|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
Facility
|
IP
|
$75,926.55
|
|
|
Service Code
|
APR-DRG 5912
|
| Hospital Charge Code |
APRDRG5911
|
| 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
|
$54,742.87
|
|
|
Service Code
|
APR-DRG 5911
|
| Hospital Charge Code |
APRDRG5911
|
| 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
|
$141,221.98
|
|
|
Service Code
|
APR-DRG 5914
|
| Hospital Charge Code |
APRDRG5911
|
| 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
|
$141,221.98
|
|
|
Service Code
|
APR-DRG 5914
|
| Hospital Charge Code |
APRDRG5913
|
| 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
|
$83,928.82
|
|
|
Service Code
|
APR-DRG 5913
|
| Hospital Charge Code |
APRDRG5912
|
| 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
|
$75,926.55
|
|
|
Service Code
|
APR-DRG 5912
|
| Hospital Charge Code |
APRDRG5912
|
| 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
|
$75,926.55
|
|
|
Service Code
|
APR-DRG 5912
|
| Hospital Charge Code |
APRDRG5914
|
| 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
|
$141,221.98
|
|
|
Service Code
|
APR-DRG 5914
|
| Hospital Charge Code |
APRDRG5912
|
| 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 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$84,136.44
|
|
|
Service Code
|
APR-DRG 5892
|
| Hospital Charge Code |
APRDRG5894
|
| Min. Negotiated Rate |
$84,136.44 |
| Max. Negotiated Rate |
$84,136.44 |
| Rate for Payer: AHCCCS Medicaid |
$84,136.44
|
| Rate for Payer: Allwell Medicaid |
$84,136.44
|
| Rate for Payer: AZCH Complete Medicaid |
$84,136.44
|
| Rate for Payer: Banner UC Health Medicaid |
$84,136.44
|
| Rate for Payer: Mercy Care Medicaid |
$84,136.44
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$84,136.44
|
|
|
Service Code
|
APR-DRG 5892
|
| Hospital Charge Code |
APRDRG5893
|
| Min. Negotiated Rate |
$84,136.44 |
| Max. Negotiated Rate |
$84,136.44 |
| Rate for Payer: AHCCCS Medicaid |
$84,136.44
|
| Rate for Payer: Allwell Medicaid |
$84,136.44
|
| Rate for Payer: AZCH Complete Medicaid |
$84,136.44
|
| Rate for Payer: Banner UC Health Medicaid |
$84,136.44
|
| Rate for Payer: Mercy Care Medicaid |
$84,136.44
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$87,221.90
|
|
|
Service Code
|
APR-DRG 5891
|
| Hospital Charge Code |
APRDRG5893
|
| Min. Negotiated Rate |
$87,221.90 |
| Max. Negotiated Rate |
$87,221.90 |
| Rate for Payer: AHCCCS Medicaid |
$87,221.90
|
| Rate for Payer: Allwell Medicaid |
$87,221.90
|
| Rate for Payer: AZCH Complete Medicaid |
$87,221.90
|
| Rate for Payer: Banner UC Health Medicaid |
$87,221.90
|
| Rate for Payer: Mercy Care Medicaid |
$87,221.90
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$87,221.90
|
|
|
Service Code
|
APR-DRG 5891
|
| Hospital Charge Code |
APRDRG5894
|
| Min. Negotiated Rate |
$87,221.90 |
| Max. Negotiated Rate |
$87,221.90 |
| Rate for Payer: AHCCCS Medicaid |
$87,221.90
|
| Rate for Payer: Allwell Medicaid |
$87,221.90
|
| Rate for Payer: AZCH Complete Medicaid |
$87,221.90
|
| Rate for Payer: Banner UC Health Medicaid |
$87,221.90
|
| Rate for Payer: Mercy Care Medicaid |
$87,221.90
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$14,492.33
|
|
|
Service Code
|
APR-DRG 5894
|
| Hospital Charge Code |
APRDRG5893
|
| Min. Negotiated Rate |
$14,492.33 |
| Max. Negotiated Rate |
$14,492.33 |
| Rate for Payer: AHCCCS Medicaid |
$14,492.33
|
| Rate for Payer: Allwell Medicaid |
$14,492.33
|
| Rate for Payer: AZCH Complete Medicaid |
$14,492.33
|
| Rate for Payer: Banner UC Health Medicaid |
$14,492.33
|
| Rate for Payer: Mercy Care Medicaid |
$14,492.33
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$76,487.67
|
|
|
Service Code
|
APR-DRG 5893
|
| Hospital Charge Code |
APRDRG5893
|
| Min. Negotiated Rate |
$76,487.67 |
| Max. Negotiated Rate |
$76,487.67 |
| Rate for Payer: AHCCCS Medicaid |
$76,487.67
|
| Rate for Payer: Allwell Medicaid |
$76,487.67
|
| Rate for Payer: AZCH Complete Medicaid |
$76,487.67
|
| Rate for Payer: Banner UC Health Medicaid |
$76,487.67
|
| Rate for Payer: Mercy Care Medicaid |
$76,487.67
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$76,487.67
|
|
|
Service Code
|
APR-DRG 5893
|
| Hospital Charge Code |
APRDRG5894
|
| Min. Negotiated Rate |
$76,487.67 |
| Max. Negotiated Rate |
$76,487.67 |
| Rate for Payer: AHCCCS Medicaid |
$76,487.67
|
| Rate for Payer: Allwell Medicaid |
$76,487.67
|
| Rate for Payer: AZCH Complete Medicaid |
$76,487.67
|
| Rate for Payer: Banner UC Health Medicaid |
$76,487.67
|
| Rate for Payer: Mercy Care Medicaid |
$76,487.67
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$14,492.33
|
|
|
Service Code
|
APR-DRG 5894
|
| Hospital Charge Code |
APRDRG5891
|
| Min. Negotiated Rate |
$14,492.33 |
| Max. Negotiated Rate |
$14,492.33 |
| Rate for Payer: AHCCCS Medicaid |
$14,492.33
|
| Rate for Payer: Allwell Medicaid |
$14,492.33
|
| Rate for Payer: AZCH Complete Medicaid |
$14,492.33
|
| Rate for Payer: Banner UC Health Medicaid |
$14,492.33
|
| Rate for Payer: Mercy Care Medicaid |
$14,492.33
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$84,136.44
|
|
|
Service Code
|
APR-DRG 5892
|
| Hospital Charge Code |
APRDRG5891
|
| Min. Negotiated Rate |
$84,136.44 |
| Max. Negotiated Rate |
$84,136.44 |
| Rate for Payer: AHCCCS Medicaid |
$84,136.44
|
| Rate for Payer: Allwell Medicaid |
$84,136.44
|
| Rate for Payer: AZCH Complete Medicaid |
$84,136.44
|
| Rate for Payer: Banner UC Health Medicaid |
$84,136.44
|
| Rate for Payer: Mercy Care Medicaid |
$84,136.44
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$14,492.33
|
|
|
Service Code
|
APR-DRG 5894
|
| Hospital Charge Code |
APRDRG5894
|
| Min. Negotiated Rate |
$14,492.33 |
| Max. Negotiated Rate |
$14,492.33 |
| Rate for Payer: AHCCCS Medicaid |
$14,492.33
|
| Rate for Payer: Allwell Medicaid |
$14,492.33
|
| Rate for Payer: AZCH Complete Medicaid |
$14,492.33
|
| Rate for Payer: Banner UC Health Medicaid |
$14,492.33
|
| Rate for Payer: Mercy Care Medicaid |
$14,492.33
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$87,221.90
|
|
|
Service Code
|
APR-DRG 5891
|
| Hospital Charge Code |
APRDRG5891
|
| Min. Negotiated Rate |
$87,221.90 |
| Max. Negotiated Rate |
$87,221.90 |
| Rate for Payer: AHCCCS Medicaid |
$87,221.90
|
| Rate for Payer: Allwell Medicaid |
$87,221.90
|
| Rate for Payer: AZCH Complete Medicaid |
$87,221.90
|
| Rate for Payer: Banner UC Health Medicaid |
$87,221.90
|
| Rate for Payer: Mercy Care Medicaid |
$87,221.90
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$76,487.67
|
|
|
Service Code
|
APR-DRG 5893
|
| Hospital Charge Code |
APRDRG5892
|
| Min. Negotiated Rate |
$76,487.67 |
| Max. Negotiated Rate |
$76,487.67 |
| Rate for Payer: AHCCCS Medicaid |
$76,487.67
|
| Rate for Payer: Allwell Medicaid |
$76,487.67
|
| Rate for Payer: AZCH Complete Medicaid |
$76,487.67
|
| Rate for Payer: Banner UC Health Medicaid |
$76,487.67
|
| Rate for Payer: Mercy Care Medicaid |
$76,487.67
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$84,136.44
|
|
|
Service Code
|
APR-DRG 5892
|
| Hospital Charge Code |
APRDRG5892
|
| Min. Negotiated Rate |
$84,136.44 |
| Max. Negotiated Rate |
$84,136.44 |
| Rate for Payer: AHCCCS Medicaid |
$84,136.44
|
| Rate for Payer: Allwell Medicaid |
$84,136.44
|
| Rate for Payer: AZCH Complete Medicaid |
$84,136.44
|
| Rate for Payer: Banner UC Health Medicaid |
$84,136.44
|
| Rate for Payer: Mercy Care Medicaid |
$84,136.44
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$76,487.67
|
|
|
Service Code
|
APR-DRG 5893
|
| Hospital Charge Code |
APRDRG5891
|
| Min. Negotiated Rate |
$76,487.67 |
| Max. Negotiated Rate |
$76,487.67 |
| Rate for Payer: AHCCCS Medicaid |
$76,487.67
|
| Rate for Payer: Allwell Medicaid |
$76,487.67
|
| Rate for Payer: AZCH Complete Medicaid |
$76,487.67
|
| Rate for Payer: Banner UC Health Medicaid |
$76,487.67
|
| Rate for Payer: Mercy Care Medicaid |
$76,487.67
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$87,221.90
|
|
|
Service Code
|
APR-DRG 5891
|
| Hospital Charge Code |
APRDRG5892
|
| Min. Negotiated Rate |
$87,221.90 |
| Max. Negotiated Rate |
$87,221.90 |
| Rate for Payer: AHCCCS Medicaid |
$87,221.90
|
| Rate for Payer: Allwell Medicaid |
$87,221.90
|
| Rate for Payer: AZCH Complete Medicaid |
$87,221.90
|
| Rate for Payer: Banner UC Health Medicaid |
$87,221.90
|
| Rate for Payer: Mercy Care Medicaid |
$87,221.90
|
|
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention
|
Facility
|
IP
|
$14,492.33
|
|
|
Service Code
|
APR-DRG 5894
|
| Hospital Charge Code |
APRDRG5892
|
| Min. Negotiated Rate |
$14,492.33 |
| Max. Negotiated Rate |
$14,492.33 |
| Rate for Payer: AHCCCS Medicaid |
$14,492.33
|
| Rate for Payer: Allwell Medicaid |
$14,492.33
|
| Rate for Payer: AZCH Complete Medicaid |
$14,492.33
|
| Rate for Payer: Banner UC Health Medicaid |
$14,492.33
|
| Rate for Payer: Mercy Care Medicaid |
$14,492.33
|
|
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
Facility
|
IP
|
$70,334.29
|
|
|
Service Code
|
APR-DRG 5932
|
| Hospital Charge Code |
APRDRG5932
|
| Min. Negotiated Rate |
$70,334.29 |
| Max. Negotiated Rate |
$70,334.29 |
| Rate for Payer: AHCCCS Medicaid |
$70,334.29
|
| Rate for Payer: Allwell Medicaid |
$70,334.29
|
| Rate for Payer: AZCH Complete Medicaid |
$70,334.29
|
| Rate for Payer: Banner UC Health Medicaid |
$70,334.29
|
| Rate for Payer: Mercy Care Medicaid |
$70,334.29
|
|
