|
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: Blue Cross Blue Shield of Arizona Health Choice |
$12,446.34
|
| Rate for Payer: Mercy Care Medicaid |
$12,446.34
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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 |
APRDRG6341
|
| Min. Negotiated Rate |
$31,339.25 |
| Max. Negotiated Rate |
$31,339.25 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$31,339.25
|
| Rate for Payer: Mercy Care Medicaid |
$31,339.25
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$12,446.34
|
| Rate for Payer: Mercy Care Medicaid |
$12,446.34
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,446.34
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$4,420.22
|
| Rate for Payer: Mercy Care Medicaid |
$4,420.22
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,420.22
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$83,928.82
|
| Rate for Payer: Mercy Care Medicaid |
$83,928.82
|
| Rate for Payer: NaphCare Correctional Healthcare |
$83,928.82
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$54,742.87
|
| Rate for Payer: Mercy Care Medicaid |
$54,742.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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 |
APRDRG5912
|
| Min. Negotiated Rate |
$141,221.98 |
| Max. Negotiated Rate |
$141,221.98 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$141,221.98
|
| Rate for Payer: Mercy Care Medicaid |
$141,221.98
|
| Rate for Payer: NaphCare Correctional Healthcare |
$141,221.98
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$75,926.55
|
| Rate for Payer: Mercy Care Medicaid |
$75,926.55
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$75,926.55
|
| Rate for Payer: Mercy Care Medicaid |
$75,926.55
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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 |
APRDRG5912
|
| Min. Negotiated Rate |
$54,742.87 |
| Max. Negotiated Rate |
$54,742.87 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$54,742.87
|
| Rate for Payer: Mercy Care Medicaid |
$54,742.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$54,742.87
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$83,928.82
|
| Rate for Payer: Mercy Care Medicaid |
$83,928.82
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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 |
APRDRG5911
|
| Min. Negotiated Rate |
$141,221.98 |
| Max. Negotiated Rate |
$141,221.98 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$141,221.98
|
| Rate for Payer: Mercy Care Medicaid |
$141,221.98
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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 |
APRDRG5914
|
| Min. Negotiated Rate |
$141,221.98 |
| Max. Negotiated Rate |
$141,221.98 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$141,221.98
|
| Rate for Payer: Mercy Care Medicaid |
$141,221.98
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$141,221.98
|
| Rate for Payer: Mercy Care Medicaid |
$141,221.98
|
| Rate for Payer: NaphCare Correctional Healthcare |
$141,221.98
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$75,926.55
|
| Rate for Payer: Mercy Care Medicaid |
$75,926.55
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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 |
APRDRG5914
|
| Min. Negotiated Rate |
$54,742.87 |
| Max. Negotiated Rate |
$54,742.87 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$54,742.87
|
| Rate for Payer: Mercy Care Medicaid |
$54,742.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$54,742.87
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$75,926.55
|
| Rate for Payer: Mercy Care Medicaid |
$75,926.55
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$83,928.82
|
| Rate for Payer: Mercy Care Medicaid |
$83,928.82
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$83,928.82
|
| Rate for Payer: Mercy Care Medicaid |
$83,928.82
|
| Rate for Payer: NaphCare Correctional Healthcare |
$83,928.82
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$54,742.87
|
| Rate for Payer: Mercy Care Medicaid |
$54,742.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$54,742.87
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$14,492.33
|
| Rate for Payer: Mercy Care Medicaid |
$14,492.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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 |
APRDRG5894
|
| Min. Negotiated Rate |
$87,221.90 |
| Max. Negotiated Rate |
$87,221.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$87,221.90
|
| Rate for Payer: Mercy Care Medicaid |
$87,221.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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
|
$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: Blue Cross Blue Shield of Arizona Health Choice |
$84,136.44
|
| Rate for Payer: Mercy Care Medicaid |
$84,136.44
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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 |
APRDRG5894
|
| Min. Negotiated Rate |
$84,136.44 |
| Max. Negotiated Rate |
$84,136.44 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$84,136.44
|
| Rate for Payer: Mercy Care Medicaid |
$84,136.44
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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 |
APRDRG5892
|
| Min. Negotiated Rate |
$87,221.90 |
| Max. Negotiated Rate |
$87,221.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$87,221.90
|
| Rate for Payer: Mercy Care Medicaid |
$87,221.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$87,221.90
|
|
