|
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
|
|
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
Facility
|
IP
|
$117,243.92
|
|
|
Service Code
|
APR-DRG 5934
|
| Hospital Charge Code |
APRDRG5931
|
| Min. Negotiated Rate |
$117,243.92 |
| Max. Negotiated Rate |
$117,243.92 |
| Rate for Payer: AHCCCS Medicaid |
$117,243.92
|
| Rate for Payer: Allwell Medicaid |
$117,243.92
|
| Rate for Payer: AZCH Complete Medicaid |
$117,243.92
|
| Rate for Payer: Banner UC Health Medicaid |
$117,243.92
|
| Rate for Payer: Mercy Care Medicaid |
$117,243.92
|
|
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
Facility
|
IP
|
$117,243.92
|
|
|
Service Code
|
APR-DRG 5934
|
| Hospital Charge Code |
APRDRG5933
|
| Min. Negotiated Rate |
$117,243.92 |
| Max. Negotiated Rate |
$117,243.92 |
| Rate for Payer: AHCCCS Medicaid |
$117,243.92
|
| Rate for Payer: Allwell Medicaid |
$117,243.92
|
| Rate for Payer: AZCH Complete Medicaid |
$117,243.92
|
| Rate for Payer: Banner UC Health Medicaid |
$117,243.92
|
| Rate for Payer: Mercy Care Medicaid |
$117,243.92
|
|
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
Facility
|
IP
|
$70,334.29
|
|
|
Service Code
|
APR-DRG 5932
|
| Hospital Charge Code |
APRDRG5933
|
| 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
|
|
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
Facility
|
IP
|
$81,194.06
|
|
|
Service Code
|
APR-DRG 5933
|
| Hospital Charge Code |
APRDRG5932
|
| Min. Negotiated Rate |
$81,194.06 |
| Max. Negotiated Rate |
$81,194.06 |
| Rate for Payer: AHCCCS Medicaid |
$81,194.06
|
| Rate for Payer: Allwell Medicaid |
$81,194.06
|
| Rate for Payer: AZCH Complete Medicaid |
$81,194.06
|
| Rate for Payer: Banner UC Health Medicaid |
$81,194.06
|
| Rate for Payer: Mercy Care Medicaid |
$81,194.06
|
|
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
Facility
|
IP
|
$81,194.06
|
|
|
Service Code
|
APR-DRG 5933
|
| Hospital Charge Code |
APRDRG5934
|
| Min. Negotiated Rate |
$81,194.06 |
| Max. Negotiated Rate |
$81,194.06 |
| Rate for Payer: AHCCCS Medicaid |
$81,194.06
|
| Rate for Payer: Allwell Medicaid |
$81,194.06
|
| Rate for Payer: AZCH Complete Medicaid |
$81,194.06
|
| Rate for Payer: Banner UC Health Medicaid |
$81,194.06
|
| Rate for Payer: Mercy Care Medicaid |
$81,194.06
|
|
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
Facility
|
IP
|
$70,334.29
|
|
|
Service Code
|
APR-DRG 5932
|
| Hospital Charge Code |
APRDRG5934
|
| 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
|
|
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
Facility
|
IP
|
$18,365.46
|
|
|
Service Code
|
APR-DRG 5931
|
| Hospital Charge Code |
APRDRG5933
|
| Min. Negotiated Rate |
$18,365.46 |
| Max. Negotiated Rate |
$18,365.46 |
| Rate for Payer: AHCCCS Medicaid |
$18,365.46
|
| Rate for Payer: Allwell Medicaid |
$18,365.46
|
| Rate for Payer: AZCH Complete Medicaid |
$18,365.46
|
| Rate for Payer: Banner UC Health Medicaid |
$18,365.46
|
| Rate for Payer: Mercy Care Medicaid |
$18,365.46
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$677.55
|
|
|
Service Code
|
APR-DRG 5811
|
| Hospital Charge Code |
APRDRG5814
|
| Min. Negotiated Rate |
$677.55 |
| Max. Negotiated Rate |
$677.55 |
| Rate for Payer: AHCCCS Medicaid |
$677.55
|
| Rate for Payer: Allwell Medicaid |
$677.55
|
| Rate for Payer: AZCH Complete Medicaid |
$677.55
|
| Rate for Payer: Banner UC Health Medicaid |
$677.55
|
| Rate for Payer: Mercy Care Medicaid |
$677.55
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$1,031.06
|
|
|
Service Code
|
APR-DRG 5812
|
| Hospital Charge Code |
APRDRG5812
|
| Min. Negotiated Rate |
$1,031.06 |
| Max. Negotiated Rate |
$1,031.06 |
| Rate for Payer: AHCCCS Medicaid |
$1,031.06
|
| Rate for Payer: Allwell Medicaid |
$1,031.06
|
| Rate for Payer: AZCH Complete Medicaid |
$1,031.06
|
| Rate for Payer: Banner UC Health Medicaid |
$1,031.06
|
| Rate for Payer: Mercy Care Medicaid |
$1,031.06
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$1,031.06
|
|
|
Service Code
|
APR-DRG 5812
|
| Hospital Charge Code |
APRDRG5813
|
| Min. Negotiated Rate |
$1,031.06 |
| Max. Negotiated Rate |
$1,031.06 |
| Rate for Payer: AHCCCS Medicaid |
$1,031.06
|
| Rate for Payer: Allwell Medicaid |
$1,031.06
|
| Rate for Payer: AZCH Complete Medicaid |
$1,031.06
|
| Rate for Payer: Banner UC Health Medicaid |
$1,031.06
|
| Rate for Payer: Mercy Care Medicaid |
$1,031.06
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$1,778.75
|
|
|
Service Code
|
APR-DRG 5813
|
| Hospital Charge Code |
APRDRG5812
|
| Min. Negotiated Rate |
$1,778.75 |
| Max. Negotiated Rate |
$1,778.75 |
| Rate for Payer: AHCCCS Medicaid |
$1,778.75
|
| Rate for Payer: Allwell Medicaid |
$1,778.75
|
| Rate for Payer: AZCH Complete Medicaid |
$1,778.75
|
| Rate for Payer: Banner UC Health Medicaid |
$1,778.75
|
| Rate for Payer: Mercy Care Medicaid |
$1,778.75
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$3,284.66
|
|
|
Service Code
|
APR-DRG 5814
|
| Hospital Charge Code |
APRDRG5813
|
| Min. Negotiated Rate |
$3,284.66 |
| Max. Negotiated Rate |
$3,284.66 |
| Rate for Payer: AHCCCS Medicaid |
$3,284.66
|
| Rate for Payer: Allwell Medicaid |
$3,284.66
|
| Rate for Payer: AZCH Complete Medicaid |
$3,284.66
|
| Rate for Payer: Banner UC Health Medicaid |
$3,284.66
|
| Rate for Payer: Mercy Care Medicaid |
$3,284.66
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$3,284.66
|
|
|
Service Code
|
APR-DRG 5814
|
| Hospital Charge Code |
APRDRG5814
|
| Min. Negotiated Rate |
$3,284.66 |
| Max. Negotiated Rate |
$3,284.66 |
| Rate for Payer: AHCCCS Medicaid |
$3,284.66
|
| Rate for Payer: Allwell Medicaid |
$3,284.66
|
| Rate for Payer: AZCH Complete Medicaid |
$3,284.66
|
| Rate for Payer: Banner UC Health Medicaid |
$3,284.66
|
| Rate for Payer: Mercy Care Medicaid |
$3,284.66
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$3,284.66
|
|
|
Service Code
|
APR-DRG 5814
|
| Hospital Charge Code |
APRDRG5811
|
| Min. Negotiated Rate |
$3,284.66 |
| Max. Negotiated Rate |
$3,284.66 |
| Rate for Payer: AHCCCS Medicaid |
$3,284.66
|
| Rate for Payer: Allwell Medicaid |
$3,284.66
|
| Rate for Payer: AZCH Complete Medicaid |
$3,284.66
|
| Rate for Payer: Banner UC Health Medicaid |
$3,284.66
|
| Rate for Payer: Mercy Care Medicaid |
$3,284.66
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$677.55
|
|
|
Service Code
|
APR-DRG 5811
|
| Hospital Charge Code |
APRDRG5813
|
| Min. Negotiated Rate |
$677.55 |
| Max. Negotiated Rate |
$677.55 |
| Rate for Payer: AHCCCS Medicaid |
$677.55
|
| Rate for Payer: Allwell Medicaid |
$677.55
|
| Rate for Payer: AZCH Complete Medicaid |
$677.55
|
| Rate for Payer: Banner UC Health Medicaid |
$677.55
|
| Rate for Payer: Mercy Care Medicaid |
$677.55
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$677.55
|
|
|
Service Code
|
APR-DRG 5811
|
| Hospital Charge Code |
APRDRG5811
|
| Min. Negotiated Rate |
$677.55 |
| Max. Negotiated Rate |
$677.55 |
| Rate for Payer: AHCCCS Medicaid |
$677.55
|
| Rate for Payer: Allwell Medicaid |
$677.55
|
| Rate for Payer: AZCH Complete Medicaid |
$677.55
|
| Rate for Payer: Banner UC Health Medicaid |
$677.55
|
| Rate for Payer: Mercy Care Medicaid |
$677.55
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$1,031.06
|
|
|
Service Code
|
APR-DRG 5812
|
| Hospital Charge Code |
APRDRG5814
|
| Min. Negotiated Rate |
$1,031.06 |
| Max. Negotiated Rate |
$1,031.06 |
| Rate for Payer: AHCCCS Medicaid |
$1,031.06
|
| Rate for Payer: Allwell Medicaid |
$1,031.06
|
| Rate for Payer: AZCH Complete Medicaid |
$1,031.06
|
| Rate for Payer: Banner UC Health Medicaid |
$1,031.06
|
| Rate for Payer: Mercy Care Medicaid |
$1,031.06
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$1,031.06
|
|
|
Service Code
|
APR-DRG 5812
|
| Hospital Charge Code |
APRDRG5811
|
| Min. Negotiated Rate |
$1,031.06 |
| Max. Negotiated Rate |
$1,031.06 |
| Rate for Payer: AHCCCS Medicaid |
$1,031.06
|
| Rate for Payer: Allwell Medicaid |
$1,031.06
|
| Rate for Payer: AZCH Complete Medicaid |
$1,031.06
|
| Rate for Payer: Banner UC Health Medicaid |
$1,031.06
|
| Rate for Payer: Mercy Care Medicaid |
$1,031.06
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$1,778.75
|
|
|
Service Code
|
APR-DRG 5813
|
| Hospital Charge Code |
APRDRG5813
|
| Min. Negotiated Rate |
$1,778.75 |
| Max. Negotiated Rate |
$1,778.75 |
| Rate for Payer: AHCCCS Medicaid |
$1,778.75
|
| Rate for Payer: Allwell Medicaid |
$1,778.75
|
| Rate for Payer: AZCH Complete Medicaid |
$1,778.75
|
| Rate for Payer: Banner UC Health Medicaid |
$1,778.75
|
| Rate for Payer: Mercy Care Medicaid |
$1,778.75
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$1,778.75
|
|
|
Service Code
|
APR-DRG 5813
|
| Hospital Charge Code |
APRDRG5814
|
| Min. Negotiated Rate |
$1,778.75 |
| Max. Negotiated Rate |
$1,778.75 |
| Rate for Payer: AHCCCS Medicaid |
$1,778.75
|
| Rate for Payer: Allwell Medicaid |
$1,778.75
|
| Rate for Payer: AZCH Complete Medicaid |
$1,778.75
|
| Rate for Payer: Banner UC Health Medicaid |
$1,778.75
|
| Rate for Payer: Mercy Care Medicaid |
$1,778.75
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$3,284.66
|
|
|
Service Code
|
APR-DRG 5814
|
| Hospital Charge Code |
APRDRG5812
|
| Min. Negotiated Rate |
$3,284.66 |
| Max. Negotiated Rate |
$3,284.66 |
| Rate for Payer: AHCCCS Medicaid |
$3,284.66
|
| Rate for Payer: Allwell Medicaid |
$3,284.66
|
| Rate for Payer: AZCH Complete Medicaid |
$3,284.66
|
| Rate for Payer: Banner UC Health Medicaid |
$3,284.66
|
| Rate for Payer: Mercy Care Medicaid |
$3,284.66
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$677.55
|
|
|
Service Code
|
APR-DRG 5811
|
| Hospital Charge Code |
APRDRG5812
|
| Min. Negotiated Rate |
$677.55 |
| Max. Negotiated Rate |
$677.55 |
| Rate for Payer: AHCCCS Medicaid |
$677.55
|
| Rate for Payer: Allwell Medicaid |
$677.55
|
| Rate for Payer: AZCH Complete Medicaid |
$677.55
|
| Rate for Payer: Banner UC Health Medicaid |
$677.55
|
| Rate for Payer: Mercy Care Medicaid |
$677.55
|
|
|
Neonate, Transferred < 5 Days Old, Born Here
|
Facility
|
IP
|
$1,778.75
|
|
|
Service Code
|
APR-DRG 5813
|
| Hospital Charge Code |
APRDRG5811
|
| Min. Negotiated Rate |
$1,778.75 |
| Max. Negotiated Rate |
$1,778.75 |
| Rate for Payer: AHCCCS Medicaid |
$1,778.75
|
| Rate for Payer: Allwell Medicaid |
$1,778.75
|
| Rate for Payer: AZCH Complete Medicaid |
$1,778.75
|
| Rate for Payer: Banner UC Health Medicaid |
$1,778.75
|
| Rate for Payer: Mercy Care Medicaid |
$1,778.75
|
|
|
Neonate, Transferred < 5 Days Old, Not Born Here
|
Facility
|
IP
|
$1,602.70
|
|
|
Service Code
|
APR-DRG 5801
|
| Hospital Charge Code |
APRDRG5804
|
| Min. Negotiated Rate |
$1,602.70 |
| Max. Negotiated Rate |
$1,602.70 |
| Rate for Payer: AHCCCS Medicaid |
$1,602.70
|
| Rate for Payer: Allwell Medicaid |
$1,602.70
|
| Rate for Payer: AZCH Complete Medicaid |
$1,602.70
|
| Rate for Payer: Banner UC Health Medicaid |
$1,602.70
|
| Rate for Payer: Mercy Care Medicaid |
$1,602.70
|
|
