Beloit Memorial Hospital

All Charges

Charge

Type

Price

EAPG 00425: LEVEL I OTHER MISCELLANEOUS ANCILLARY SERVICES

Facility OP

$1.86

Service Code	EAPG 00425
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$1.86
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1.86
Rate for Payer: Molina Healthcare Medicaid	$1.86

EAPG 00451: SMOKING CESSATION TREATMENT

Facility OP

$25.59

Service Code	EAPG 00451
Min. Negotiated Rate	$25.59
Max. Negotiated Rate	$25.59
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$25.59
Rate for Payer: Molina Healthcare Medicaid	$25.59

EAPG 00489: LEVEL II OTHER MISCELLANEOUS ANCILLARY SERVICES

Facility OP

$94.37

Service Code	EAPG 00489
Min. Negotiated Rate	$94.37
Max. Negotiated Rate	$94.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$94.37
Rate for Payer: Molina Healthcare Medicaid	$94.37

EAPG 00510: MAJOR SIGNS, SYMPTOMS AND FINDINGS

Facility OP

$109.54

Service Code	EAPG 00510
Min. Negotiated Rate	$109.54
Max. Negotiated Rate	$109.54
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$109.54
Rate for Payer: Molina Healthcare Medicaid	$109.54

EAPG 00525: LEVEL II CNS DIAGNOSES

Facility OP

$103.38

Service Code	EAPG 00525
Min. Negotiated Rate	$103.38
Max. Negotiated Rate	$103.38
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$103.38
Rate for Payer: Molina Healthcare Medicaid	$103.38

EAPG 00554: LEVEL II OTHER OPHTHALMIC DIAGNOSES

Facility OP

$120.11

Service Code	EAPG 00554
Min. Negotiated Rate	$120.11
Max. Negotiated Rate	$120.11
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$120.11
Rate for Payer: Molina Healthcare Medicaid	$120.11

EAPG 00565: LEVEL II OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility OP

$118.98

Service Code	EAPG 00565
Min. Negotiated Rate	$118.98
Max. Negotiated Rate	$118.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$118.98
Rate for Payer: Molina Healthcare Medicaid	$118.98

EAPG 00573: COMMUNITY ACQUIRED PNUEMONIA

Facility OP

$159.05

Service Code	EAPG 00573
Min. Negotiated Rate	$159.05
Max. Negotiated Rate	$159.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$159.05
Rate for Payer: Molina Healthcare Medicaid	$159.05

EAPG 00577: LEVEL II OTHER RESPIRATORY DIAGNOSES

Facility OP

$157.73

Service Code	EAPG 00577
Min. Negotiated Rate	$157.73
Max. Negotiated Rate	$157.73
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$157.73
Rate for Payer: Molina Healthcare Medicaid	$157.73

EAPG 00578: PNEUMONIA EXCEPT FOR COMMUNITY ACQUIRED PNEUMONIA

Facility OP

$118.74

Service Code	EAPG 00578
Min. Negotiated Rate	$118.74
Max. Negotiated Rate	$118.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$118.74
Rate for Payer: Molina Healthcare Medicaid	$118.74

EAPG 00593: LEVEL II CARDIOVASCULAR DIAGNOSES

Facility OP

$115.31

Service Code	EAPG 00593
Min. Negotiated Rate	$115.31
Max. Negotiated Rate	$115.31
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$115.31
Rate for Payer: Molina Healthcare Medicaid	$115.31

EAPG 00603: LEVEL II CARDIAC ARRHYTHMIA & CONDUCTION DIAGNOSES

Facility OP

$113.45

Service Code	EAPG 00603
Min. Negotiated Rate	$113.45
Max. Negotiated Rate	$113.45
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$113.45
Rate for Payer: Molina Healthcare Medicaid	$113.45

EAPG 00625: LEVEL II GASTROINTESTINAL DIAGNOSES

Facility OP

$124.51

Service Code	EAPG 00625
Min. Negotiated Rate	$124.51
Max. Negotiated Rate	$124.51
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$124.51
Rate for Payer: Molina Healthcare Medicaid	$124.51

EAPG 00640: LEVEL II HEPATOBILIARY DIAGNOSES

Facility OP

$121.97

Service Code	EAPG 00640
Min. Negotiated Rate	$121.97
Max. Negotiated Rate	$121.97
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$121.97
Rate for Payer: Molina Healthcare Medicaid	$121.97

EAPG 00661: LEVEL II OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES

Facility OP

$126.71

Service Code	EAPG 00661
Min. Negotiated Rate	$126.71
Max. Negotiated Rate	$126.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$126.71
Rate for Payer: Molina Healthcare Medicaid	$126.71

EAPG 00693: LEVEL II ENDOCRINE DIAGNOSES

Facility OP

$103.62

Service Code	EAPG 00693
Min. Negotiated Rate	$103.62
Max. Negotiated Rate	$103.62
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$103.62
Rate for Payer: Molina Healthcare Medicaid	$103.62

EAPG 00742: NEOPLASMS OF THE MALE REPRODUCTIVE SYSTEM

Facility OP

$88.60

Service Code	EAPG 00742
Min. Negotiated Rate	$88.60
Max. Negotiated Rate	$88.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$88.60
Rate for Payer: Molina Healthcare Medicaid	$88.60

EAPG 00753: LEVEL II MENSTRUAL AND OTHER FEMALE DIAGNOSES

Facility OP

$123.58

Service Code	EAPG 00753
Min. Negotiated Rate	$123.58
Max. Negotiated Rate	$123.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$123.58
Rate for Payer: Molina Healthcare Medicaid	$123.58

EAPG 00772: LEVEL II NEONATAL DIAGNOSES

Facility OP

$115.26

Service Code	EAPG 00772
Min. Negotiated Rate	$115.26
Max. Negotiated Rate	$115.26
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$115.26
Rate for Payer: Molina Healthcare Medicaid	$115.26

EAPG 00782: CONGENITAL FACTOR DEFICIENCIES

Facility OP

$116.54

Service Code	EAPG 00782
Min. Negotiated Rate	$116.54
Max. Negotiated Rate	$116.54
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$116.54
Rate for Payer: Molina Healthcare Medicaid	$116.54

EAPG 00784: SICKLE CELL ANEMIA

Facility OP

$147.60

Service Code	EAPG 00784
Min. Negotiated Rate	$147.60
Max. Negotiated Rate	$147.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$147.60
Rate for Payer: Molina Healthcare Medicaid	$147.60

EAPG 00786: IRON DEFICIENCY ANEMIA

Facility OP

$116.15

Service Code	EAPG 00786
Min. Negotiated Rate	$116.15
Max. Negotiated Rate	$116.15
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$116.15
Rate for Payer: Molina Healthcare Medicaid	$116.15

EAPG 103: LEVEL II VARICOSE VEIN AND RELATED PROCEDURES

Facility OP

$1,175.35

Service Code	EAPG 00103
Min. Negotiated Rate	$1,130.14
Max. Negotiated Rate	$1,175.35
Rate for Payer: Anthem Medicaid	$1,130.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,130.14
Rate for Payer: Dean Health Medicaid	$1,130.14
Rate for Payer: Independent Care Health Plan Medicaid	$1,130.14
Rate for Payer: Managed Health Services Medicaid	$1,175.35
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,130.14
Rate for Payer: United Healthcare Medicaid	$1,130.14
Rate for Payer: WMAP Medicaid	$1,130.14

EAPG 104: MAJOR OPEN CORONARY ARTERY PROCEDURES INCLUDING CABG

Facility OP

$7,538.33

Service Code	EAPG 00104
Min. Negotiated Rate	$7,248.39
Max. Negotiated Rate	$7,538.33
Rate for Payer: Anthem Medicaid	$7,248.39
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$7,248.39
Rate for Payer: Dean Health Medicaid	$7,248.39
Rate for Payer: Independent Care Health Plan Medicaid	$7,248.39
Rate for Payer: Managed Health Services Medicaid	$7,538.33
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$7,248.39
Rate for Payer: United Healthcare Medicaid	$7,248.39
Rate for Payer: WMAP Medicaid	$7,248.39

EAPG 105: MAJOR OPEN CARDIAC AND CARDIAC VALVE PROCEDURES

Facility OP

$4,690.10

Service Code	EAPG 00105
Min. Negotiated Rate	$4,509.71
Max. Negotiated Rate	$4,690.10
Rate for Payer: Anthem Medicaid	$4,509.71
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4,509.71
Rate for Payer: Dean Health Medicaid	$4,509.71
Rate for Payer: Independent Care Health Plan Medicaid	$4,509.71
Rate for Payer: Managed Health Services Medicaid	$4,690.10
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4,509.71
Rate for Payer: United Healthcare Medicaid	$4,509.71
Rate for Payer: WMAP Medicaid	$4,509.71

Price Transparency.

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