
| Rate for Payer: Banner UC Health Medicaid |
$22,038.69
|
| Rate for Payer: Mercy Care Medicaid |
$22,038.69
|
|
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
Facility
|
IP
|
$123,339.09
|
|
|
Service Code
|
APR-DRG 6314
|
| Hospital Charge Code |
APRDRG6311
|
| Min. Negotiated Rate |
$123,339.09 |
| Max. Negotiated Rate |
$123,339.09 |
| Rate for Payer: AHCCCS Medicaid |
$123,339.09
|
| Rate for Payer: Allwell Medicaid |
$123,339.09
|
| Rate for Payer: AZCH Complete Medicaid |
$123,339.09
|
| Rate for Payer: Banner UC Health Medicaid |
$123,339.09
|
| Rate for Payer: Mercy Care Medicaid |
$123,339.09
|
|
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
Facility
|
IP
|
$9,427.52
|
|
|
Service Code
|
APR-DRG 6311
|
| Hospital Charge Code |
APRDRG6313
|
| Min. Negotiated Rate |
$9,427.52 |
| Max. Negotiated Rate |
$9,427.52 |
| Rate for Payer: AHCCCS Medicaid |
$9,427.52
|
| Rate for Payer: Allwell Medicaid |
$9,427.52
|
| Rate for Payer: AZCH Complete Medicaid |
$9,427.52
|
| Rate for Payer: Banner UC Health Medicaid |
$9,427.52
|
| Rate for Payer: Mercy Care Medicaid |
$9,427.52
|
|
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
Facility
|
IP
|
$123,339.09
|
|
|
Service Code
|
APR-DRG 6314
|
| Hospital Charge Code |
APRDRG6312
|
| Min. Negotiated Rate |
$123,339.09 |
| Max. Negotiated Rate |
$123,339.09 |
| Rate for Payer: AHCCCS Medicaid |
$123,339.09
|
| Rate for Payer: Allwell Medicaid |
$123,339.09
|
| Rate for Payer: AZCH Complete Medicaid |
$123,339.09
|
| Rate for Payer: Banner UC Health Medicaid |
$123,339.09
|
| Rate for Payer: Mercy Care Medicaid |
$123,339.09
|
|
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
Facility
|
IP
|
$9,427.52
|
|
|
Service Code
|
APR-DRG 6311
|
| Hospital Charge Code |
APRDRG6311
|
| Min. Negotiated Rate |
$9,427.52 |
| Max. Negotiated Rate |
$9,427.52 |
| Rate for Payer: AHCCCS Medicaid |
$9,427.52
|
| Rate for Payer: Allwell Medicaid |
$9,427.52
|
| Rate for Payer: AZCH Complete Medicaid |
$9,427.52
|
| Rate for Payer: Banner UC Health Medicaid |
$9,427.52
|
| Rate for Payer: Mercy Care Medicaid |
$9,427.52
|
|
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
Facility
|
IP
|
$22,038.69
|
|
|
Service Code
|
APR-DRG 6312
|
| Hospital Charge Code |
APRDRG6312
|
| Min. Negotiated Rate |
$22,038.69 |
| Max. Negotiated Rate |
$22,038.69 |
| Rate for Payer: AHCCCS Medicaid |
$22,038.69
|
| Rate for Payer: Allwell Medicaid |
$22,038.69
|
| Rate for Payer: AZCH Complete Medicaid |
$22,038.69
|
| Rate for Payer: Banner UC Health Medicaid |
$22,038.69
|
| Rate for Payer: Mercy Care Medicaid |
$22,038.69
|
|
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
Facility
|
IP
|
$9,427.52
|
|
|
Service Code
|
APR-DRG 6311
|
| Hospital Charge Code |
APRDRG6314
|
| Min. Negotiated Rate |
$9,427.52 |
| Max. Negotiated Rate |
$9,427.52 |
| Rate for Payer: AHCCCS Medicaid |
$9,427.52
|
| Rate for Payer: Allwell Medicaid |
$9,427.52
|
| Rate for Payer: AZCH Complete Medicaid |
$9,427.52
|
| Rate for Payer: Banner UC Health Medicaid |
$9,427.52
|
| Rate for Payer: Mercy Care Medicaid |
$9,427.52
|
|
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
Facility
|
IP
|
$22,038.69
|
|
|
Service Code
|
APR-DRG 6312
|
| Hospital Charge Code |
APRDRG6313
|
| Min. Negotiated Rate |
$22,038.69 |
| Max. Negotiated Rate |
$22,038.69 |
| Rate for Payer: AHCCCS Medicaid |
$22,038.69
|
| Rate for Payer: Allwell Medicaid |
$22,038.69
|
| Rate for Payer: AZCH Complete Medicaid |
$22,038.69
|
| Rate for Payer: Banner UC Health Medicaid |
$22,038.69
|
| Rate for Payer: Mercy Care Medicaid |
$22,038.69
|
|
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
Facility
|
IP
|
$123,339.09
|
|
|
Service Code
|
APR-DRG 6314
|
| Hospital Charge Code |
APRDRG6313
|
| Min. Negotiated Rate |
$123,339.09 |
| Max. Negotiated Rate |
$123,339.09 |
| Rate for Payer: AHCCCS Medicaid |
$123,339.09
|
| Rate for Payer: Allwell Medicaid |
$123,339.09
|
| Rate for Payer: AZCH Complete Medicaid |
$123,339.09
|
| Rate for Payer: Banner UC Health Medicaid |
$123,339.09
|
| Rate for Payer: Mercy Care Medicaid |
$123,339.09
|
|
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
Facility
|
IP
|
$41,104.14
|
|
|
Service Code
|
APR-DRG 6313
|
| Hospital Charge Code |
APRDRG6311
|
| Min. Negotiated Rate |
$41,104.14 |
| Max. Negotiated Rate |
$41,104.14 |
| Rate for Payer: AHCCCS Medicaid |
$41,104.14
|
| Rate for Payer: Allwell Medicaid |
$41,104.14
|
| Rate for Payer: AZCH Complete Medicaid |
$41,104.14
|
| Rate for Payer: Banner UC Health Medicaid |
$41,104.14
|
| Rate for Payer: Mercy Care Medicaid |
$41,104.14
|
|
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
Facility
|
IP
|
$41,104.14
|
|
|
Service Code
|
APR-DRG 6313
|
| Hospital Charge Code |
APRDRG6313
|
| Min. Negotiated Rate |
$41,104.14 |
| Max. Negotiated Rate |
$41,104.14 |
| Rate for Payer: AHCCCS Medicaid |
$41,104.14
|
| Rate for Payer: Allwell Medicaid |
$41,104.14
|
| Rate for Payer: AZCH Complete Medicaid |
$41,104.14
|
| Rate for Payer: Banner UC Health Medicaid |
$41,104.14
|
| Rate for Payer: Mercy Care Medicaid |
$41,104.14
|
|
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
Facility
|
IP
|
$9,427.52
|
|
|
Service Code
|
APR-DRG 6311
|
| Hospital Charge Code |
APRDRG6312
|
| Min. Negotiated Rate |
$9,427.52 |
| Max. Negotiated Rate |
$9,427.52 |
| Rate for Payer: AHCCCS Medicaid |
$9,427.52
|
| Rate for Payer: Allwell Medicaid |
$9,427.52
|
| Rate for Payer: AZCH Complete Medicaid |
$9,427.52
|
| Rate for Payer: Banner UC Health Medicaid |
$9,427.52
|
| Rate for Payer: Mercy Care Medicaid |
$9,427.52
|
|
