Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
Facility
|
IP
|
$7,709.79
|
|
Service Code
|
APR-DRG 6392
|
Hospital Charge Code |
APRDRG6394
|
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 Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$8,599.16
|
|
Service Code
|
APR-DRG 6342
|
Hospital Charge Code |
APRDRG6342
|
Min. Negotiated Rate |
$8,599.16 |
Max. Negotiated Rate |
$8,599.16 |
Rate for Payer: AHCCCS Medicaid |
$8,599.16
|
Rate for Payer: Allwell Medicaid |
$8,599.16
|
Rate for Payer: AZCH Complete Medicaid |
$8,599.16
|
Rate for Payer: Banner UC Health Medicaid |
$8,599.16
|
Rate for Payer: Mercy Care Medicaid |
$8,599.16
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$31,339.25
|
|
Service Code
|
APR-DRG 6344
|
Hospital Charge Code |
APRDRG6343
|
Min. Negotiated Rate |
$31,339.25 |
Max. Negotiated Rate |
$31,339.25 |
Rate for Payer: AHCCCS Medicaid |
$31,339.25
|
Rate for Payer: Allwell Medicaid |
$31,339.25
|
Rate for Payer: AZCH Complete Medicaid |
$31,339.25
|
Rate for Payer: Banner UC Health Medicaid |
$31,339.25
|
Rate for Payer: Mercy Care Medicaid |
$31,339.25
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$8,599.16
|
|
Service Code
|
APR-DRG 6342
|
Hospital Charge Code |
APRDRG6344
|
Min. Negotiated Rate |
$8,599.16 |
Max. Negotiated Rate |
$8,599.16 |
Rate for Payer: AHCCCS Medicaid |
$8,599.16
|
Rate for Payer: Allwell Medicaid |
$8,599.16
|
Rate for Payer: AZCH Complete Medicaid |
$8,599.16
|
Rate for Payer: Banner UC Health Medicaid |
$8,599.16
|
Rate for Payer: Mercy Care Medicaid |
$8,599.16
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$12,446.34
|
|
Service Code
|
APR-DRG 6343
|
Hospital Charge Code |
APRDRG6343
|
Min. Negotiated Rate |
$12,446.34 |
Max. Negotiated Rate |
$12,446.34 |
Rate for Payer: AHCCCS Medicaid |
$12,446.34
|
Rate for Payer: Allwell Medicaid |
$12,446.34
|
Rate for Payer: AZCH Complete Medicaid |
$12,446.34
|
Rate for Payer: Banner UC Health Medicaid |
$12,446.34
|
Rate for Payer: Mercy Care Medicaid |
$12,446.34
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$12,446.34
|
|
Service Code
|
APR-DRG 6343
|
Hospital Charge Code |
APRDRG6342
|
Min. Negotiated Rate |
$12,446.34 |
Max. Negotiated Rate |
$12,446.34 |
Rate for Payer: AHCCCS Medicaid |
$12,446.34
|
Rate for Payer: Allwell Medicaid |
$12,446.34
|
Rate for Payer: AZCH Complete Medicaid |
$12,446.34
|
Rate for Payer: Banner UC Health Medicaid |
$12,446.34
|
Rate for Payer: Mercy Care Medicaid |
$12,446.34
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$31,339.25
|
|
Service Code
|
APR-DRG 6344
|
Hospital Charge Code |
APRDRG6342
|
Min. Negotiated Rate |
$31,339.25 |
Max. Negotiated Rate |
$31,339.25 |
Rate for Payer: AHCCCS Medicaid |
$31,339.25
|
Rate for Payer: Allwell Medicaid |
$31,339.25
|
Rate for Payer: AZCH Complete Medicaid |
$31,339.25
|
Rate for Payer: Banner UC Health Medicaid |
$31,339.25
|
Rate for Payer: Mercy Care Medicaid |
$31,339.25
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$4,420.22
|
|
Service Code
|
APR-DRG 6341
|
Hospital Charge Code |
APRDRG6343
|
Min. Negotiated Rate |
$4,420.22 |
Max. Negotiated Rate |
$4,420.22 |
Rate for Payer: AHCCCS Medicaid |
$4,420.22
|
Rate for Payer: Allwell Medicaid |
$4,420.22
|
Rate for Payer: AZCH Complete Medicaid |
$4,420.22
|
Rate for Payer: Banner UC Health Medicaid |
$4,420.22
|
Rate for Payer: Mercy Care Medicaid |
$4,420.22
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$31,339.25
|
|
Service Code
|
APR-DRG 6344
|
Hospital Charge Code |
APRDRG6341
|
Min. Negotiated Rate |
$31,339.25 |
Max. Negotiated Rate |
$31,339.25 |
Rate for Payer: AHCCCS Medicaid |
$31,339.25
|
Rate for Payer: Allwell Medicaid |
$31,339.25
|
Rate for Payer: AZCH Complete Medicaid |
$31,339.25
|
Rate for Payer: Banner UC Health Medicaid |
$31,339.25
|
Rate for Payer: Mercy Care Medicaid |
$31,339.25
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$12,446.34
|
|
Service Code
|
APR-DRG 6343
|
Hospital Charge Code |
APRDRG6344
|
Min. Negotiated Rate |
$12,446.34 |
Max. Negotiated Rate |
$12,446.34 |
Rate for Payer: AHCCCS Medicaid |
$12,446.34
|
Rate for Payer: Allwell Medicaid |
$12,446.34
|
Rate for Payer: AZCH Complete Medicaid |
$12,446.34
|
Rate for Payer: Banner UC Health Medicaid |
$12,446.34
|
Rate for Payer: Mercy Care Medicaid |
$12,446.34
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$12,446.34
|
|
Service Code
|
APR-DRG 6343
|
Hospital Charge Code |
APRDRG6341
|
Min. Negotiated Rate |
$12,446.34 |
Max. Negotiated Rate |
$12,446.34 |
Rate for Payer: AHCCCS Medicaid |
$12,446.34
|
Rate for Payer: Allwell Medicaid |
$12,446.34
|
Rate for Payer: AZCH Complete Medicaid |
$12,446.34
|
Rate for Payer: Banner UC Health Medicaid |
$12,446.34
|
Rate for Payer: Mercy Care Medicaid |
$12,446.34
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$8,599.16
|
|
Service Code
|
APR-DRG 6342
|
Hospital Charge Code |
APRDRG6343
|
Min. Negotiated Rate |
$8,599.16 |
Max. Negotiated Rate |
$8,599.16 |
Rate for Payer: AHCCCS Medicaid |
$8,599.16
|
Rate for Payer: Allwell Medicaid |
$8,599.16
|
Rate for Payer: AZCH Complete Medicaid |
$8,599.16
|
Rate for Payer: Banner UC Health Medicaid |
$8,599.16
|
Rate for Payer: Mercy Care Medicaid |
$8,599.16
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$8,599.16
|
|
Service Code
|
APR-DRG 6342
|
Hospital Charge Code |
APRDRG6341
|
Min. Negotiated Rate |
$8,599.16 |
Max. Negotiated Rate |
$8,599.16 |
Rate for Payer: AHCCCS Medicaid |
$8,599.16
|
Rate for Payer: Allwell Medicaid |
$8,599.16
|
Rate for Payer: AZCH Complete Medicaid |
$8,599.16
|
Rate for Payer: Banner UC Health Medicaid |
$8,599.16
|
Rate for Payer: Mercy Care Medicaid |
$8,599.16
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$4,420.22
|
|
Service Code
|
APR-DRG 6341
|
Hospital Charge Code |
APRDRG6341
|
Min. Negotiated Rate |
$4,420.22 |
Max. Negotiated Rate |
$4,420.22 |
Rate for Payer: AHCCCS Medicaid |
$4,420.22
|
Rate for Payer: Allwell Medicaid |
$4,420.22
|
Rate for Payer: AZCH Complete Medicaid |
$4,420.22
|
Rate for Payer: Banner UC Health Medicaid |
$4,420.22
|
Rate for Payer: Mercy Care Medicaid |
$4,420.22
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$4,420.22
|
|
Service Code
|
APR-DRG 6341
|
Hospital Charge Code |
APRDRG6344
|
Min. Negotiated Rate |
$4,420.22 |
Max. Negotiated Rate |
$4,420.22 |
Rate for Payer: AHCCCS Medicaid |
$4,420.22
|
Rate for Payer: Allwell Medicaid |
$4,420.22
|
Rate for Payer: AZCH Complete Medicaid |
$4,420.22
|
Rate for Payer: Banner UC Health Medicaid |
$4,420.22
|
Rate for Payer: Mercy Care Medicaid |
$4,420.22
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$4,420.22
|
|
Service Code
|
APR-DRG 6341
|
Hospital Charge Code |
APRDRG6342
|
Min. Negotiated Rate |
$4,420.22 |
Max. Negotiated Rate |
$4,420.22 |
Rate for Payer: AHCCCS Medicaid |
$4,420.22
|
Rate for Payer: Allwell Medicaid |
$4,420.22
|
Rate for Payer: AZCH Complete Medicaid |
$4,420.22
|
Rate for Payer: Banner UC Health Medicaid |
$4,420.22
|
Rate for Payer: Mercy Care Medicaid |
$4,420.22
|
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition
|
Facility
|
IP
|
$31,339.25
|
|
Service Code
|
APR-DRG 6344
|
Hospital Charge Code |
APRDRG6344
|
Min. Negotiated Rate |
$31,339.25 |
Max. Negotiated Rate |
$31,339.25 |
Rate for Payer: AHCCCS Medicaid |
$31,339.25
|
Rate for Payer: Allwell Medicaid |
$31,339.25
|
Rate for Payer: AZCH Complete Medicaid |
$31,339.25
|
Rate for Payer: Banner UC Health Medicaid |
$31,339.25
|
Rate for Payer: Mercy Care Medicaid |
$31,339.25
|
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
Facility
|
IP
|
$75,926.55
|
|
Service Code
|
APR-DRG 5912
|
Hospital Charge Code |
APRDRG5913
|
Min. Negotiated Rate |
$75,926.55 |
Max. Negotiated Rate |
$75,926.55 |
Rate for Payer: AHCCCS Medicaid |
$75,926.55
|
Rate for Payer: Allwell Medicaid |
$75,926.55
|
Rate for Payer: AZCH Complete Medicaid |
$75,926.55
|
Rate for Payer: Banner UC Health Medicaid |
$75,926.55
|
Rate for Payer: Mercy Care Medicaid |
$75,926.55
|
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
Facility
|
IP
|
$83,928.82
|
|
Service Code
|
APR-DRG 5913
|
Hospital Charge Code |
APRDRG5914
|
Min. Negotiated Rate |
$83,928.82 |
Max. Negotiated Rate |
$83,928.82 |
Rate for Payer: AHCCCS Medicaid |
$83,928.82
|
Rate for Payer: Allwell Medicaid |
$83,928.82
|
Rate for Payer: AZCH Complete Medicaid |
$83,928.82
|
Rate for Payer: Banner UC Health Medicaid |
$83,928.82
|
Rate for Payer: Mercy Care Medicaid |
$83,928.82
|
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
Facility
|
IP
|
$83,928.82
|
|
Service Code
|
APR-DRG 5913
|
Hospital Charge Code |
APRDRG5911
|
Min. Negotiated Rate |
$83,928.82 |
Max. Negotiated Rate |
$83,928.82 |
Rate for Payer: AHCCCS Medicaid |
$83,928.82
|
Rate for Payer: Allwell Medicaid |
$83,928.82
|
Rate for Payer: AZCH Complete Medicaid |
$83,928.82
|
Rate for Payer: Banner UC Health Medicaid |
$83,928.82
|
Rate for Payer: Mercy Care Medicaid |
$83,928.82
|
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
Facility
|
IP
|
$83,928.82
|
|
Service Code
|
APR-DRG 5913
|
Hospital Charge Code |
APRDRG5913
|
Min. Negotiated Rate |
$83,928.82 |
Max. Negotiated Rate |
$83,928.82 |
Rate for Payer: AHCCCS Medicaid |
$83,928.82
|
Rate for Payer: Allwell Medicaid |
$83,928.82
|
Rate for Payer: AZCH Complete Medicaid |
$83,928.82
|
Rate for Payer: Banner UC Health Medicaid |
$83,928.82
|
Rate for Payer: Mercy Care Medicaid |
$83,928.82
|
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
Facility
|
IP
|
$141,221.98
|
|
Service Code
|
APR-DRG 5914
|
Hospital Charge Code |
APRDRG5914
|
Min. Negotiated Rate |
$141,221.98 |
Max. Negotiated Rate |
$141,221.98 |
Rate for Payer: AHCCCS Medicaid |
$141,221.98
|
Rate for Payer: Allwell Medicaid |
$141,221.98
|
Rate for Payer: AZCH Complete Medicaid |
$141,221.98
|
Rate for Payer: Banner UC Health Medicaid |
$141,221.98
|
Rate for Payer: Mercy Care Medicaid |
$141,221.98
|
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
Facility
|
IP
|
$54,742.87
|
|
Service Code
|
APR-DRG 5911
|
Hospital Charge Code |
APRDRG5913
|
Min. Negotiated Rate |
$54,742.87 |
Max. Negotiated Rate |
$54,742.87 |
Rate for Payer: AHCCCS Medicaid |
$54,742.87
|
Rate for Payer: Allwell Medicaid |
$54,742.87
|
Rate for Payer: AZCH Complete Medicaid |
$54,742.87
|
Rate for Payer: Banner UC Health Medicaid |
$54,742.87
|
Rate for Payer: Mercy Care Medicaid |
$54,742.87
|
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
Facility
|
IP
|
$54,742.87
|
|
Service Code
|
APR-DRG 5911
|
Hospital Charge Code |
APRDRG5912
|
Min. Negotiated Rate |
$54,742.87 |
Max. Negotiated Rate |
$54,742.87 |
Rate for Payer: AHCCCS Medicaid |
$54,742.87
|
Rate for Payer: Allwell Medicaid |
$54,742.87
|
Rate for Payer: AZCH Complete Medicaid |
$54,742.87
|
Rate for Payer: Banner UC Health Medicaid |
$54,742.87
|
Rate for Payer: Mercy Care Medicaid |
$54,742.87
|
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
Facility
|
IP
|
$54,742.87
|
|
Service Code
|
APR-DRG 5911
|
Hospital Charge Code |
APRDRG5914
|
Min. Negotiated Rate |
$54,742.87 |
Max. Negotiated Rate |
$54,742.87 |
Rate for Payer: AHCCCS Medicaid |
$54,742.87
|
Rate for Payer: Allwell Medicaid |
$54,742.87
|
Rate for Payer: AZCH Complete Medicaid |
$54,742.87
|
Rate for Payer: Banner UC Health Medicaid |
$54,742.87
|
Rate for Payer: Mercy Care Medicaid |
$54,742.87
|
|