Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$10,785.02

Service Code	APR-DRG 6251
Min. Negotiated Rate	$9,579.93
Max. Negotiated Rate	$10,785.02
Rate for Payer: Anthem Medicaid	$10,327.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$10,327.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$10,327.25
Rate for Payer: Dean Health Medicaid	$10,327.25
Rate for Payer: Independent Care Health Plan Medicaid	$9,579.93
Rate for Payer: Managed Health Services Medicaid	$10,785.02
Rate for Payer: Molina Healthcare Medicaid	$10,327.25
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$10,327.25
Rate for Payer: United Healthcare Medicaid	$10,327.25

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$56,730.97

Service Code	APR-DRG 6254
Min. Negotiated Rate	$50,391.98
Max. Negotiated Rate	$56,730.97
Rate for Payer: Anthem Medicaid	$54,323.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$54,323.03
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54,323.03
Rate for Payer: Dean Health Medicaid	$54,323.03
Rate for Payer: Independent Care Health Plan Medicaid	$50,391.98
Rate for Payer: Managed Health Services Medicaid	$56,730.97
Rate for Payer: Molina Healthcare Medicaid	$54,323.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54,323.03
Rate for Payer: United Healthcare Medicaid	$54,323.03

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$15,695.27

Service Code	APR-DRG 6252
Min. Negotiated Rate	$13,941.52
Max. Negotiated Rate	$15,695.27
Rate for Payer: Anthem Medicaid	$15,029.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$15,029.09
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$15,029.09
Rate for Payer: Dean Health Medicaid	$15,029.09
Rate for Payer: Independent Care Health Plan Medicaid	$13,941.52
Rate for Payer: Managed Health Services Medicaid	$15,695.27
Rate for Payer: Molina Healthcare Medicaid	$15,029.09
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$15,029.09
Rate for Payer: United Healthcare Medicaid	$15,029.09

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$26,041.88

Service Code	APR-DRG 6253
Min. Negotiated Rate	$23,132.02
Max. Negotiated Rate	$26,041.88
Rate for Payer: Anthem Medicaid	$24,936.54
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$24,936.54
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$24,936.54
Rate for Payer: Dean Health Medicaid	$24,936.54
Rate for Payer: Independent Care Health Plan Medicaid	$23,132.02
Rate for Payer: Managed Health Services Medicaid	$26,041.88
Rate for Payer: Molina Healthcare Medicaid	$24,936.54
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$24,936.54
Rate for Payer: United Healthcare Medicaid	$24,936.54

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$19,904.06

Service Code	APR-DRG 6222
Min. Negotiated Rate	$17,680.03
Max. Negotiated Rate	$19,904.06
Rate for Payer: Anthem Medicaid	$19,059.24
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$19,059.24
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$19,059.24
Rate for Payer: Dean Health Medicaid	$19,059.24
Rate for Payer: Independent Care Health Plan Medicaid	$17,680.03
Rate for Payer: Managed Health Services Medicaid	$19,904.06
Rate for Payer: Molina Healthcare Medicaid	$19,059.24
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$19,059.24
Rate for Payer: United Healthcare Medicaid	$19,059.24

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$13,766.25

Service Code	APR-DRG 6221
Min. Negotiated Rate	$12,228.04
Max. Negotiated Rate	$13,766.25
Rate for Payer: Anthem Medicaid	$13,181.94
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$13,181.94
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$13,181.94
Rate for Payer: Dean Health Medicaid	$13,181.94
Rate for Payer: Independent Care Health Plan Medicaid	$12,228.04
Rate for Payer: Managed Health Services Medicaid	$13,766.25
Rate for Payer: Molina Healthcare Medicaid	$13,181.94
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$13,181.94
Rate for Payer: United Healthcare Medicaid	$13,181.94

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$28,409.32

Service Code	APR-DRG 6223
Min. Negotiated Rate	$25,234.93
Max. Negotiated Rate	$28,409.32
Rate for Payer: Anthem Medicaid	$27,203.49
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$27,203.49
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$27,203.49
Rate for Payer: Dean Health Medicaid	$27,203.49
Rate for Payer: Independent Care Health Plan Medicaid	$25,234.93
Rate for Payer: Managed Health Services Medicaid	$28,409.32
Rate for Payer: Molina Healthcare Medicaid	$27,203.49
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$27,203.49
Rate for Payer: United Healthcare Medicaid	$27,203.49

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$42,350.94

Service Code	APR-DRG 6224
Min. Negotiated Rate	$37,618.74
Max. Negotiated Rate	$42,350.94
Rate for Payer: Anthem Medicaid	$40,553.36
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$40,553.36
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$40,553.36
Rate for Payer: Dean Health Medicaid	$40,553.36
Rate for Payer: Independent Care Health Plan Medicaid	$37,618.74
Rate for Payer: Managed Health Services Medicaid	$42,350.94
Rate for Payer: Molina Healthcare Medicaid	$40,553.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$40,553.36
Rate for Payer: United Healthcare Medicaid	$40,553.36

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

Facility

$1,490.61

Service Code	APR-DRG 6402
Min. Negotiated Rate	$1,324.06
Max. Negotiated Rate	$1,490.61
Rate for Payer: Anthem Medicaid	$1,427.34
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,427.34
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,427.34
Rate for Payer: Dean Health Medicaid	$1,427.34
Rate for Payer: Independent Care Health Plan Medicaid	$1,324.06
Rate for Payer: Managed Health Services Medicaid	$1,490.61
Rate for Payer: Molina Healthcare Medicaid	$1,427.34
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,427.34
Rate for Payer: United Healthcare Medicaid	$1,427.34

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

Facility

$3,244.27

Service Code	APR-DRG 6403
Min. Negotiated Rate	$2,881.77
Max. Negotiated Rate	$3,244.27
Rate for Payer: Anthem Medicaid	$3,106.57
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3,106.57
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$3,106.57
Rate for Payer: Dean Health Medicaid	$3,106.57
Rate for Payer: Independent Care Health Plan Medicaid	$2,881.77
Rate for Payer: Managed Health Services Medicaid	$3,244.27
Rate for Payer: Molina Healthcare Medicaid	$3,106.57
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$3,106.57
Rate for Payer: United Healthcare Medicaid	$3,106.57

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

Facility

$18,062.72

Service Code	APR-DRG 6404
Min. Negotiated Rate	$16,044.43
Max. Negotiated Rate	$18,062.72
Rate for Payer: Anthem Medicaid	$17,296.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$17,296.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$17,296.05
Rate for Payer: Dean Health Medicaid	$17,296.05
Rate for Payer: Independent Care Health Plan Medicaid	$16,044.43
Rate for Payer: Managed Health Services Medicaid	$18,062.72
Rate for Payer: Molina Healthcare Medicaid	$17,296.05
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$17,296.05
Rate for Payer: United Healthcare Medicaid	$17,296.05

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

Facility

$964.51

Service Code	APR-DRG 6401
Min. Negotiated Rate	$856.74
Max. Negotiated Rate	$964.51
Rate for Payer: Anthem Medicaid	$923.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$923.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$923.58
Rate for Payer: Dean Health Medicaid	$923.58
Rate for Payer: Independent Care Health Plan Medicaid	$856.74
Rate for Payer: Managed Health Services Medicaid	$964.51
Rate for Payer: Molina Healthcare Medicaid	$923.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$923.58
Rate for Payer: United Healthcare Medicaid	$923.58

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$6,839.28

Service Code	APR-DRG 6361
Min. Negotiated Rate	$6,075.08
Max. Negotiated Rate	$6,839.28
Rate for Payer: Anthem Medicaid	$6,548.99
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$6,548.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$6,548.99
Rate for Payer: Dean Health Medicaid	$6,548.99
Rate for Payer: Independent Care Health Plan Medicaid	$6,075.08
Rate for Payer: Managed Health Services Medicaid	$6,839.28
Rate for Payer: Molina Healthcare Medicaid	$6,548.99
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$6,548.99
Rate for Payer: United Healthcare Medicaid	$6,548.99

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$23,148.34

Service Code	APR-DRG 6364
Min. Negotiated Rate	$20,561.80
Max. Negotiated Rate	$23,148.34
Rate for Payer: Anthem Medicaid	$22,165.81
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$22,165.81
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$22,165.81
Rate for Payer: Dean Health Medicaid	$22,165.81
Rate for Payer: Independent Care Health Plan Medicaid	$20,561.80
Rate for Payer: Managed Health Services Medicaid	$23,148.34
Rate for Payer: Molina Healthcare Medicaid	$22,165.81
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$22,165.81
Rate for Payer: United Healthcare Medicaid	$22,165.81

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$23,148.34

Service Code	APR-DRG 6363
Min. Negotiated Rate	$20,561.80
Max. Negotiated Rate	$23,148.34
Rate for Payer: Anthem Medicaid	$22,165.81
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$22,165.81
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$22,165.81
Rate for Payer: Dean Health Medicaid	$22,165.81
Rate for Payer: Independent Care Health Plan Medicaid	$20,561.80
Rate for Payer: Managed Health Services Medicaid	$23,148.34
Rate for Payer: Molina Healthcare Medicaid	$22,165.81
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$22,165.81
Rate for Payer: United Healthcare Medicaid	$22,165.81

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$11,135.75

Service Code	APR-DRG 6362
Min. Negotiated Rate	$9,891.47
Max. Negotiated Rate	$11,135.75
Rate for Payer: Anthem Medicaid	$10,663.10
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$10,663.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$10,663.10
Rate for Payer: Dean Health Medicaid	$10,663.10
Rate for Payer: Independent Care Health Plan Medicaid	$9,891.47
Rate for Payer: Managed Health Services Medicaid	$11,135.75
Rate for Payer: Molina Healthcare Medicaid	$10,663.10
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$10,663.10
Rate for Payer: United Healthcare Medicaid	$10,663.10

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$2,192.08

Service Code	APR-DRG 6331
Min. Negotiated Rate	$1,947.14
Max. Negotiated Rate	$2,192.08
Rate for Payer: Anthem Medicaid	$2,099.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,099.03
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,099.03
Rate for Payer: Dean Health Medicaid	$2,099.03
Rate for Payer: Independent Care Health Plan Medicaid	$1,947.14
Rate for Payer: Managed Health Services Medicaid	$2,192.08
Rate for Payer: Molina Healthcare Medicaid	$2,099.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,099.03
Rate for Payer: United Healthcare Medicaid	$2,099.03

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$24,726.63

Service Code	APR-DRG 6333
Min. Negotiated Rate	$21,963.74
Max. Negotiated Rate	$24,726.63
Rate for Payer: Anthem Medicaid	$23,677.11
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$23,677.11
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$23,677.11
Rate for Payer: Dean Health Medicaid	$23,677.11
Rate for Payer: Independent Care Health Plan Medicaid	$21,963.74
Rate for Payer: Managed Health Services Medicaid	$24,726.63
Rate for Payer: Molina Healthcare Medicaid	$23,677.11
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$23,677.11
Rate for Payer: United Healthcare Medicaid	$23,677.11

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$9,557.46

Service Code	APR-DRG 6332
Min. Negotiated Rate	$8,489.53
Max. Negotiated Rate	$9,557.46
Rate for Payer: Anthem Medicaid	$9,151.79
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$9,151.79
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$9,151.79
Rate for Payer: Dean Health Medicaid	$9,151.79
Rate for Payer: Independent Care Health Plan Medicaid	$8,489.53
Rate for Payer: Managed Health Services Medicaid	$9,557.46
Rate for Payer: Molina Healthcare Medicaid	$9,151.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$9,151.79
Rate for Payer: United Healthcare Medicaid	$9,151.79

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$65,148.54

Service Code	APR-DRG 6334
Min. Negotiated Rate	$57,869.00
Max. Negotiated Rate	$65,148.54
Rate for Payer: Anthem Medicaid	$62,383.32
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$62,383.32
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$62,383.32
Rate for Payer: Dean Health Medicaid	$62,383.32
Rate for Payer: Independent Care Health Plan Medicaid	$57,869.00
Rate for Payer: Managed Health Services Medicaid	$65,148.54
Rate for Payer: Molina Healthcare Medicaid	$62,383.32
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$62,383.32
Rate for Payer: United Healthcare Medicaid	$62,383.32

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$180,364.14

Service Code	APR-DRG 6304
Min. Negotiated Rate	$160,210.68
Max. Negotiated Rate	$180,364.14
Rate for Payer: Anthem Medicaid	$172,708.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$172,708.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$172,708.60
Rate for Payer: Dean Health Medicaid	$172,708.60
Rate for Payer: Independent Care Health Plan Medicaid	$160,210.68
Rate for Payer: Managed Health Services Medicaid	$180,364.14
Rate for Payer: Molina Healthcare Medicaid	$172,708.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$172,708.60
Rate for Payer: United Healthcare Medicaid	$172,708.60

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$23,499.07

Service Code	APR-DRG 6301
Min. Negotiated Rate	$20,873.34
Max. Negotiated Rate	$23,499.07
Rate for Payer: Anthem Medicaid	$22,501.66
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$22,501.66
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$22,501.66
Rate for Payer: Dean Health Medicaid	$22,501.66
Rate for Payer: Independent Care Health Plan Medicaid	$20,873.34
Rate for Payer: Managed Health Services Medicaid	$23,499.07
Rate for Payer: Molina Healthcare Medicaid	$22,501.66
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$22,501.66
Rate for Payer: United Healthcare Medicaid	$22,501.66

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$45,332.16

Service Code	APR-DRG 6302
Min. Negotiated Rate	$40,266.86
Max. Negotiated Rate	$45,332.16
Rate for Payer: Anthem Medicaid	$43,408.04
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$43,408.04
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$43,408.04
Rate for Payer: Dean Health Medicaid	$43,408.04
Rate for Payer: Independent Care Health Plan Medicaid	$40,266.86
Rate for Payer: Managed Health Services Medicaid	$45,332.16
Rate for Payer: Molina Healthcare Medicaid	$43,408.04
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$43,408.04
Rate for Payer: United Healthcare Medicaid	$43,408.04

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$99,432.64

Service Code	APR-DRG 6303
Min. Negotiated Rate	$88,322.27
Max. Negotiated Rate	$99,432.64
Rate for Payer: Anthem Medicaid	$95,212.23
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$95,212.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$95,212.23
Rate for Payer: Dean Health Medicaid	$95,212.23
Rate for Payer: Independent Care Health Plan Medicaid	$88,322.27
Rate for Payer: Managed Health Services Medicaid	$99,432.64
Rate for Payer: Molina Healthcare Medicaid	$95,212.23
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$95,212.23
Rate for Payer: United Healthcare Medicaid	$95,212.23

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$6,751.60

Service Code	APR-DRG 6311
Min. Negotiated Rate	$5,997.19
Max. Negotiated Rate	$6,751.60
Rate for Payer: Anthem Medicaid	$6,465.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$6,465.03
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$6,465.03
Rate for Payer: Dean Health Medicaid	$6,465.03
Rate for Payer: Independent Care Health Plan Medicaid	$5,997.19
Rate for Payer: Managed Health Services Medicaid	$6,751.60
Rate for Payer: Molina Healthcare Medicaid	$6,465.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$6,465.03
Rate for Payer: United Healthcare Medicaid	$6,465.03

Know your out-of-pocket cost for care.

All Charges