Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION

Facility

$11,048.07

Service Code	APR-DRG 6141
Min. Negotiated Rate	$9,813.59
Max. Negotiated Rate	$11,048.07
Rate for Payer: Anthem Medicaid	$10,579.14
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$10,579.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$10,579.14
Rate for Payer: Dean Health Medicaid	$10,579.14
Rate for Payer: Independent Care Health Plan Medicaid	$9,813.59
Rate for Payer: Managed Health Services Medicaid	$11,048.07
Rate for Payer: Molina Healthcare Medicaid	$10,579.14
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$10,579.14
Rate for Payer: United Healthcare Medicaid	$10,579.14

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$21,833.09

Service Code	APR-DRG 6121
Min. Negotiated Rate	$19,393.51
Max. Negotiated Rate	$21,833.09
Rate for Payer: Anthem Medicaid	$20,906.39
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$20,906.39
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$20,906.39
Rate for Payer: Dean Health Medicaid	$20,906.39
Rate for Payer: Independent Care Health Plan Medicaid	$19,393.51
Rate for Payer: Managed Health Services Medicaid	$21,833.09
Rate for Payer: Molina Healthcare Medicaid	$20,906.39
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$20,906.39
Rate for Payer: United Healthcare Medicaid	$20,906.39

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$45,244.48

Service Code	APR-DRG 6123
Min. Negotiated Rate	$40,188.97
Max. Negotiated Rate	$45,244.48
Rate for Payer: Anthem Medicaid	$43,324.08
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$43,324.08
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$43,324.08
Rate for Payer: Dean Health Medicaid	$43,324.08
Rate for Payer: Independent Care Health Plan Medicaid	$40,188.97
Rate for Payer: Managed Health Services Medicaid	$45,244.48
Rate for Payer: Molina Healthcare Medicaid	$43,324.08
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$43,324.08
Rate for Payer: United Healthcare Medicaid	$43,324.08

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$65,236.23

Service Code	APR-DRG 6124
Min. Negotiated Rate	$57,946.89
Max. Negotiated Rate	$65,236.23
Rate for Payer: Anthem Medicaid	$62,467.28
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$62,467.28
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$62,467.28
Rate for Payer: Dean Health Medicaid	$62,467.28
Rate for Payer: Independent Care Health Plan Medicaid	$57,946.89
Rate for Payer: Managed Health Services Medicaid	$65,236.23
Rate for Payer: Molina Healthcare Medicaid	$62,467.28
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$62,467.28
Rate for Payer: United Healthcare Medicaid	$62,467.28

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$31,653.60

Service Code	APR-DRG 6122
Min. Negotiated Rate	$28,116.70
Max. Negotiated Rate	$31,653.60
Rate for Payer: Anthem Medicaid	$30,310.07
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$30,310.07
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$30,310.07
Rate for Payer: Dean Health Medicaid	$30,310.07
Rate for Payer: Independent Care Health Plan Medicaid	$28,116.70
Rate for Payer: Managed Health Services Medicaid	$31,653.60
Rate for Payer: Molina Healthcare Medicaid	$30,310.07
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$30,310.07
Rate for Payer: United Healthcare Medicaid	$30,310.07

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility

$46,822.78

Service Code	APR-DRG 6092
Min. Negotiated Rate	$41,590.91
Max. Negotiated Rate	$46,822.78
Rate for Payer: Anthem Medicaid	$44,835.39
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$44,835.39
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$44,835.39
Rate for Payer: Dean Health Medicaid	$44,835.39
Rate for Payer: Independent Care Health Plan Medicaid	$41,590.91
Rate for Payer: Managed Health Services Medicaid	$46,822.78
Rate for Payer: Molina Healthcare Medicaid	$44,835.39
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$44,835.39
Rate for Payer: United Healthcare Medicaid	$44,835.39

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility

$37,616.05

Service Code	APR-DRG 6091
Min. Negotiated Rate	$33,412.92
Max. Negotiated Rate	$37,616.05
Rate for Payer: Anthem Medicaid	$36,019.44
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$36,019.44
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$36,019.44
Rate for Payer: Dean Health Medicaid	$36,019.44
Rate for Payer: Independent Care Health Plan Medicaid	$33,412.92
Rate for Payer: Managed Health Services Medicaid	$37,616.05
Rate for Payer: Molina Healthcare Medicaid	$36,019.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$36,019.44
Rate for Payer: United Healthcare Medicaid	$36,019.44

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility

$71,724.78

Service Code	APR-DRG 6093
Min. Negotiated Rate	$63,710.42
Max. Negotiated Rate	$71,724.78
Rate for Payer: Anthem Medicaid	$68,680.43
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$68,680.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$68,680.43
Rate for Payer: Dean Health Medicaid	$68,680.43
Rate for Payer: Independent Care Health Plan Medicaid	$63,710.42
Rate for Payer: Managed Health Services Medicaid	$71,724.78
Rate for Payer: Molina Healthcare Medicaid	$68,680.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$68,680.43
Rate for Payer: United Healthcare Medicaid	$68,680.43

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility

$206,756.75

Service Code	APR-DRG 6094
Min. Negotiated Rate	$183,654.24
Max. Negotiated Rate	$206,756.75
Rate for Payer: Anthem Medicaid	$197,980.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$197,980.98
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$197,980.98
Rate for Payer: Dean Health Medicaid	$197,980.98
Rate for Payer: Independent Care Health Plan Medicaid	$183,654.24
Rate for Payer: Managed Health Services Medicaid	$206,756.75
Rate for Payer: Molina Healthcare Medicaid	$197,980.98
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$197,980.98
Rate for Payer: United Healthcare Medicaid	$197,980.98

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility

$145,203.21

Service Code	APR-DRG 5881
Min. Negotiated Rate	$128,978.55
Max. Negotiated Rate	$145,203.21
Rate for Payer: Anthem Medicaid	$139,040.08
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$139,040.08
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$139,040.08
Rate for Payer: Dean Health Medicaid	$139,040.08
Rate for Payer: Independent Care Health Plan Medicaid	$128,978.55
Rate for Payer: Managed Health Services Medicaid	$145,203.21
Rate for Payer: Molina Healthcare Medicaid	$139,040.08
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$139,040.08
Rate for Payer: United Healthcare Medicaid	$139,040.08

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility

$197,637.71

Service Code	APR-DRG 5883
Min. Negotiated Rate	$175,554.14
Max. Negotiated Rate	$197,637.71
Rate for Payer: Anthem Medicaid	$189,249.00
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$189,249.00
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$189,249.00
Rate for Payer: Dean Health Medicaid	$189,249.00
Rate for Payer: Independent Care Health Plan Medicaid	$175,554.14
Rate for Payer: Managed Health Services Medicaid	$197,637.71
Rate for Payer: Molina Healthcare Medicaid	$189,249.00
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$189,249.00
Rate for Payer: United Healthcare Medicaid	$189,249.00

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility

$296,807.29

Service Code	APR-DRG 5884
Min. Negotiated Rate	$263,642.76
Max. Negotiated Rate	$296,807.29
Rate for Payer: Anthem Medicaid	$284,209.34
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$284,209.34
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$284,209.34
Rate for Payer: Dean Health Medicaid	$284,209.34
Rate for Payer: Independent Care Health Plan Medicaid	$263,642.76
Rate for Payer: Managed Health Services Medicaid	$296,807.29
Rate for Payer: Molina Healthcare Medicaid	$284,209.34
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$284,209.34
Rate for Payer: United Healthcare Medicaid	$284,209.34

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility

$169,403.75

Service Code	APR-DRG 5882
Min. Negotiated Rate	$150,474.98
Max. Negotiated Rate	$169,403.75
Rate for Payer: Anthem Medicaid	$162,213.42
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$162,213.42
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$162,213.42
Rate for Payer: Dean Health Medicaid	$162,213.42
Rate for Payer: Independent Care Health Plan Medicaid	$150,474.98
Rate for Payer: Managed Health Services Medicaid	$169,403.75
Rate for Payer: Molina Healthcare Medicaid	$162,213.42
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$162,213.42
Rate for Payer: United Healthcare Medicaid	$162,213.42

NEONATE BIRTH WEIGHT 2000-2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility

$16,747.47

Service Code	APR-DRG 6264
Min. Negotiated Rate	$14,876.15
Max. Negotiated Rate	$16,747.47
Rate for Payer: Anthem Medicaid	$16,036.63
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$16,036.63
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$16,036.63
Rate for Payer: Dean Health Medicaid	$16,036.63
Rate for Payer: Independent Care Health Plan Medicaid	$14,876.15
Rate for Payer: Managed Health Services Medicaid	$16,747.47
Rate for Payer: Molina Healthcare Medicaid	$16,036.63
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$16,036.63
Rate for Payer: United Healthcare Medicaid	$16,036.63

NEONATE BIRTH WEIGHT 2000-2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility

$2,893.54

Service Code	APR-DRG 6262
Min. Negotiated Rate	$2,570.22
Max. Negotiated Rate	$2,893.54
Rate for Payer: Anthem Medicaid	$2,770.73
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,770.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,770.73
Rate for Payer: Dean Health Medicaid	$2,770.73
Rate for Payer: Independent Care Health Plan Medicaid	$2,570.22
Rate for Payer: Managed Health Services Medicaid	$2,893.54
Rate for Payer: Molina Healthcare Medicaid	$2,770.73
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,770.73
Rate for Payer: United Healthcare Medicaid	$2,770.73

NEONATE BIRTH WEIGHT 2000-2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility

$1,315.25

Service Code	APR-DRG 6261
Min. Negotiated Rate	$1,168.28
Max. Negotiated Rate	$1,315.25
Rate for Payer: Anthem Medicaid	$1,259.42
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,259.42
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,259.42
Rate for Payer: Dean Health Medicaid	$1,259.42
Rate for Payer: Independent Care Health Plan Medicaid	$1,168.28
Rate for Payer: Managed Health Services Medicaid	$1,315.25
Rate for Payer: Molina Healthcare Medicaid	$1,259.42
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,259.42
Rate for Payer: United Healthcare Medicaid	$1,259.42

NEONATE BIRTH WEIGHT 2000-2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility

$8,329.89

Service Code	APR-DRG 6263
Min. Negotiated Rate	$7,399.13
Max. Negotiated Rate	$8,329.89
Rate for Payer: Anthem Medicaid	$7,976.33
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$7,976.33
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$7,976.33
Rate for Payer: Dean Health Medicaid	$7,976.33
Rate for Payer: Independent Care Health Plan Medicaid	$7,399.13
Rate for Payer: Managed Health Services Medicaid	$8,329.89
Rate for Payer: Molina Healthcare Medicaid	$7,976.33
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$7,976.33
Rate for Payer: United Healthcare Medicaid	$7,976.33

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$9,995.87

Service Code	APR-DRG 6231
Min. Negotiated Rate	$8,878.96
Max. Negotiated Rate	$9,995.87
Rate for Payer: Anthem Medicaid	$9,571.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$9,571.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$9,571.60
Rate for Payer: Dean Health Medicaid	$9,571.60
Rate for Payer: Independent Care Health Plan Medicaid	$8,878.96
Rate for Payer: Managed Health Services Medicaid	$9,995.87
Rate for Payer: Molina Healthcare Medicaid	$9,571.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$9,571.60
Rate for Payer: United Healthcare Medicaid	$9,571.60

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$34,371.78

Service Code	APR-DRG 6233
Min. Negotiated Rate	$30,531.16
Max. Negotiated Rate	$34,371.78
Rate for Payer: Anthem Medicaid	$32,912.87
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$32,912.87
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$32,912.87
Rate for Payer: Dean Health Medicaid	$32,912.87
Rate for Payer: Independent Care Health Plan Medicaid	$30,531.16
Rate for Payer: Managed Health Services Medicaid	$34,371.78
Rate for Payer: Molina Healthcare Medicaid	$32,912.87
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$32,912.87
Rate for Payer: United Healthcare Medicaid	$32,912.87

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$17,273.57

Service Code	APR-DRG 6232
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

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$45,770.58

Service Code	APR-DRG 6234
Min. Negotiated Rate	$40,656.28
Max. Negotiated Rate	$45,770.58
Rate for Payer: Anthem Medicaid	$43,827.85
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$43,827.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$43,827.85
Rate for Payer: Dean Health Medicaid	$43,827.85
Rate for Payer: Independent Care Health Plan Medicaid	$40,656.28
Rate for Payer: Managed Health Services Medicaid	$45,770.58
Rate for Payer: Molina Healthcare Medicaid	$43,827.85
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$43,827.85
Rate for Payer: United Healthcare Medicaid	$43,827.85

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility

$16,133.69

Service Code	APR-DRG 6212
Min. Negotiated Rate	$14,330.95
Max. Negotiated Rate	$16,133.69
Rate for Payer: Anthem Medicaid	$15,448.90
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$15,448.90
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$15,448.90
Rate for Payer: Dean Health Medicaid	$15,448.90
Rate for Payer: Independent Care Health Plan Medicaid	$14,330.95
Rate for Payer: Managed Health Services Medicaid	$16,133.69
Rate for Payer: Molina Healthcare Medicaid	$15,448.90
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$15,448.90
Rate for Payer: United Healthcare Medicaid	$15,448.90

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility

$64,008.66

Service Code	APR-DRG 6214
Min. Negotiated Rate	$56,856.49
Max. Negotiated Rate	$64,008.66
Rate for Payer: Anthem Medicaid	$61,291.82
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$61,291.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$61,291.82
Rate for Payer: Dean Health Medicaid	$61,291.82
Rate for Payer: Independent Care Health Plan Medicaid	$56,856.49
Rate for Payer: Managed Health Services Medicaid	$64,008.66
Rate for Payer: Molina Healthcare Medicaid	$61,291.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$61,291.82
Rate for Payer: United Healthcare Medicaid	$61,291.82

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility

$32,179.70

Service Code	APR-DRG 6213
Min. Negotiated Rate	$28,584.02
Max. Negotiated Rate	$32,179.70
Rate for Payer: Anthem Medicaid	$30,813.83
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$30,813.83
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$30,813.83
Rate for Payer: Dean Health Medicaid	$30,813.83
Rate for Payer: Independent Care Health Plan Medicaid	$28,584.02
Rate for Payer: Managed Health Services Medicaid	$32,179.70
Rate for Payer: Molina Healthcare Medicaid	$30,813.83
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$30,813.83
Rate for Payer: United Healthcare Medicaid	$30,813.83

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility

$5,348.67

Service Code	APR-DRG 6211
Min. Negotiated Rate	$4,751.02
Max. Negotiated Rate	$5,348.67
Rate for Payer: Anthem Medicaid	$5,121.65
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$5,121.65
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5,121.65
Rate for Payer: Dean Health Medicaid	$5,121.65
Rate for Payer: Independent Care Health Plan Medicaid	$4,751.02
Rate for Payer: Managed Health Services Medicaid	$5,348.67
Rate for Payer: Molina Healthcare Medicaid	$5,121.65
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5,121.65
Rate for Payer: United Healthcare Medicaid	$5,121.65

Know your out-of-pocket cost for care.

All Charges