Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

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

$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 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: United Healthcare Medicaid	$172,708.60
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

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$58,484.63

Service Code	APR-DRG 6313
Min. Negotiated Rate	$51,949.70
Max. Negotiated Rate	$58,484.63
Rate for Payer: Anthem Medicaid	$56,002.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$56,002.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$56,002.25
Rate for Payer: Dean Health Medicaid	$56,002.25
Rate for Payer: Independent Care Health Plan Medicaid	$51,949.70
Rate for Payer: Managed Health Services Medicaid	$58,484.63
Rate for Payer: Molina Healthcare Medicaid	$56,002.25
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$56,002.25
Rate for Payer: United Healthcare Medicaid	$56,002.25

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

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$198,865.27

Service Code	APR-DRG 6314
Min. Negotiated Rate	$176,644.54
Max. Negotiated Rate	$198,865.27
Rate for Payer: Anthem Medicaid	$190,424.46
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$190,424.46
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$190,424.46
Rate for Payer: Dean Health Medicaid	$190,424.46
Rate for Payer: Independent Care Health Plan Medicaid	$176,644.54
Rate for Payer: Managed Health Services Medicaid	$198,865.27
Rate for Payer: Molina Healthcare Medicaid	$190,424.46
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$190,424.46
Rate for Payer: United Healthcare Medicaid	$190,424.46

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$33,670.31

Service Code	APR-DRG 6312
Min. Negotiated Rate	$29,908.07
Max. Negotiated Rate	$33,670.31
Rate for Payer: Anthem Medicaid	$32,241.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$32,241.18
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$32,241.18
Rate for Payer: Dean Health Medicaid	$32,241.18
Rate for Payer: Independent Care Health Plan Medicaid	$29,908.07
Rate for Payer: Managed Health Services Medicaid	$33,670.31
Rate for Payer: Molina Healthcare Medicaid	$32,241.18
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$32,241.18
Rate for Payer: United Healthcare Medicaid	$32,241.18

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$27,532.49

Service Code	APR-DRG 6394
Min. Negotiated Rate	$24,456.08
Max. Negotiated Rate	$27,532.49
Rate for Payer: Anthem Medicaid	$26,363.88
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$26,363.88
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$26,363.88
Rate for Payer: Dean Health Medicaid	$26,363.88
Rate for Payer: Independent Care Health Plan Medicaid	$24,456.08
Rate for Payer: Managed Health Services Medicaid	$27,532.49
Rate for Payer: Molina Healthcare Medicaid	$26,363.88
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$26,363.88
Rate for Payer: United Healthcare Medicaid	$26,363.88

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$18,325.77

Service Code	APR-DRG 6393
Min. Negotiated Rate	$16,278.09
Max. Negotiated Rate	$18,325.77
Rate for Payer: Anthem Medicaid	$17,547.93
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$17,547.93
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$17,547.93
Rate for Payer: Dean Health Medicaid	$17,547.93
Rate for Payer: Independent Care Health Plan Medicaid	$16,278.09
Rate for Payer: Managed Health Services Medicaid	$18,325.77
Rate for Payer: Molina Healthcare Medicaid	$17,547.93
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$17,547.93
Rate for Payer: United Healthcare Medicaid	$17,547.93

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$3,244.27

Service Code	APR-DRG 6391
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 WITH OTHER SIGNIFICANT CONDITION

Facility

$6,225.50

Service Code	APR-DRG 6392
Min. Negotiated Rate	$5,529.88
Max. Negotiated Rate	$6,225.50
Rate for Payer: Anthem Medicaid	$5,961.26
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$5,961.26
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5,961.26
Rate for Payer: Dean Health Medicaid	$5,961.26
Rate for Payer: Independent Care Health Plan Medicaid	$5,529.88
Rate for Payer: Managed Health Services Medicaid	$6,225.50
Rate for Payer: Molina Healthcare Medicaid	$5,961.26
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5,961.26
Rate for Payer: United Healthcare Medicaid	$5,961.26

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

Facility

$39,457.39

Service Code	APR-DRG 6344
Min. Negotiated Rate	$35,048.52
Max. Negotiated Rate	$39,457.39
Rate for Payer: Anthem Medicaid	$37,782.63
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$37,782.63
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$37,782.63
Rate for Payer: Dean Health Medicaid	$37,782.63
Rate for Payer: Independent Care Health Plan Medicaid	$35,048.52
Rate for Payer: Managed Health Services Medicaid	$39,457.39
Rate for Payer: Molina Healthcare Medicaid	$37,782.63
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$37,782.63
Rate for Payer: United Healthcare Medicaid	$37,782.63

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

Facility

$20,605.53

Service Code	APR-DRG 6343
Min. Negotiated Rate	$18,303.12
Max. Negotiated Rate	$20,605.53
Rate for Payer: Anthem Medicaid	$19,730.93
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$19,730.93
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$19,730.93
Rate for Payer: Dean Health Medicaid	$19,730.93
Rate for Payer: Independent Care Health Plan Medicaid	$18,303.12
Rate for Payer: Managed Health Services Medicaid	$20,605.53
Rate for Payer: Molina Healthcare Medicaid	$19,730.93
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$19,730.93
Rate for Payer: United Healthcare Medicaid	$19,730.93

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

Facility

$6,313.18

Service Code	APR-DRG 6341
Min. Negotiated Rate	$5,607.76
Max. Negotiated Rate	$6,313.18
Rate for Payer: Anthem Medicaid	$6,045.22
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$6,045.22
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$6,045.22
Rate for Payer: Dean Health Medicaid	$6,045.22
Rate for Payer: Independent Care Health Plan Medicaid	$5,607.76
Rate for Payer: Managed Health Services Medicaid	$6,313.18
Rate for Payer: Molina Healthcare Medicaid	$6,045.22
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$6,045.22
Rate for Payer: United Healthcare Medicaid	$6,045.22

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

Facility

$10,346.61

Service Code	APR-DRG 6342
Min. Negotiated Rate	$9,190.50
Max. Negotiated Rate	$10,346.61
Rate for Payer: Anthem Medicaid	$9,907.45
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$9,907.45
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$9,907.45
Rate for Payer: Dean Health Medicaid	$9,907.45
Rate for Payer: Independent Care Health Plan Medicaid	$9,190.50
Rate for Payer: Managed Health Services Medicaid	$10,346.61
Rate for Payer: Molina Healthcare Medicaid	$9,907.45
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$9,907.45
Rate for Payer: United Healthcare Medicaid	$9,907.45

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$146,781.51

Service Code	APR-DRG 5913
Min. Negotiated Rate	$130,380.49
Max. Negotiated Rate	$146,781.51
Rate for Payer: Anthem Medicaid	$140,551.38
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$140,551.38
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$140,551.38
Rate for Payer: Dean Health Medicaid	$140,551.38
Rate for Payer: Independent Care Health Plan Medicaid	$130,380.49
Rate for Payer: Managed Health Services Medicaid	$146,781.51
Rate for Payer: Molina Healthcare Medicaid	$140,551.38
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$140,551.38
Rate for Payer: United Healthcare Medicaid	$140,551.38

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$26,743.35

Service Code	APR-DRG 5911
Min. Negotiated Rate	$23,755.11
Max. Negotiated Rate	$26,743.35
Rate for Payer: Anthem Medicaid	$25,608.23
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$25,608.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$25,608.23
Rate for Payer: Dean Health Medicaid	$25,608.23
Rate for Payer: Independent Care Health Plan Medicaid	$23,755.11
Rate for Payer: Managed Health Services Medicaid	$26,743.35
Rate for Payer: Molina Healthcare Medicaid	$25,608.23
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$25,608.23
Rate for Payer: United Healthcare Medicaid	$25,608.23

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$125,912.93

Service Code	APR-DRG 5912
Min. Negotiated Rate	$111,843.72
Max. Negotiated Rate	$125,912.93
Rate for Payer: Anthem Medicaid	$120,568.57
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$120,568.57
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$120,568.57
Rate for Payer: Dean Health Medicaid	$120,568.57
Rate for Payer: Independent Care Health Plan Medicaid	$111,843.72
Rate for Payer: Managed Health Services Medicaid	$125,912.93
Rate for Payer: Molina Healthcare Medicaid	$120,568.57
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$120,568.57
Rate for Payer: United Healthcare Medicaid	$120,568.57

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$194,568.80

Service Code	APR-DRG 5914
Min. Negotiated Rate	$172,828.15
Max. Negotiated Rate	$194,568.80
Rate for Payer: Anthem Medicaid	$186,310.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$186,310.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$186,310.35
Rate for Payer: Dean Health Medicaid	$186,310.35
Rate for Payer: Independent Care Health Plan Medicaid	$172,828.15
Rate for Payer: Managed Health Services Medicaid	$194,568.80
Rate for Payer: Molina Healthcare Medicaid	$186,310.35
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$186,310.35
Rate for Payer: United Healthcare Medicaid	$186,310.35

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

$138,363.93

Service Code	APR-DRG 5893
Min. Negotiated Rate	$122,903.48
Max. Negotiated Rate	$138,363.93
Rate for Payer: Anthem Medicaid	$132,491.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$132,491.09
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$132,491.09
Rate for Payer: Dean Health Medicaid	$132,491.09
Rate for Payer: Independent Care Health Plan Medicaid	$122,903.48
Rate for Payer: Managed Health Services Medicaid	$138,363.93
Rate for Payer: Molina Healthcare Medicaid	$132,491.09
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$132,491.09
Rate for Payer: United Healthcare Medicaid	$132,491.09

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

$138,363.93

Service Code	APR-DRG 5892
Min. Negotiated Rate	$122,903.48
Max. Negotiated Rate	$138,363.93
Rate for Payer: Anthem Medicaid	$132,491.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$132,491.09
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$132,491.09
Rate for Payer: Dean Health Medicaid	$132,491.09
Rate for Payer: Independent Care Health Plan Medicaid	$122,903.48
Rate for Payer: Managed Health Services Medicaid	$138,363.93
Rate for Payer: Molina Healthcare Medicaid	$132,491.09
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$132,491.09
Rate for Payer: United Healthcare Medicaid	$132,491.09

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

$2,893.54

Service Code	APR-DRG 5894
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 < 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

$138,363.93

Service Code	APR-DRG 5891
Min. Negotiated Rate	$122,903.48
Max. Negotiated Rate	$138,363.93
Rate for Payer: Anthem Medicaid	$132,491.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$132,491.09
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$132,491.09
Rate for Payer: Dean Health Medicaid	$132,491.09
Rate for Payer: Independent Care Health Plan Medicaid	$122,903.48
Rate for Payer: Managed Health Services Medicaid	$138,363.93
Rate for Payer: Molina Healthcare Medicaid	$132,491.09
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$132,491.09
Rate for Payer: United Healthcare Medicaid	$132,491.09

Know your out-of-pocket cost for care.

All Charges