Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$51,710.88

Service Code	MSDRG 803
Min. Negotiated Rate	$14,742.60
Max. Negotiated Rate	$51,710.88
Rate for Payer: Aetna Managed Medicare	$14,742.60
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$40,559.71
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$31,088.69
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$29,536.29
Rate for Payer: Anthem Medicare Advantage	$14,742.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$14,742.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$14,742.60
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$14,742.60
Rate for Payer: Dean Health DHI/DHP/ASO	$32,787.98
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$14,742.60
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$37,684.30
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$14,742.60
Rate for Payer: Independent Care Health Plan Medicare	$14,742.60
Rate for Payer: Managed Health Services Medicare Advantage	$14,742.60
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$14,742.60
Rate for Payer: NAPHCARE Commercial	$22,113.90
Rate for Payer: Quartz Medicare Advantage	$14,742.60
Rate for Payer: The Alliance Commercial	$51,710.88
Rate for Payer: United Healthcare Medicare Advantage	$14,742.60
Rate for Payer: United Healthcare PPO	$29,337.70
Rate for Payer: Wellcare Medicare	$14,742.60

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$95,193.28

Service Code	MSDRG 802
Min. Negotiated Rate	$31,017.80
Max. Negotiated Rate	$95,193.28
Rate for Payer: Aetna Managed Medicare	$31,017.80
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$86,929.87
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$66,631.04
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$63,303.84
Rate for Payer: Anthem Medicare Advantage	$31,017.80
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$31,017.80
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$31,017.80
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$31,017.80
Rate for Payer: Dean Health DHI/DHP/ASO	$70,273.07
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$31,017.80
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$68,755.28
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$31,017.80
Rate for Payer: Independent Care Health Plan Medicare	$31,017.80
Rate for Payer: Managed Health Services Medicare Advantage	$31,017.80
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$31,017.80
Rate for Payer: NAPHCARE Commercial	$46,526.70
Rate for Payer: Quartz Medicare Advantage	$31,017.80
Rate for Payer: The Alliance Commercial	$95,193.28
Rate for Payer: United Healthcare Medicare Advantage	$31,017.80
Rate for Payer: United Healthcare PPO	$53,526.87
Rate for Payer: Wellcare Medicare	$31,017.80

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$33,800.00

Service Code	MSDRG 804
Min. Negotiated Rate	$10,891.29
Max. Negotiated Rate	$33,800.00
Rate for Payer: Aetna Managed Medicare	$10,891.29
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$29,586.84
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$22,678.07
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$21,545.65
Rate for Payer: Anthem Medicare Advantage	$10,891.29
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$10,891.29
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$10,891.29
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$10,891.29
Rate for Payer: Dean Health DHI/DHP/ASO	$23,917.64
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$10,891.29
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$24,546.91
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$10,891.29
Rate for Payer: Independent Care Health Plan Medicare	$10,891.29
Rate for Payer: Managed Health Services Medicare Advantage	$10,891.29
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$10,891.29
Rate for Payer: NAPHCARE Commercial	$16,336.93
Rate for Payer: Quartz Medicare Advantage	$10,891.29
Rate for Payer: The Alliance Commercial	$33,800.00
Rate for Payer: United Healthcare Medicare Advantage	$10,891.29
Rate for Payer: United Healthcare PPO	$19,110.08
Rate for Payer: Wellcare Medicare	$10,891.29

OTHER PATHOLOGICAL FRACTURES W/O MUSCULOSKELETAL MALIGNANCY

Facility

$60.87

Service Code	EAPG 00649
Min. Negotiated Rate	$58.52
Max. Negotiated Rate	$60.87
Rate for Payer: Anthem Medicaid	$58.52
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$58.52
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$58.52
Rate for Payer: Dean Health Medicaid	$58.52
Rate for Payer: Independent Care Health Plan Medicaid	$58.52
Rate for Payer: Managed Health Services Medicaid	$60.87
Rate for Payer: Molina Healthcare Medicaid	$58.52
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$58.52
Rate for Payer: United Healthcare Medicaid	$58.52

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$20,079.43

Service Code	APR-DRG 0292
Min. Negotiated Rate	$17,835.80
Max. Negotiated Rate	$20,079.43
Rate for Payer: Anthem Medicaid	$19,227.16
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$19,227.16
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$19,227.16
Rate for Payer: Dean Health Medicaid	$19,227.16
Rate for Payer: Independent Care Health Plan Medicaid	$17,835.80
Rate for Payer: Managed Health Services Medicaid	$20,079.43
Rate for Payer: Molina Healthcare Medicaid	$19,227.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$19,227.16
Rate for Payer: United Healthcare Medicaid	$19,227.16

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$28,847.74

Service Code	APR-DRG 0293
Min. Negotiated Rate	$25,624.36
Max. Negotiated Rate	$28,847.74
Rate for Payer: Anthem Medicaid	$27,623.30
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$27,623.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$27,623.30
Rate for Payer: Dean Health Medicaid	$27,623.30
Rate for Payer: Independent Care Health Plan Medicaid	$25,624.36
Rate for Payer: Managed Health Services Medicaid	$28,847.74
Rate for Payer: Molina Healthcare Medicaid	$27,623.30
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$27,623.30
Rate for Payer: United Healthcare Medicaid	$27,623.30

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$38,492.88

Service Code	APR-DRG 0294
Min. Negotiated Rate	$34,191.78
Max. Negotiated Rate	$38,492.88
Rate for Payer: Anthem Medicaid	$36,859.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$36,859.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$36,859.05
Rate for Payer: Dean Health Medicaid	$36,859.05
Rate for Payer: Independent Care Health Plan Medicaid	$34,191.78
Rate for Payer: Managed Health Services Medicaid	$38,492.88
Rate for Payer: Molina Healthcare Medicaid	$36,859.05
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$36,859.05
Rate for Payer: United Healthcare Medicaid	$36,859.05

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$16,046.01

Service Code	APR-DRG 0291
Min. Negotiated Rate	$14,253.06
Max. Negotiated Rate	$16,046.01
Rate for Payer: Anthem Medicaid	$15,364.94
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$15,364.94
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$15,364.94
Rate for Payer: Dean Health Medicaid	$15,364.94
Rate for Payer: Independent Care Health Plan Medicaid	$14,253.06
Rate for Payer: Managed Health Services Medicaid	$16,046.01
Rate for Payer: Molina Healthcare Medicaid	$15,364.94
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$15,364.94
Rate for Payer: United Healthcare Medicaid	$15,364.94

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$14,467.71

Service Code	APR-DRG 1821
Min. Negotiated Rate	$12,851.12
Max. Negotiated Rate	$14,467.71
Rate for Payer: Anthem Medicaid	$13,853.63
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$13,853.63
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$13,853.63
Rate for Payer: Dean Health Medicaid	$13,853.63
Rate for Payer: Independent Care Health Plan Medicaid	$12,851.12
Rate for Payer: Managed Health Services Medicaid	$14,467.71
Rate for Payer: Molina Healthcare Medicaid	$13,853.63
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$13,853.63
Rate for Payer: United Healthcare Medicaid	$13,853.63

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$17,799.67

Service Code	APR-DRG 1822
Min. Negotiated Rate	$15,810.78
Max. Negotiated Rate	$17,799.67
Rate for Payer: Anthem Medicaid	$17,044.16
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$17,044.16
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$17,044.16
Rate for Payer: Dean Health Medicaid	$17,044.16
Rate for Payer: Independent Care Health Plan Medicaid	$15,810.78
Rate for Payer: Managed Health Services Medicaid	$17,799.67
Rate for Payer: Molina Healthcare Medicaid	$17,044.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$17,044.16
Rate for Payer: United Healthcare Medicaid	$17,044.16

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$22,709.92

Service Code	APR-DRG 1823
Min. Negotiated Rate	$20,172.37
Max. Negotiated Rate	$22,709.92
Rate for Payer: Anthem Medicaid	$21,746.00
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$21,746.00
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$21,746.00
Rate for Payer: Dean Health Medicaid	$21,746.00
Rate for Payer: Independent Care Health Plan Medicaid	$20,172.37
Rate for Payer: Managed Health Services Medicaid	$22,709.92
Rate for Payer: Molina Healthcare Medicaid	$21,746.00
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$21,746.00
Rate for Payer: United Healthcare Medicaid	$21,746.00

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$35,511.66

Service Code	APR-DRG 1824
Min. Negotiated Rate	$31,543.67
Max. Negotiated Rate	$35,511.66
Rate for Payer: Anthem Medicaid	$34,004.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$34,004.37
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$34,004.37
Rate for Payer: Dean Health Medicaid	$34,004.37
Rate for Payer: Independent Care Health Plan Medicaid	$31,543.67
Rate for Payer: Managed Health Services Medicaid	$35,511.66
Rate for Payer: Molina Healthcare Medicaid	$34,004.37
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$34,004.37
Rate for Payer: United Healthcare Medicaid	$34,004.37

OTHER PNEUMONIA

Facility

$5,787.08

Service Code	APR-DRG 1392
Min. Negotiated Rate	$5,140.45
Max. Negotiated Rate	$5,787.08
Rate for Payer: Anthem Medicaid	$5,541.45
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$5,541.45
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5,541.45
Rate for Payer: Dean Health Medicaid	$5,541.45
Rate for Payer: Independent Care Health Plan Medicaid	$5,140.45
Rate for Payer: Managed Health Services Medicaid	$5,787.08
Rate for Payer: Molina Healthcare Medicaid	$5,541.45
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5,541.45
Rate for Payer: United Healthcare Medicaid	$5,541.45

OTHER PNEUMONIA

Facility

$14,292.35

Service Code	APR-DRG 1394
Min. Negotiated Rate	$12,695.35
Max. Negotiated Rate	$14,292.35
Rate for Payer: Anthem Medicaid	$13,685.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$13,685.71
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$13,685.71
Rate for Payer: Dean Health Medicaid	$13,685.71
Rate for Payer: Independent Care Health Plan Medicaid	$12,695.35
Rate for Payer: Managed Health Services Medicaid	$14,292.35
Rate for Payer: Molina Healthcare Medicaid	$13,685.71
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$13,685.71
Rate for Payer: United Healthcare Medicaid	$13,685.71

OTHER PNEUMONIA

Facility

$8,768.31

Service Code	APR-DRG 1393
Min. Negotiated Rate	$7,788.56
Max. Negotiated Rate	$8,768.31
Rate for Payer: Anthem Medicaid	$8,396.14
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$8,396.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$8,396.14
Rate for Payer: Dean Health Medicaid	$8,396.14
Rate for Payer: Independent Care Health Plan Medicaid	$7,788.56
Rate for Payer: Managed Health Services Medicaid	$8,768.31
Rate for Payer: Molina Healthcare Medicaid	$8,396.14
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$8,396.14
Rate for Payer: United Healthcare Medicaid	$8,396.14

OTHER PNEUMONIA

Facility

$4,208.79

Service Code	APR-DRG 1391
Min. Negotiated Rate	$3,738.51
Max. Negotiated Rate	$4,208.79
Rate for Payer: Anthem Medicaid	$4,030.15
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$4,030.15
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4,030.15
Rate for Payer: Dean Health Medicaid	$4,030.15
Rate for Payer: Independent Care Health Plan Medicaid	$3,738.51
Rate for Payer: Managed Health Services Medicaid	$4,208.79
Rate for Payer: Molina Healthcare Medicaid	$4,030.15
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4,030.15
Rate for Payer: United Healthcare Medicaid	$4,030.15

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$14,029.30

Service Code	APR-DRG 4052
Min. Negotiated Rate	$12,461.70
Max. Negotiated Rate	$14,029.30
Rate for Payer: Anthem Medicaid	$13,433.82
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$13,433.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$13,433.82
Rate for Payer: Dean Health Medicaid	$13,433.82
Rate for Payer: Independent Care Health Plan Medicaid	$12,461.70
Rate for Payer: Managed Health Services Medicaid	$14,029.30
Rate for Payer: Molina Healthcare Medicaid	$13,433.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$13,433.82
Rate for Payer: United Healthcare Medicaid	$13,433.82

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$20,956.26

Service Code	APR-DRG 4053
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

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$39,983.49

Service Code	APR-DRG 4054
Min. Negotiated Rate	$35,515.83
Max. Negotiated Rate	$39,983.49
Rate for Payer: Anthem Medicaid	$38,286.40
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$38,286.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$38,286.40
Rate for Payer: Dean Health Medicaid	$38,286.40
Rate for Payer: Independent Care Health Plan Medicaid	$35,515.83
Rate for Payer: Managed Health Services Medicaid	$39,983.49
Rate for Payer: Molina Healthcare Medicaid	$38,286.40
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$38,286.40
Rate for Payer: United Healthcare Medicaid	$38,286.40

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$11,574.17

Service Code	APR-DRG 4051
Min. Negotiated Rate	$10,280.90
Max. Negotiated Rate	$11,574.17
Rate for Payer: Anthem Medicaid	$11,082.90
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$11,082.90
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$11,082.90
Rate for Payer: Dean Health Medicaid	$11,082.90
Rate for Payer: Independent Care Health Plan Medicaid	$10,280.90
Rate for Payer: Managed Health Services Medicaid	$11,574.17
Rate for Payer: Molina Healthcare Medicaid	$11,082.90
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$11,082.90
Rate for Payer: United Healthcare Medicaid	$11,082.90

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$15,870.64

Service Code	APR-DRG 6512
Min. Negotiated Rate	$14,097.29
Max. Negotiated Rate	$15,870.64
Rate for Payer: Anthem Medicaid	$15,197.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$15,197.01
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$15,197.01
Rate for Payer: Dean Health Medicaid	$15,197.01
Rate for Payer: Independent Care Health Plan Medicaid	$14,097.29
Rate for Payer: Managed Health Services Medicaid	$15,870.64
Rate for Payer: Molina Healthcare Medicaid	$15,197.01
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$15,197.01
Rate for Payer: United Healthcare Medicaid	$15,197.01

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$11,223.44

Service Code	APR-DRG 6511
Min. Negotiated Rate	$9,969.36
Max. Negotiated Rate	$11,223.44
Rate for Payer: United Healthcare Medicaid	$10,747.06
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

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$41,649.47

Service Code	APR-DRG 6514
Min. Negotiated Rate	$36,995.66
Max. Negotiated Rate	$41,649.47
Rate for Payer: Anthem Medicaid	$39,881.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$39,881.67
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$39,881.67
Rate for Payer: Dean Health Medicaid	$39,881.67
Rate for Payer: Independent Care Health Plan Medicaid	$36,995.66
Rate for Payer: Managed Health Services Medicaid	$41,649.47
Rate for Payer: Molina Healthcare Medicaid	$39,881.67
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$39,881.67
Rate for Payer: United Healthcare Medicaid	$39,881.67

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$21,570.04

Service Code	APR-DRG 6513
Min. Negotiated Rate	$19,159.86
Max. Negotiated Rate	$21,570.04
Rate for Payer: Anthem Medicaid	$20,654.50
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$20,654.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$20,654.50
Rate for Payer: Dean Health Medicaid	$20,654.50
Rate for Payer: Independent Care Health Plan Medicaid	$19,159.86
Rate for Payer: Managed Health Services Medicaid	$21,570.04
Rate for Payer: Molina Healthcare Medicaid	$20,654.50
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$20,654.50
Rate for Payer: United Healthcare Medicaid	$20,654.50

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$12,714.05

Service Code	APR-DRG 1211
Min. Negotiated Rate	$11,293.41
Max. Negotiated Rate	$12,714.05
Rate for Payer: Anthem Medicaid	$12,174.40
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$12,174.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$12,174.40
Rate for Payer: Dean Health Medicaid	$12,174.40
Rate for Payer: Independent Care Health Plan Medicaid	$11,293.41
Rate for Payer: Managed Health Services Medicaid	$12,714.05
Rate for Payer: Molina Healthcare Medicaid	$12,174.40
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$12,174.40
Rate for Payer: United Healthcare Medicaid	$12,174.40

Know your out-of-pocket cost for care.

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