|
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
|
$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
|
$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 |
APRDRG6314
|
| 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
|
$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
|
$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
|
$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
|
$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
|
$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
|
|
|
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 Significant Condition
|
Facility
|
IP
|
$3,922.93
|
|
|
Service Code
|
APR-DRG 6391
|
| Hospital Charge Code |
APRDRG6393
|
| Min. Negotiated Rate |
$3,922.93 |
| Max. Negotiated Rate |
$3,922.93 |
| Rate for Payer: AHCCCS Medicaid |
$3,922.93
|
| Rate for Payer: Allwell Medicaid |
$3,922.93
|
| Rate for Payer: AZCH Complete Medicaid |
$3,922.93
|
| Rate for Payer: Banner UC Health Medicaid |
$3,922.93
|
| Rate for Payer: Mercy Care Medicaid |
$3,922.93
|
|
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$7,709.79
|
|
|
Service Code
|
APR-DRG 6392
|
| Hospital Charge Code |
APRDRG6391
|
| Min. Negotiated Rate |
$7,709.79 |
| Max. Negotiated Rate |
$7,709.79 |
| Rate for Payer: AHCCCS Medicaid |
$7,709.79
|
| Rate for Payer: Allwell Medicaid |
$7,709.79
|
| Rate for Payer: AZCH Complete Medicaid |
$7,709.79
|
| Rate for Payer: Banner UC Health Medicaid |
$7,709.79
|
| Rate for Payer: Mercy Care Medicaid |
$7,709.79
|
|
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$13,297.84
|
|
|
Service Code
|
APR-DRG 6393
|
| Hospital Charge Code |
APRDRG6391
|
| Min. Negotiated Rate |
$13,297.84 |
| Max. Negotiated Rate |
$13,297.84 |
| Rate for Payer: AHCCCS Medicaid |
$13,297.84
|
| Rate for Payer: Allwell Medicaid |
$13,297.84
|
| Rate for Payer: AZCH Complete Medicaid |
$13,297.84
|
| Rate for Payer: Banner UC Health Medicaid |
$13,297.84
|
| Rate for Payer: Mercy Care Medicaid |
$13,297.84
|
|
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$7,709.79
|
|
|
Service Code
|
APR-DRG 6392
|
| Hospital Charge Code |
APRDRG6393
|
| Min. Negotiated Rate |
$7,709.79 |
| Max. Negotiated Rate |
$7,709.79 |
| Rate for Payer: AHCCCS Medicaid |
$7,709.79
|
| Rate for Payer: Allwell Medicaid |
$7,709.79
|
| Rate for Payer: AZCH Complete Medicaid |
$7,709.79
|
| Rate for Payer: Banner UC Health Medicaid |
$7,709.79
|
| Rate for Payer: Mercy Care Medicaid |
$7,709.79
|
|
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$17,697.72
|
|
|
Service Code
|
APR-DRG 6394
|
| Hospital Charge Code |
APRDRG6391
|
| Min. Negotiated Rate |
$17,697.72 |
| Max. Negotiated Rate |
$17,697.72 |
| Rate for Payer: AHCCCS Medicaid |
$17,697.72
|
| Rate for Payer: Allwell Medicaid |
$17,697.72
|
| Rate for Payer: AZCH Complete Medicaid |
$17,697.72
|
| Rate for Payer: Banner UC Health Medicaid |
$17,697.72
|
| Rate for Payer: Mercy Care Medicaid |
$17,697.72
|
|
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$3,922.93
|
|
|
Service Code
|
APR-DRG 6391
|
| Hospital Charge Code |
APRDRG6394
|
| Min. Negotiated Rate |
$3,922.93 |
| Max. Negotiated Rate |
$3,922.93 |
| Rate for Payer: AHCCCS Medicaid |
$3,922.93
|
| Rate for Payer: Allwell Medicaid |
$3,922.93
|
| Rate for Payer: AZCH Complete Medicaid |
$3,922.93
|
| Rate for Payer: Banner UC Health Medicaid |
$3,922.93
|
| Rate for Payer: Mercy Care Medicaid |
$3,922.93
|
|
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$7,709.79
|
|
|
Service Code
|
APR-DRG 6392
|
| Hospital Charge Code |
APRDRG6392
|
| Min. Negotiated Rate |
$7,709.79 |
| Max. Negotiated Rate |
$7,709.79 |
| Rate for Payer: AHCCCS Medicaid |
$7,709.79
|
| Rate for Payer: Allwell Medicaid |
$7,709.79
|
| Rate for Payer: AZCH Complete Medicaid |
$7,709.79
|
| Rate for Payer: Banner UC Health Medicaid |
$7,709.79
|
| Rate for Payer: Mercy Care Medicaid |
$7,709.79
|
|
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$17,697.72
|
|
|
Service Code
|
APR-DRG 6394
|
| Hospital Charge Code |
APRDRG6394
|
| Min. Negotiated Rate |
$17,697.72 |
| Max. Negotiated Rate |
$17,697.72 |
| Rate for Payer: AHCCCS Medicaid |
$17,697.72
|
| Rate for Payer: Allwell Medicaid |
$17,697.72
|
| Rate for Payer: AZCH Complete Medicaid |
$17,697.72
|
| Rate for Payer: Banner UC Health Medicaid |
$17,697.72
|
| Rate for Payer: Mercy Care Medicaid |
$17,697.72
|
|
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$13,297.84
|
|
|
Service Code
|
APR-DRG 6393
|
| Hospital Charge Code |
APRDRG6394
|
| Min. Negotiated Rate |
$13,297.84 |
| Max. Negotiated Rate |
$13,297.84 |
| Rate for Payer: AHCCCS Medicaid |
$13,297.84
|
| Rate for Payer: Allwell Medicaid |
$13,297.84
|
| Rate for Payer: AZCH Complete Medicaid |
$13,297.84
|
| Rate for Payer: Banner UC Health Medicaid |
$13,297.84
|
| Rate for Payer: Mercy Care Medicaid |
$13,297.84
|
|
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$3,922.93
|
|
|
Service Code
|
APR-DRG 6391
|
| Hospital Charge Code |
APRDRG6392
|
| Min. Negotiated Rate |
$3,922.93 |
| Max. Negotiated Rate |
$3,922.93 |
| Rate for Payer: AHCCCS Medicaid |
$3,922.93
|
| Rate for Payer: Allwell Medicaid |
$3,922.93
|
| Rate for Payer: AZCH Complete Medicaid |
$3,922.93
|
| Rate for Payer: Banner UC Health Medicaid |
$3,922.93
|
| Rate for Payer: Mercy Care Medicaid |
$3,922.93
|
|
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$3,922.93
|
|
|
Service Code
|
APR-DRG 6391
|
| Hospital Charge Code |
APRDRG6391
|
| Min. Negotiated Rate |
$3,922.93 |
| Max. Negotiated Rate |
$3,922.93 |
| Rate for Payer: AHCCCS Medicaid |
$3,922.93
|
| Rate for Payer: Allwell Medicaid |
$3,922.93
|
| Rate for Payer: AZCH Complete Medicaid |
$3,922.93
|
| Rate for Payer: Banner UC Health Medicaid |
$3,922.93
|
| Rate for Payer: Mercy Care Medicaid |
$3,922.93
|
|
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$13,297.84
|
|
|
Service Code
|
APR-DRG 6393
|
| Hospital Charge Code |
APRDRG6392
|
| Min. Negotiated Rate |
$13,297.84 |
| Max. Negotiated Rate |
$13,297.84 |
| Rate for Payer: AHCCCS Medicaid |
$13,297.84
|
| Rate for Payer: Allwell Medicaid |
$13,297.84
|
| Rate for Payer: AZCH Complete Medicaid |
$13,297.84
|
| Rate for Payer: Banner UC Health Medicaid |
$13,297.84
|
| Rate for Payer: Mercy Care Medicaid |
$13,297.84
|
|
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$17,697.72
|
|
|
Service Code
|
APR-DRG 6394
|
| Hospital Charge Code |
APRDRG6393
|
| Min. Negotiated Rate |
$17,697.72 |
| Max. Negotiated Rate |
$17,697.72 |
| Rate for Payer: AHCCCS Medicaid |
$17,697.72
|
| Rate for Payer: Allwell Medicaid |
$17,697.72
|
| Rate for Payer: AZCH Complete Medicaid |
$17,697.72
|
| Rate for Payer: Banner UC Health Medicaid |
$17,697.72
|
| Rate for Payer: Mercy Care Medicaid |
$17,697.72
|
|
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$13,297.84
|
|
|
Service Code
|
APR-DRG 6393
|
| Hospital Charge Code |
APRDRG6393
|
| Min. Negotiated Rate |
$13,297.84 |
| Max. Negotiated Rate |
$13,297.84 |
| Rate for Payer: AHCCCS Medicaid |
$13,297.84
|
| Rate for Payer: Allwell Medicaid |
$13,297.84
|
| Rate for Payer: AZCH Complete Medicaid |
$13,297.84
|
| Rate for Payer: Banner UC Health Medicaid |
$13,297.84
|
| Rate for Payer: Mercy Care Medicaid |
$13,297.84
|
|
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$17,697.72
|
|
|
Service Code
|
APR-DRG 6394
|
| Hospital Charge Code |
APRDRG6392
|
| Min. Negotiated Rate |
$17,697.72 |
| Max. Negotiated Rate |
$17,697.72 |
| Rate for Payer: AHCCCS Medicaid |
$17,697.72
|
| Rate for Payer: Allwell Medicaid |
$17,697.72
|
| Rate for Payer: AZCH Complete Medicaid |
$17,697.72
|
| Rate for Payer: Banner UC Health Medicaid |
$17,697.72
|
| Rate for Payer: Mercy Care Medicaid |
$17,697.72
|
|
