|
Neonate, Transferred < 5 Days Old, Not Born Here
|
Facility
|
IP
|
$2,324.44
|
|
|
Service Code
|
APR-DRG 5802
|
| Hospital Charge Code |
APRDRG5801
|
| Min. Negotiated Rate |
$2,324.44 |
| Max. Negotiated Rate |
$2,324.44 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,324.44
|
| Rate for Payer: Mercy Care Medicaid |
$2,324.44
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,324.44
|
|
|
Neonate, Transferred < 5 Days Old, Not Born Here
|
Facility
|
IP
|
$7,004.18
|
|
|
Service Code
|
APR-DRG 5804
|
| Hospital Charge Code |
APRDRG5801
|
| Min. Negotiated Rate |
$7,004.18 |
| Max. Negotiated Rate |
$7,004.18 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,004.18
|
| Rate for Payer: Mercy Care Medicaid |
$7,004.18
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,004.18
|
|
|
Neonate, Transferred < 5 Days Old, Not Born Here
|
Facility
|
IP
|
$3,941.17
|
|
|
Service Code
|
APR-DRG 5803
|
| Hospital Charge Code |
APRDRG5803
|
| Min. Negotiated Rate |
$3,941.17 |
| Max. Negotiated Rate |
$3,941.17 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,941.17
|
| Rate for Payer: Mercy Care Medicaid |
$3,941.17
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,941.17
|
|
|
Neonate, Transferred < 5 Days Old, Not Born Here
|
Facility
|
IP
|
$7,004.18
|
|
|
Service Code
|
APR-DRG 5804
|
| Hospital Charge Code |
APRDRG5804
|
| Min. Negotiated Rate |
$7,004.18 |
| Max. Negotiated Rate |
$7,004.18 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,004.18
|
| Rate for Payer: Mercy Care Medicaid |
$7,004.18
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,004.18
|
|
|
Neonate, Transferred < 5 Days Old, Not Born Here
|
Facility
|
IP
|
$1,602.70
|
|
|
Service Code
|
APR-DRG 5801
|
| Hospital Charge Code |
APRDRG5803
|
| Min. Negotiated Rate |
$1,602.70 |
| Max. Negotiated Rate |
$1,602.70 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$1,602.70
|
| Rate for Payer: Mercy Care Medicaid |
$1,602.70
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,602.70
|
|
|
Neonate, Transferred < 5 Days Old, Not Born Here
|
Facility
|
IP
|
$3,941.17
|
|
|
Service Code
|
APR-DRG 5803
|
| Hospital Charge Code |
APRDRG5804
|
| Min. Negotiated Rate |
$3,941.17 |
| Max. Negotiated Rate |
$3,941.17 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,941.17
|
| Rate for Payer: Mercy Care Medicaid |
$3,941.17
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,941.17
|
|
|
Neonate, Transferred < 5 Days Old, Not Born Here
|
Facility
|
IP
|
$2,324.44
|
|
|
Service Code
|
APR-DRG 5802
|
| Hospital Charge Code |
APRDRG5804
|
| Min. Negotiated Rate |
$2,324.44 |
| Max. Negotiated Rate |
$2,324.44 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,324.44
|
| Rate for Payer: Mercy Care Medicaid |
$2,324.44
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,324.44
|
|
|
Neonate, Transferred < 5 Days Old, Not Born Here
|
Facility
|
IP
|
$3,941.17
|
|
|
Service Code
|
APR-DRG 5803
|
| Hospital Charge Code |
APRDRG5801
|
| Min. Negotiated Rate |
$3,941.17 |
| Max. Negotiated Rate |
$3,941.17 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,941.17
|
| Rate for Payer: Mercy Care Medicaid |
$3,941.17
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,941.17
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$1,602.70
|
| Rate for Payer: Mercy Care Medicaid |
$1,602.70
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,602.70
|
|
|
Neonate, Transferred < 5 Days Old, Not Born Here
|
Facility
|
IP
|
$1,602.70
|
|
|
Service Code
|
APR-DRG 5801
|
| Hospital Charge Code |
APRDRG5802
|
| Min. Negotiated Rate |
$1,602.70 |
| Max. Negotiated Rate |
$1,602.70 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$1,602.70
|
| Rate for Payer: Mercy Care Medicaid |
$1,602.70
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,602.70
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$209,775.41
|
|
|
Service Code
|
APR-DRG 5833
|
| Hospital Charge Code |
APRDRG5834
|
| Min. Negotiated Rate |
$209,775.41 |
| Max. Negotiated Rate |
$209,775.41 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$209,775.41
|
| Rate for Payer: Mercy Care Medicaid |
$209,775.41
|
| Rate for Payer: NaphCare Correctional Healthcare |
$209,775.41
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$261,126.31
|
|
|
Service Code
|
APR-DRG 5834
|
| Hospital Charge Code |
APRDRG5834
|
| Min. Negotiated Rate |
$261,126.31 |
| Max. Negotiated Rate |
$261,126.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$261,126.31
|
| Rate for Payer: Mercy Care Medicaid |
$261,126.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$261,126.31
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$261,126.31
|
|
|
Service Code
|
APR-DRG 5834
|
| Hospital Charge Code |
APRDRG5833
|
| Min. Negotiated Rate |
$261,126.31 |
| Max. Negotiated Rate |
$261,126.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$261,126.31
|
| Rate for Payer: Mercy Care Medicaid |
$261,126.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$261,126.31
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$142,335.80
|
|
|
Service Code
|
APR-DRG 5832
|
| Hospital Charge Code |
APRDRG5831
|
| Min. Negotiated Rate |
$142,335.80 |
| Max. Negotiated Rate |
$142,335.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$142,335.80
|
| Rate for Payer: Mercy Care Medicaid |
$142,335.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$142,335.80
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$112,462.48
|
|
|
Service Code
|
APR-DRG 5831
|
| Hospital Charge Code |
APRDRG5834
|
| Min. Negotiated Rate |
$112,462.48 |
| Max. Negotiated Rate |
$112,462.48 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$112,462.48
|
| Rate for Payer: Mercy Care Medicaid |
$112,462.48
|
| Rate for Payer: NaphCare Correctional Healthcare |
$112,462.48
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$112,462.48
|
|
|
Service Code
|
APR-DRG 5831
|
| Hospital Charge Code |
APRDRG5832
|
| Min. Negotiated Rate |
$112,462.48 |
| Max. Negotiated Rate |
$112,462.48 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$112,462.48
|
| Rate for Payer: Mercy Care Medicaid |
$112,462.48
|
| Rate for Payer: NaphCare Correctional Healthcare |
$112,462.48
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$209,775.41
|
|
|
Service Code
|
APR-DRG 5833
|
| Hospital Charge Code |
APRDRG5833
|
| Min. Negotiated Rate |
$209,775.41 |
| Max. Negotiated Rate |
$209,775.41 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$209,775.41
|
| Rate for Payer: Mercy Care Medicaid |
$209,775.41
|
| Rate for Payer: NaphCare Correctional Healthcare |
$209,775.41
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$112,462.48
|
|
|
Service Code
|
APR-DRG 5831
|
| Hospital Charge Code |
APRDRG5833
|
| Min. Negotiated Rate |
$112,462.48 |
| Max. Negotiated Rate |
$112,462.48 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$112,462.48
|
| Rate for Payer: Mercy Care Medicaid |
$112,462.48
|
| Rate for Payer: NaphCare Correctional Healthcare |
$112,462.48
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$142,335.80
|
|
|
Service Code
|
APR-DRG 5832
|
| Hospital Charge Code |
APRDRG5832
|
| Min. Negotiated Rate |
$142,335.80 |
| Max. Negotiated Rate |
$142,335.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$142,335.80
|
| Rate for Payer: Mercy Care Medicaid |
$142,335.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$142,335.80
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$112,462.48
|
|
|
Service Code
|
APR-DRG 5831
|
| Hospital Charge Code |
APRDRG5831
|
| Min. Negotiated Rate |
$112,462.48 |
| Max. Negotiated Rate |
$112,462.48 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$112,462.48
|
| Rate for Payer: Mercy Care Medicaid |
$112,462.48
|
| Rate for Payer: NaphCare Correctional Healthcare |
$112,462.48
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$209,775.41
|
|
|
Service Code
|
APR-DRG 5833
|
| Hospital Charge Code |
APRDRG5832
|
| Min. Negotiated Rate |
$209,775.41 |
| Max. Negotiated Rate |
$209,775.41 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$209,775.41
|
| Rate for Payer: Mercy Care Medicaid |
$209,775.41
|
| Rate for Payer: NaphCare Correctional Healthcare |
$209,775.41
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$261,126.31
|
|
|
Service Code
|
APR-DRG 5834
|
| Hospital Charge Code |
APRDRG5832
|
| Min. Negotiated Rate |
$261,126.31 |
| Max. Negotiated Rate |
$261,126.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$261,126.31
|
| Rate for Payer: Mercy Care Medicaid |
$261,126.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$261,126.31
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$142,335.80
|
|
|
Service Code
|
APR-DRG 5832
|
| Hospital Charge Code |
APRDRG5834
|
| Min. Negotiated Rate |
$142,335.80 |
| Max. Negotiated Rate |
$142,335.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$142,335.80
|
| Rate for Payer: Mercy Care Medicaid |
$142,335.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$142,335.80
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$209,775.41
|
|
|
Service Code
|
APR-DRG 5833
|
| Hospital Charge Code |
APRDRG5831
|
| Min. Negotiated Rate |
$209,775.41 |
| Max. Negotiated Rate |
$209,775.41 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$209,775.41
|
| Rate for Payer: Mercy Care Medicaid |
$209,775.41
|
| Rate for Payer: NaphCare Correctional Healthcare |
$209,775.41
|
|
|
Neonate With Ecmo
|
Facility
|
IP
|
$261,126.31
|
|
|
Service Code
|
APR-DRG 5834
|
| Hospital Charge Code |
APRDRG5831
|
| Min. Negotiated Rate |
$261,126.31 |
| Max. Negotiated Rate |
$261,126.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$261,126.31
|
| Rate for Payer: Mercy Care Medicaid |
$261,126.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$261,126.31
|
|
