Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY

Facility

$18,764.18

Service Code	APR-DRG 5014
Min. Negotiated Rate	$16,667.52
Max. Negotiated Rate	$18,764.18
Rate for Payer: Anthem Medicaid	$17,967.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$17,967.74
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$17,967.74
Rate for Payer: Dean Health Medicaid	$17,967.74
Rate for Payer: Independent Care Health Plan Medicaid	$16,667.52
Rate for Payer: Managed Health Services Medicaid	$18,764.18
Rate for Payer: Molina Healthcare Medicaid	$17,967.74
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$17,967.74
Rate for Payer: United Healthcare Medicaid	$17,967.74

MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY

Facility

$4,822.57

Service Code	APR-DRG 5011
Min. Negotiated Rate	$4,283.71
Max. Negotiated Rate	$4,822.57
Rate for Payer: Anthem Medicaid	$4,617.88
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$4,617.88
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4,617.88
Rate for Payer: Dean Health Medicaid	$4,617.88
Rate for Payer: Independent Care Health Plan Medicaid	$4,283.71
Rate for Payer: Managed Health Services Medicaid	$4,822.57
Rate for Payer: Molina Healthcare Medicaid	$4,617.88
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4,617.88
Rate for Payer: United Healthcare Medicaid	$4,617.88

MALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

$30.88

Service Code	EAPG 00744
Min. Negotiated Rate	$29.69
Max. Negotiated Rate	$30.88
Rate for Payer: Anthem Medicaid	$29.69
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$29.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$29.69
Rate for Payer: Dean Health Medicaid	$29.69
Rate for Payer: Independent Care Health Plan Medicaid	$29.69
Rate for Payer: Managed Health Services Medicaid	$30.88
Rate for Payer: Molina Healthcare Medicaid	$29.69
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$29.69
Rate for Payer: United Healthcare Medicaid	$29.69

MALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

$30.80

Service Code	EAPG 00740
Min. Negotiated Rate	$29.61
Max. Negotiated Rate	$30.80
Rate for Payer: Anthem Medicaid	$29.61
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$29.61
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$29.61
Rate for Payer: Dean Health Medicaid	$29.61
Rate for Payer: Independent Care Health Plan Medicaid	$29.61
Rate for Payer: Managed Health Services Medicaid	$30.80
Rate for Payer: Molina Healthcare Medicaid	$29.61
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$29.61
Rate for Payer: United Healthcare Medicaid	$29.61

MALFUNCTION, REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE

Facility

$20,956.26

Service Code	APR-DRG 2524
Min. Negotiated Rate	$18,614.66
Max. Negotiated Rate	$20,956.26
Rate for Payer: Anthem Medicaid	$20,066.77
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$20,066.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$20,066.77
Rate for Payer: Dean Health Medicaid	$20,066.77
Rate for Payer: Independent Care Health Plan Medicaid	$18,614.66
Rate for Payer: Managed Health Services Medicaid	$20,956.26
Rate for Payer: Molina Healthcare Medicaid	$20,066.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$20,066.77
Rate for Payer: United Healthcare Medicaid	$20,066.77

MALFUNCTION, REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE

Facility

$7,453.06

Service Code	APR-DRG 2522
Min. Negotiated Rate	$6,620.28
Max. Negotiated Rate	$7,453.06
Rate for Payer: Anthem Medicaid	$7,136.72
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$7,136.72
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$7,136.72
Rate for Payer: Dean Health Medicaid	$7,136.72
Rate for Payer: Independent Care Health Plan Medicaid	$6,620.28
Rate for Payer: Managed Health Services Medicaid	$7,453.06
Rate for Payer: Molina Healthcare Medicaid	$7,136.72
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$7,136.72
Rate for Payer: United Healthcare Medicaid	$7,136.72

MALFUNCTION, REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE

Facility

$11,223.44

Service Code	APR-DRG 2523
Min. Negotiated Rate	$9,969.36
Max. Negotiated Rate	$11,223.44
Rate for Payer: Anthem Medicaid	$10,747.06
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$10,747.06
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$10,747.06
Rate for Payer: Dean Health Medicaid	$10,747.06
Rate for Payer: Independent Care Health Plan Medicaid	$9,969.36
Rate for Payer: Managed Health Services Medicaid	$11,223.44
Rate for Payer: Molina Healthcare Medicaid	$10,747.06
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$10,747.06
Rate for Payer: United Healthcare Medicaid	$10,747.06

MALFUNCTION, REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE

Facility

$5,699.40

Service Code	APR-DRG 2521
Min. Negotiated Rate	$5,062.56
Max. Negotiated Rate	$5,699.40
Rate for Payer: Anthem Medicaid	$5,457.49
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$5,457.49
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5,457.49
Rate for Payer: Dean Health Medicaid	$5,457.49
Rate for Payer: Independent Care Health Plan Medicaid	$5,062.56
Rate for Payer: Managed Health Services Medicaid	$5,699.40
Rate for Payer: Molina Healthcare Medicaid	$5,457.49
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5,457.49
Rate for Payer: United Healthcare Medicaid	$5,457.49

MALFUNCTION, REACTION AND COMPLICATION OF GI DEVICE OR PROCEDURE

Facility

$72.91

Service Code	EAPG 00629
Min. Negotiated Rate	$70.11
Max. Negotiated Rate	$72.91
Rate for Payer: Anthem Medicaid	$70.11
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$70.11
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.11
Rate for Payer: Dean Health Medicaid	$70.11
Rate for Payer: Independent Care Health Plan Medicaid	$70.11
Rate for Payer: Managed Health Services Medicaid	$72.91
Rate for Payer: Molina Healthcare Medicaid	$70.11
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.11
Rate for Payer: United Healthcare Medicaid	$70.11

MALFUNCTION, REACTION, COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE

Facility

$11,749.54

Service Code	APR-DRG 2063
Min. Negotiated Rate	$10,436.67
Max. Negotiated Rate	$11,749.54
Rate for Payer: Anthem Medicaid	$11,250.83
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$11,250.83
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$11,250.83
Rate for Payer: Dean Health Medicaid	$11,250.83
Rate for Payer: Independent Care Health Plan Medicaid	$10,436.67
Rate for Payer: Managed Health Services Medicaid	$11,749.54
Rate for Payer: Molina Healthcare Medicaid	$11,250.83
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$11,250.83
Rate for Payer: United Healthcare Medicaid	$11,250.83

MALFUNCTION, REACTION, COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE

Facility

$20,517.85

Service Code	APR-DRG 2064
Min. Negotiated Rate	$18,225.23
Max. Negotiated Rate	$20,517.85
Rate for Payer: Anthem Medicaid	$19,646.97
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$19,646.97
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$19,646.97
Rate for Payer: Dean Health Medicaid	$19,646.97
Rate for Payer: Independent Care Health Plan Medicaid	$18,225.23
Rate for Payer: Managed Health Services Medicaid	$20,517.85
Rate for Payer: Molina Healthcare Medicaid	$19,646.97
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$19,646.97
Rate for Payer: United Healthcare Medicaid	$19,646.97

MALFUNCTION, REACTION, COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE

Facility

$6,488.55

Service Code	APR-DRG 2061
Min. Negotiated Rate	$5,763.53
Max. Negotiated Rate	$6,488.55
Rate for Payer: Anthem Medicaid	$6,213.14
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$6,213.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$6,213.14
Rate for Payer: Dean Health Medicaid	$6,213.14
Rate for Payer: Independent Care Health Plan Medicaid	$5,763.53
Rate for Payer: Managed Health Services Medicaid	$6,488.55
Rate for Payer: Molina Healthcare Medicaid	$6,213.14
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$6,213.14
Rate for Payer: United Healthcare Medicaid	$6,213.14

MALFUNCTION, REACTION, COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE

Facility

$7,803.80

Service Code	APR-DRG 2062
Min. Negotiated Rate	$6,931.82
Max. Negotiated Rate	$7,803.80
Rate for Payer: Anthem Medicaid	$7,472.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$7,472.56
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$7,472.56
Rate for Payer: Dean Health Medicaid	$7,472.56
Rate for Payer: Independent Care Health Plan Medicaid	$6,931.82
Rate for Payer: Managed Health Services Medicaid	$7,803.80
Rate for Payer: Molina Healthcare Medicaid	$7,472.56
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$7,472.56
Rate for Payer: United Healthcare Medicaid	$7,472.56

MALFUNCTION, REACTION, COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE

Facility

$17,273.57

Service Code	APR-DRG 4664
Min. Negotiated Rate	$15,343.46
Max. Negotiated Rate	$17,273.57
Rate for Payer: Anthem Medicaid	$16,540.40
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$16,540.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$16,540.40
Rate for Payer: Dean Health Medicaid	$16,540.40
Rate for Payer: Independent Care Health Plan Medicaid	$15,343.46
Rate for Payer: Managed Health Services Medicaid	$17,273.57
Rate for Payer: Molina Healthcare Medicaid	$16,540.40
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$16,540.40
Rate for Payer: United Healthcare Medicaid	$16,540.40

MALFUNCTION, REACTION, COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE

Facility

$5,085.62

Service Code	APR-DRG 4661
Min. Negotiated Rate	$4,517.36
Max. Negotiated Rate	$5,085.62
Rate for Payer: Anthem Medicaid	$4,869.76
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$4,869.76
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4,869.76
Rate for Payer: Dean Health Medicaid	$4,869.76
Rate for Payer: Independent Care Health Plan Medicaid	$4,517.36
Rate for Payer: Managed Health Services Medicaid	$5,085.62
Rate for Payer: Molina Healthcare Medicaid	$4,869.76
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4,869.76
Rate for Payer: United Healthcare Medicaid	$4,869.76

MALFUNCTION, REACTION, COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE

Facility

$10,258.92

Service Code	APR-DRG 4663
Min. Negotiated Rate	$9,112.62
Max. Negotiated Rate	$10,258.92
Rate for Payer: Anthem Medicaid	$9,823.48
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$9,823.48
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$9,823.48
Rate for Payer: Dean Health Medicaid	$9,823.48
Rate for Payer: Independent Care Health Plan Medicaid	$9,112.62
Rate for Payer: Managed Health Services Medicaid	$10,258.92
Rate for Payer: Molina Healthcare Medicaid	$9,823.48
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$9,823.48
Rate for Payer: United Healthcare Medicaid	$9,823.48

MALFUNCTION, REACTION, COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE

Facility

$6,488.55

Service Code	APR-DRG 4662
Min. Negotiated Rate	$5,763.53
Max. Negotiated Rate	$6,488.55
Rate for Payer: Anthem Medicaid	$6,213.14
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$6,213.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$6,213.14
Rate for Payer: Dean Health Medicaid	$6,213.14
Rate for Payer: Independent Care Health Plan Medicaid	$5,763.53
Rate for Payer: Managed Health Services Medicaid	$6,488.55
Rate for Payer: Molina Healthcare Medicaid	$6,213.14
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$6,213.14
Rate for Payer: United Healthcare Medicaid	$6,213.14

MALFUNCTION, REACTION, COMPLICATION OF NEUROLOGICAL DEVICE OR PROC

Facility

$38.15

Service Code	EAPG 00537
Min. Negotiated Rate	$36.69
Max. Negotiated Rate	$38.15
Rate for Payer: Anthem Medicaid	$36.69
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$36.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$36.69
Rate for Payer: Dean Health Medicaid	$36.69
Rate for Payer: Independent Care Health Plan Medicaid	$36.69
Rate for Payer: Managed Health Services Medicaid	$38.15
Rate for Payer: Molina Healthcare Medicaid	$36.69
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$36.69
Rate for Payer: United Healthcare Medicaid	$36.69

MALFUNCTION, REACTION, COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$11,223.44

Service Code	APR-DRG 3493
Min. Negotiated Rate	$9,969.36
Max. Negotiated Rate	$11,223.44
Rate for Payer: Anthem Medicaid	$10,747.06
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$10,747.06
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$10,747.06
Rate for Payer: Dean Health Medicaid	$10,747.06
Rate for Payer: Independent Care Health Plan Medicaid	$9,969.36
Rate for Payer: Managed Health Services Medicaid	$11,223.44
Rate for Payer: Molina Healthcare Medicaid	$10,747.06
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$10,747.06
Rate for Payer: United Healthcare Medicaid	$10,747.06

MALFUNCTION, REACTION, COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$5,699.40

Service Code	APR-DRG 3491
Min. Negotiated Rate	$5,062.56
Max. Negotiated Rate	$5,699.40
Rate for Payer: Anthem Medicaid	$5,457.49
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$5,457.49
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5,457.49
Rate for Payer: Dean Health Medicaid	$5,457.49
Rate for Payer: Independent Care Health Plan Medicaid	$5,062.56
Rate for Payer: Managed Health Services Medicaid	$5,699.40
Rate for Payer: Molina Healthcare Medicaid	$5,457.49
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5,457.49
Rate for Payer: United Healthcare Medicaid	$5,457.49

MALFUNCTION, REACTION, COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$7,803.80

Service Code	APR-DRG 3492
Min. Negotiated Rate	$6,931.82
Max. Negotiated Rate	$7,803.80
Rate for Payer: Anthem Medicaid	$7,472.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$7,472.56
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$7,472.56
Rate for Payer: Dean Health Medicaid	$7,472.56
Rate for Payer: Independent Care Health Plan Medicaid	$6,931.82
Rate for Payer: Managed Health Services Medicaid	$7,803.80
Rate for Payer: Molina Healthcare Medicaid	$7,472.56
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$7,472.56
Rate for Payer: United Healthcare Medicaid	$7,472.56

MALFUNCTION, REACTION, COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$18,588.82

Service Code	APR-DRG 3494
Min. Negotiated Rate	$16,511.75
Max. Negotiated Rate	$18,588.82
Rate for Payer: Anthem Medicaid	$17,799.82
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$17,799.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$17,799.82
Rate for Payer: Dean Health Medicaid	$17,799.82
Rate for Payer: Independent Care Health Plan Medicaid	$16,511.75
Rate for Payer: Managed Health Services Medicaid	$18,588.82
Rate for Payer: Molina Healthcare Medicaid	$17,799.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$17,799.82
Rate for Payer: United Healthcare Medicaid	$17,799.82

MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC

Facility

$55.04

Service Code	EAPG 00725
Min. Negotiated Rate	$52.93
Max. Negotiated Rate	$55.04
Rate for Payer: Anthem Medicaid	$52.93
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$52.93
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$52.93
Rate for Payer: Dean Health Medicaid	$52.93
Rate for Payer: Independent Care Health Plan Medicaid	$52.93
Rate for Payer: Managed Health Services Medicaid	$55.04
Rate for Payer: Molina Healthcare Medicaid	$52.93
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$52.93
Rate for Payer: United Healthcare Medicaid	$52.93

MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$42.70

Service Code	EAPG 00659
Min. Negotiated Rate	$41.06
Max. Negotiated Rate	$42.70
Rate for Payer: Anthem Medicaid	$41.06
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$41.06
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$41.06
Rate for Payer: Dean Health Medicaid	$41.06
Rate for Payer: Independent Care Health Plan Medicaid	$41.06
Rate for Payer: Managed Health Services Medicaid	$42.70
Rate for Payer: Molina Healthcare Medicaid	$41.06
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$41.06
Rate for Payer: United Healthcare Medicaid	$41.06

MALFUNCTION, REACTION, OR COMPLICATION OF CARDIOVASCULAR DEVICE OR PROC

Facility

$53.72

Service Code	EAPG 00589
Min. Negotiated Rate	$51.65
Max. Negotiated Rate	$53.72
Rate for Payer: Anthem Medicaid	$51.65
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$51.65
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$51.65
Rate for Payer: Dean Health Medicaid	$51.65
Rate for Payer: Independent Care Health Plan Medicaid	$51.65
Rate for Payer: Managed Health Services Medicaid	$53.72
Rate for Payer: Molina Healthcare Medicaid	$51.65
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$51.65
Rate for Payer: United Healthcare Medicaid	$51.65

Know your out-of-pocket cost for care.

All Charges