Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$37,936.08

Service Code	MSDRG 750
Min. Negotiated Rate	$11,808.74
Max. Negotiated Rate	$37,936.08
Rate for Payer: Aetna Managed Medicare	$11,808.74
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$32,200.78
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$24,681.63
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$23,449.16
Rate for Payer: Anthem Medicare Advantage	$11,808.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$11,808.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$11,808.74
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$11,808.74
Rate for Payer: Dean Health DHI/DHP/ASO	$26,030.72
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$11,808.74
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$27,580.80
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$11,808.74
Rate for Payer: Independent Care Health Plan Medicare	$11,808.74
Rate for Payer: Managed Health Services Medicare Advantage	$11,808.74
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$11,808.74
Rate for Payer: NAPHCARE Commercial	$17,713.11
Rate for Payer: Quartz Medicare Advantage	$11,808.74
Rate for Payer: The Alliance Commercial	$37,936.08
Rate for Payer: United Healthcare Medicare Advantage	$11,808.74
Rate for Payer: United Healthcare PPO	$21,472.01
Rate for Payer: Wellcare Medicare	$11,808.74

OTHER GASTROENTERITIS, NAUSEA AND VOMITING

Facility

$8,417.58

Service Code	APR-DRG 2493
Min. Negotiated Rate	$7,477.02
Max. Negotiated Rate	$8,417.58
Rate for Payer: Anthem Medicaid	$8,060.29
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$8,060.29
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$8,060.29
Rate for Payer: Dean Health Medicaid	$8,060.29
Rate for Payer: Independent Care Health Plan Medicaid	$7,477.02
Rate for Payer: Managed Health Services Medicaid	$8,417.58
Rate for Payer: Molina Healthcare Medicaid	$8,060.29
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$8,060.29
Rate for Payer: United Healthcare Medicaid	$8,060.29

OTHER GASTROENTERITIS, NAUSEA AND VOMITING

Facility

$15,519.91

Service Code	APR-DRG 2494
Min. Negotiated Rate	$13,785.75
Max. Negotiated Rate	$15,519.91
Rate for Payer: Anthem Medicaid	$14,861.17
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$14,861.17
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$14,861.17
Rate for Payer: Dean Health Medicaid	$14,861.17
Rate for Payer: Independent Care Health Plan Medicaid	$13,785.75
Rate for Payer: Managed Health Services Medicaid	$15,519.91
Rate for Payer: Molina Healthcare Medicaid	$14,861.17
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$14,861.17
Rate for Payer: United Healthcare Medicaid	$14,861.17

OTHER GASTROENTERITIS, NAUSEA AND VOMITING

Facility

$5,699.40

Service Code	APR-DRG 2492
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

OTHER GASTROENTERITIS, NAUSEA AND VOMITING

Facility

$4,559.52

Service Code	APR-DRG 2491
Min. Negotiated Rate	$4,050.05
Max. Negotiated Rate	$4,559.52
Rate for Payer: Anthem Medicaid	$4,365.99
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$4,365.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4,365.99
Rate for Payer: Dean Health Medicaid	$4,365.99
Rate for Payer: Independent Care Health Plan Medicaid	$4,050.05
Rate for Payer: Managed Health Services Medicaid	$4,559.52
Rate for Payer: Molina Healthcare Medicaid	$4,365.99
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4,365.99
Rate for Payer: United Healthcare Medicaid	$4,365.99

OTHER GASTROINTESTINAL SYSTEM DIAGNOSES

Facility

$40.34

Service Code	EAPG 00624
Min. Negotiated Rate	$38.79
Max. Negotiated Rate	$40.34
Rate for Payer: Anthem Medicaid	$38.79
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$38.79
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$38.79
Rate for Payer: Dean Health Medicaid	$38.79
Rate for Payer: Independent Care Health Plan Medicaid	$38.79
Rate for Payer: Managed Health Services Medicaid	$40.34
Rate for Payer: Molina Healthcare Medicaid	$38.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$38.79
Rate for Payer: United Healthcare Medicaid	$38.79

OTHER GYNECOLOGICAL PROCEDURES

Facility

$112.78

Service Code	EAPG 00209
Min. Negotiated Rate	$108.44
Max. Negotiated Rate	$112.78
Rate for Payer: Anthem Medicaid	$108.44
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$108.44
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$108.44
Rate for Payer: Dean Health Medicaid	$108.44
Rate for Payer: Independent Care Health Plan Medicaid	$108.44
Rate for Payer: Managed Health Services Medicaid	$112.78
Rate for Payer: Molina Healthcare Medicaid	$108.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$108.44
Rate for Payer: United Healthcare Medicaid	$108.44

OTHER GYN PROCEDURES FOR MALIGNANCY

Facility

$12,012.58

Service Code	APR-DRG 5201
Min. Negotiated Rate	$10,670.33
Max. Negotiated Rate	$12,012.58
Rate for Payer: Anthem Medicaid	$11,502.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$11,502.71
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$11,502.71
Rate for Payer: Dean Health Medicaid	$11,502.71
Rate for Payer: Independent Care Health Plan Medicaid	$10,670.33
Rate for Payer: Managed Health Services Medicaid	$12,012.58
Rate for Payer: Molina Healthcare Medicaid	$11,502.71
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$11,502.71
Rate for Payer: United Healthcare Medicaid	$11,502.71

OTHER GYN PROCEDURES FOR MALIGNANCY

Facility

$15,344.54

Service Code	APR-DRG 5202
Min. Negotiated Rate	$13,629.98
Max. Negotiated Rate	$15,344.54
Rate for Payer: Anthem Medicaid	$14,693.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$14,693.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$14,693.25
Rate for Payer: Dean Health Medicaid	$14,693.25
Rate for Payer: Independent Care Health Plan Medicaid	$13,629.98
Rate for Payer: Managed Health Services Medicaid	$15,344.54
Rate for Payer: Molina Healthcare Medicaid	$14,693.25
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$14,693.25
Rate for Payer: United Healthcare Medicaid	$14,693.25

OTHER GYN PROCEDURES FOR MALIGNANCY

Facility

$23,586.75

Service Code	APR-DRG 5203
Min. Negotiated Rate	$20,951.23
Max. Negotiated Rate	$23,586.75
Rate for Payer: Anthem Medicaid	$22,585.62
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$22,585.62
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$22,585.62
Rate for Payer: Dean Health Medicaid	$22,585.62
Rate for Payer: Independent Care Health Plan Medicaid	$20,951.23
Rate for Payer: Managed Health Services Medicaid	$23,586.75
Rate for Payer: Molina Healthcare Medicaid	$22,585.62
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$22,585.62
Rate for Payer: United Healthcare Medicaid	$22,585.62

OTHER GYN PROCEDURES FOR MALIGNANCY

Facility

$44,367.65

Service Code	APR-DRG 5204
Min. Negotiated Rate	$39,410.11
Max. Negotiated Rate	$44,367.65
Rate for Payer: Anthem Medicaid	$42,484.47
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$42,484.47
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$42,484.47
Rate for Payer: Dean Health Medicaid	$42,484.47
Rate for Payer: Independent Care Health Plan Medicaid	$39,410.11
Rate for Payer: Managed Health Services Medicaid	$44,367.65
Rate for Payer: Molina Healthcare Medicaid	$42,484.47
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$42,484.47
Rate for Payer: United Healthcare Medicaid	$42,484.47

OTHER HEART ASSIST SYSTEM IMPLANT

Facility

$282,766.64

Service Code	MSDRG 215
Min. Negotiated Rate	$76,759.45
Max. Negotiated Rate	$282,766.64
Rate for Payer: Aetna Managed Medicare	$76,759.45
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$217,253.77
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$166,523.26
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$158,207.97
Rate for Payer: Anthem Medicare Advantage	$76,759.45
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$76,759.45
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$76,759.45
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$76,759.45
Rate for Payer: Dean Health DHI/DHP/ASO	$175,625.35
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$76,759.45
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$207,156.14
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$76,759.45
Rate for Payer: Independent Care Health Plan Medicare	$76,759.45
Rate for Payer: Managed Health Services Medicare Advantage	$76,759.45
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$76,759.45
Rate for Payer: NAPHCARE Commercial	$115,139.17
Rate for Payer: Quartz Medicare Advantage	$76,759.45
Rate for Payer: The Alliance Commercial	$282,766.64
Rate for Payer: United Healthcare Medicare Advantage	$76,759.45
Rate for Payer: United Healthcare PPO	$161,273.72
Rate for Payer: Wellcare Medicare	$76,759.45

OTHER HEMATOLOGICAL DIAGNOSES

Facility

$43.01

Service Code	EAPG 00780
Min. Negotiated Rate	$41.35
Max. Negotiated Rate	$43.01
Rate for Payer: Anthem Medicaid	$41.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$41.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$41.35
Rate for Payer: Dean Health Medicaid	$41.35
Rate for Payer: Independent Care Health Plan Medicaid	$41.35
Rate for Payer: Managed Health Services Medicaid	$43.01
Rate for Payer: Molina Healthcare Medicaid	$41.35
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$41.35
Rate for Payer: United Healthcare Medicaid	$41.35

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC

Facility

$59,273.76

Service Code	MSDRG 424
Min. Negotiated Rate	$17,262.14
Max. Negotiated Rate	$59,273.76
Rate for Payer: Aetna Managed Medicare	$17,262.14
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$47,738.23
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$36,590.96
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$34,763.81
Rate for Payer: Anthem Medicare Advantage	$17,262.14
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$17,262.14
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$17,262.14
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$17,262.14
Rate for Payer: Dean Health DHI/DHP/ASO	$38,591.01
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$17,262.14
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$42,330.44
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$17,262.14
Rate for Payer: Independent Care Health Plan Medicare	$17,262.14
Rate for Payer: Managed Health Services Medicare Advantage	$17,262.14
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$17,262.14
Rate for Payer: NAPHCARE Commercial	$25,893.21
Rate for Payer: Quartz Medicare Advantage	$17,262.14
Rate for Payer: The Alliance Commercial	$59,273.76
Rate for Payer: United Healthcare Medicare Advantage	$17,262.14
Rate for Payer: United Healthcare PPO	$32,954.79
Rate for Payer: Wellcare Medicare	$17,262.14

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC

Facility

$108,466.80

Service Code	MSDRG 423
Min. Negotiated Rate	$32,311.28
Max. Negotiated Rate	$108,466.80
Rate for Payer: Aetna Managed Medicare	$32,311.28
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$90,615.14
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$69,455.77
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$65,987.52
Rate for Payer: Anthem Medicare Advantage	$32,311.28
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$32,311.28
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$32,311.28
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$32,311.28
Rate for Payer: Dean Health DHI/DHP/ASO	$73,252.19
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$32,311.28
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$79,313.05
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$32,311.28
Rate for Payer: Independent Care Health Plan Medicare	$32,311.28
Rate for Payer: Managed Health Services Medicare Advantage	$32,311.28
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$32,311.28
Rate for Payer: NAPHCARE Commercial	$48,466.92
Rate for Payer: Quartz Medicare Advantage	$32,311.28
Rate for Payer: The Alliance Commercial	$108,466.80
Rate for Payer: United Healthcare Medicare Advantage	$32,311.28
Rate for Payer: United Healthcare PPO	$61,746.22
Rate for Payer: Wellcare Medicare	$32,311.28

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC

Facility

$44,624.32

Service Code	MSDRG 425
Min. Negotiated Rate	$11,996.38
Max. Negotiated Rate	$44,624.32
Rate for Payer: Aetna Managed Medicare	$11,996.38
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$32,735.35
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$25,091.38
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$23,838.45
Rate for Payer: Anthem Medicare Advantage	$11,996.38
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$11,996.38
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$11,996.38
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$11,996.38
Rate for Payer: Dean Health DHI/DHP/ASO	$26,462.86
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$11,996.38
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$32,486.53
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$11,996.38
Rate for Payer: Independent Care Health Plan Medicare	$11,996.38
Rate for Payer: Managed Health Services Medicare Advantage	$11,996.38
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$11,996.38
Rate for Payer: NAPHCARE Commercial	$17,994.57
Rate for Payer: Quartz Medicare Advantage	$11,996.38
Rate for Payer: The Alliance Commercial	$44,624.32
Rate for Payer: United Healthcare Medicare Advantage	$11,996.38
Rate for Payer: United Healthcare PPO	$25,291.18
Rate for Payer: Wellcare Medicare	$11,996.38

OTHER HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES

Facility

$11,749.54

Service Code	APR-DRG 2641
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

OTHER HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES

Facility

$39,895.81

Service Code	APR-DRG 2644
Min. Negotiated Rate	$35,437.95
Max. Negotiated Rate	$39,895.81
Rate for Payer: Anthem Medicaid	$38,202.44
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$38,202.44
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$38,202.44
Rate for Payer: Dean Health Medicaid	$38,202.44
Rate for Payer: Independent Care Health Plan Medicaid	$35,437.95
Rate for Payer: Managed Health Services Medicaid	$39,895.81
Rate for Payer: Molina Healthcare Medicaid	$38,202.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$38,202.44
Rate for Payer: United Healthcare Medicaid	$38,202.44

OTHER HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES

Facility

$14,818.44

Service Code	APR-DRG 2642
Min. Negotiated Rate	$13,162.67
Max. Negotiated Rate	$14,818.44
Rate for Payer: Anthem Medicaid	$14,189.48
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$14,189.48
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$14,189.48
Rate for Payer: Dean Health Medicaid	$14,189.48
Rate for Payer: Independent Care Health Plan Medicaid	$13,162.67
Rate for Payer: Managed Health Services Medicaid	$14,818.44
Rate for Payer: Molina Healthcare Medicaid	$14,189.48
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$14,189.48
Rate for Payer: United Healthcare Medicaid	$14,189.48

OTHER HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES

Facility

$22,183.82

Service Code	APR-DRG 2643
Min. Negotiated Rate	$19,705.06
Max. Negotiated Rate	$22,183.82
Rate for Payer: Anthem Medicaid	$21,242.23
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$21,242.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$21,242.23
Rate for Payer: Dean Health Medicaid	$21,242.23
Rate for Payer: Independent Care Health Plan Medicaid	$19,705.06
Rate for Payer: Managed Health Services Medicaid	$22,183.82
Rate for Payer: Molina Healthcare Medicaid	$21,242.23
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$21,242.23
Rate for Payer: United Healthcare Medicaid	$21,242.23

OTHER HEPATOBILIARY SYSTEM DIAGNOSES

Facility

$40.06

Service Code	EAPG 00639
Min. Negotiated Rate	$38.52
Max. Negotiated Rate	$40.06
Rate for Payer: Anthem Medicaid	$38.52
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$38.52
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$38.52
Rate for Payer: Dean Health Medicaid	$38.52
Rate for Payer: Independent Care Health Plan Medicaid	$38.52
Rate for Payer: Managed Health Services Medicaid	$40.06
Rate for Payer: Molina Healthcare Medicaid	$38.52
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$38.52
Rate for Payer: United Healthcare Medicaid	$38.52

OTHER INFECTIOUS AND PARASITIC DISEASES

Facility

$4,822.57

Service Code	APR-DRG 7241
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

OTHER INFECTIOUS AND PARASITIC DISEASES

Facility

$6,926.96

Service Code	APR-DRG 7242
Min. Negotiated Rate	$6,152.96
Max. Negotiated Rate	$6,926.96
Rate for Payer: Anthem Medicaid	$6,632.95
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$6,632.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$6,632.95
Rate for Payer: Dean Health Medicaid	$6,632.95
Rate for Payer: Independent Care Health Plan Medicaid	$6,152.96
Rate for Payer: Managed Health Services Medicaid	$6,926.96
Rate for Payer: Molina Healthcare Medicaid	$6,632.95
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$6,632.95
Rate for Payer: United Healthcare Medicaid	$6,632.95

OTHER INFECTIOUS AND PARASITIC DISEASES

Facility

$34.16

Service Code	EAPG 00809
Min. Negotiated Rate	$32.85
Max. Negotiated Rate	$34.16
Rate for Payer: Anthem Medicaid	$32.85
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$32.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$32.85
Rate for Payer: Dean Health Medicaid	$32.85
Rate for Payer: Independent Care Health Plan Medicaid	$32.85
Rate for Payer: Managed Health Services Medicaid	$34.16
Rate for Payer: Molina Healthcare Medicaid	$32.85
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$32.85
Rate for Payer: United Healthcare Medicaid	$32.85

OTHER INFECTIOUS AND PARASITIC DISEASES

Facility

$21,394.68

Service Code	APR-DRG 7244
Min. Negotiated Rate	$19,004.09
Max. Negotiated Rate	$21,394.68
Rate for Payer: Anthem Medicaid	$20,486.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$20,486.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$20,486.58
Rate for Payer: Dean Health Medicaid	$20,486.58
Rate for Payer: Independent Care Health Plan Medicaid	$19,004.09
Rate for Payer: Managed Health Services Medicaid	$21,394.68
Rate for Payer: Molina Healthcare Medicaid	$20,486.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$20,486.58
Rate for Payer: United Healthcare Medicaid	$20,486.58

Know your out-of-pocket cost for care.

All Charges