Beloit Memorial Hospital

All Charges

Charge

Type

Price

EAPG 2030: MINOR MUSCULOSKELETAL PROCEDURES

Facility OP

$79.50

Service Code	EAPG 02030
Min. Negotiated Rate	$76.44
Max. Negotiated Rate	$79.50
Rate for Payer: Anthem Medicaid	$76.44
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$76.44
Rate for Payer: Dean Health Medicaid	$76.44
Rate for Payer: Independent Care Health Plan Medicaid	$76.44
Rate for Payer: Managed Health Services Medicaid	$79.50
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$76.44
Rate for Payer: United Healthcare Medicaid	$76.44
Rate for Payer: WMAP Medicaid	$76.44

EAPG 203: GLOBAL ANTEPARTUM AND POSTPARTUM VISITS

Facility OP

$105.66

Service Code	EAPG 00203
Min. Negotiated Rate	$101.60
Max. Negotiated Rate	$105.66
Rate for Payer: Anthem Medicaid	$101.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$101.60
Rate for Payer: Dean Health Medicaid	$101.60
Rate for Payer: Independent Care Health Plan Medicaid	$101.60
Rate for Payer: Managed Health Services Medicaid	$105.66
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$101.60
Rate for Payer: United Healthcare Medicaid	$101.60
Rate for Payer: WMAP Medicaid	$101.60

EAPG 2040: LEVEL I DRUG SCREENING AND DEFINITIVE TESTS

Facility OP

$4.88

Service Code	EAPG 02040
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$4.88
Rate for Payer: Anthem Medicaid	$4.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4.69
Rate for Payer: Dean Health Medicaid	$4.69
Rate for Payer: Independent Care Health Plan Medicaid	$4.69
Rate for Payer: Managed Health Services Medicaid	$4.88
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4.69
Rate for Payer: United Healthcare Medicaid	$4.69
Rate for Payer: WMAP Medicaid	$4.69

EAPG 2041: LEVEL II DRUG SCREENING AND DEFINITIVE TESTS

Facility OP

$24.44

Service Code	EAPG 02041
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$24.44
Rate for Payer: Anthem Medicaid	$23.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$23.50
Rate for Payer: Dean Health Medicaid	$23.50
Rate for Payer: Independent Care Health Plan Medicaid	$23.50
Rate for Payer: Managed Health Services Medicaid	$24.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$23.50
Rate for Payer: United Healthcare Medicaid	$23.50
Rate for Payer: WMAP Medicaid	$23.50

EAPG 2042: LEVEL III DRUG SCREENING AND DEFINITIVE TESTS

Facility OP

$56.92

Service Code	EAPG 02042
Min. Negotiated Rate	$54.73
Max. Negotiated Rate	$56.92
Rate for Payer: Anthem Medicaid	$54.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.73
Rate for Payer: Dean Health Medicaid	$54.73
Rate for Payer: Independent Care Health Plan Medicaid	$54.73
Rate for Payer: Managed Health Services Medicaid	$56.92
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.73
Rate for Payer: United Healthcare Medicaid	$54.73
Rate for Payer: WMAP Medicaid	$54.73

EAPG 2043: LEVEL III BLOOD AND TISSUE TYPING TESTS

Facility OP

$56.79

Service Code	EAPG 02043
Min. Negotiated Rate	$54.61
Max. Negotiated Rate	$56.79
Rate for Payer: Anthem Medicaid	$54.61
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.61
Rate for Payer: Dean Health Medicaid	$54.61
Rate for Payer: Independent Care Health Plan Medicaid	$54.61
Rate for Payer: Managed Health Services Medicaid	$56.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.61
Rate for Payer: United Healthcare Medicaid	$54.61
Rate for Payer: WMAP Medicaid	$54.61

EAPG 2044: LEVEL IV COMPLEX LABORATORY, MOLECULAR PATHOLOGY AND GENETIC TESTS

Facility OP

$229.79

Service Code	EAPG 02044
Min. Negotiated Rate	$220.95
Max. Negotiated Rate	$229.79
Rate for Payer: Anthem Medicaid	$220.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$220.95
Rate for Payer: Dean Health Medicaid	$220.95
Rate for Payer: Independent Care Health Plan Medicaid	$220.95
Rate for Payer: Managed Health Services Medicaid	$229.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$220.95
Rate for Payer: United Healthcare Medicaid	$220.95
Rate for Payer: WMAP Medicaid	$220.95

EAPG 2045: ADVANCED MOLECULAR PATHOLOGY AND GENETIC TESTS

Facility OP

$816.44

Service Code	EAPG 02045
Min. Negotiated Rate	$785.04
Max. Negotiated Rate	$816.44
Rate for Payer: Anthem Medicaid	$785.04
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$785.04
Rate for Payer: Dean Health Medicaid	$785.04
Rate for Payer: Independent Care Health Plan Medicaid	$785.04
Rate for Payer: Managed Health Services Medicaid	$816.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$785.04
Rate for Payer: United Healthcare Medicaid	$785.04
Rate for Payer: WMAP Medicaid	$785.04

EAPG 204: LEVEL I HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility OP

$1,778.60

Service Code	EAPG 00204
Min. Negotiated Rate	$1,710.19
Max. Negotiated Rate	$1,778.60
Rate for Payer: Anthem Medicaid	$1,710.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,710.19
Rate for Payer: Dean Health Medicaid	$1,710.19
Rate for Payer: Independent Care Health Plan Medicaid	$1,710.19
Rate for Payer: Managed Health Services Medicaid	$1,778.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,710.19
Rate for Payer: United Healthcare Medicaid	$1,710.19
Rate for Payer: WMAP Medicaid	$1,710.19

EAPG 205: OBSTETRICAL PROCEDURES

Facility OP

$731.90

Service Code	EAPG 00205
Min. Negotiated Rate	$703.75
Max. Negotiated Rate	$731.90
Rate for Payer: Anthem Medicaid	$703.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$703.75
Rate for Payer: Dean Health Medicaid	$703.75
Rate for Payer: Independent Care Health Plan Medicaid	$703.75
Rate for Payer: Managed Health Services Medicaid	$731.90
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$703.75
Rate for Payer: United Healthcare Medicaid	$703.75
Rate for Payer: WMAP Medicaid	$703.75

EAPG 2061: CLASS I BLOOD PRODUCTS

Facility OP

$54.13

Service Code	EAPG 02061
Min. Negotiated Rate	$52.05
Max. Negotiated Rate	$54.13
Rate for Payer: Anthem Medicaid	$52.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$52.05
Rate for Payer: Dean Health Medicaid	$52.05
Rate for Payer: Independent Care Health Plan Medicaid	$52.05
Rate for Payer: Managed Health Services Medicaid	$54.13
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$52.05
Rate for Payer: United Healthcare Medicaid	$52.05
Rate for Payer: WMAP Medicaid	$52.05

EAPG 2062: CLASS II BLOOD PRODUCTS

Facility OP

$119.36

Service Code	EAPG 02062
Min. Negotiated Rate	$114.77
Max. Negotiated Rate	$119.36
Rate for Payer: Anthem Medicaid	$114.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$114.77
Rate for Payer: Dean Health Medicaid	$114.77
Rate for Payer: Independent Care Health Plan Medicaid	$114.77
Rate for Payer: Managed Health Services Medicaid	$119.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$114.77
Rate for Payer: United Healthcare Medicaid	$114.77
Rate for Payer: WMAP Medicaid	$114.77

EAPG 206: LEVEL II HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility OP

$2,514.72

Service Code	EAPG 00206
Min. Negotiated Rate	$2,418.00
Max. Negotiated Rate	$2,514.72
Rate for Payer: Anthem Medicaid	$2,418.00
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,418.00
Rate for Payer: Dean Health Medicaid	$2,418.00
Rate for Payer: Independent Care Health Plan Medicaid	$2,418.00
Rate for Payer: Managed Health Services Medicaid	$2,514.72
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,418.00
Rate for Payer: United Healthcare Medicaid	$2,418.00
Rate for Payer: WMAP Medicaid	$2,418.00

EAPG 2070: MONTHLY CARE AND CASE MANAGEMENT SERVICES

Facility OP

$21.29

Service Code	EAPG 02070
Min. Negotiated Rate	$20.47
Max. Negotiated Rate	$21.29
Rate for Payer: Anthem Medicaid	$20.47
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$20.47
Rate for Payer: Dean Health Medicaid	$20.47
Rate for Payer: Independent Care Health Plan Medicaid	$20.47
Rate for Payer: Managed Health Services Medicaid	$21.29
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$20.47
Rate for Payer: United Healthcare Medicaid	$20.47
Rate for Payer: WMAP Medicaid	$20.47

EAPG 2071: MONTHLY BEHAVIORAL HEALTH CARE AND CASE MANAGEMENT SERVICES

Facility OP

$36.64

Service Code	EAPG 02071
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$36.64
Rate for Payer: Anthem Medicaid	$35.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$35.23
Rate for Payer: Dean Health Medicaid	$35.23
Rate for Payer: Independent Care Health Plan Medicaid	$35.23
Rate for Payer: Managed Health Services Medicaid	$36.64
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$35.23
Rate for Payer: United Healthcare Medicaid	$35.23
Rate for Payer: WMAP Medicaid	$35.23

EAPG 2072: MONTHLY TREATMENT MANAGEMENT SERVICES

Facility OP

$18.02

Service Code	EAPG 02072
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$18.02
Rate for Payer: Anthem Medicaid	$17.33
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$17.33
Rate for Payer: Dean Health Medicaid	$17.33
Rate for Payer: Independent Care Health Plan Medicaid	$17.33
Rate for Payer: Managed Health Services Medicaid	$18.02
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$17.33
Rate for Payer: United Healthcare Medicaid	$17.33
Rate for Payer: WMAP Medicaid	$17.33

EAPG 207: LEVEL I OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES

Facility OP

$1,004.33

Service Code	EAPG 00207
Min. Negotiated Rate	$965.70
Max. Negotiated Rate	$1,004.33
Rate for Payer: Anthem Medicaid	$965.70
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$965.70
Rate for Payer: Dean Health Medicaid	$965.70
Rate for Payer: Independent Care Health Plan Medicaid	$965.70
Rate for Payer: Managed Health Services Medicaid	$1,004.33
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$965.70
Rate for Payer: United Healthcare Medicaid	$965.70
Rate for Payer: WMAP Medicaid	$965.70

EAPG 208: LEVEL II OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES

Facility OP

$1,830.61

Service Code	EAPG 00208
Min. Negotiated Rate	$1,760.20
Max. Negotiated Rate	$1,830.61
Rate for Payer: Anthem Medicaid	$1,760.20
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,760.20
Rate for Payer: Dean Health Medicaid	$1,760.20
Rate for Payer: Independent Care Health Plan Medicaid	$1,760.20
Rate for Payer: Managed Health Services Medicaid	$1,830.61
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,760.20
Rate for Payer: United Healthcare Medicaid	$1,760.20
Rate for Payer: WMAP Medicaid	$1,760.20

EAPG 209: OTHER GYNECOLOGICAL PROCEDURES

Facility OP

$229.78

Service Code	EAPG 00209
Min. Negotiated Rate	$220.94
Max. Negotiated Rate	$229.78
Rate for Payer: Anthem Medicaid	$220.94
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$220.94
Rate for Payer: Dean Health Medicaid	$220.94
Rate for Payer: Independent Care Health Plan Medicaid	$220.94
Rate for Payer: Managed Health Services Medicaid	$229.78
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$220.94
Rate for Payer: United Healthcare Medicaid	$220.94
Rate for Payer: WMAP Medicaid	$220.94

EAPG 20: BREAST BIOPSIES, EXCISIONS, AND OTHER RELATED PROCEDURES

Facility OP

$974.22

Service Code	EAPG 00020
Min. Negotiated Rate	$552.75
Max. Negotiated Rate	$974.22
Rate for Payer: Anthem Medicaid	$552.75
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$974.22
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$552.75
Rate for Payer: Dean Health Medicaid	$552.75
Rate for Payer: Independent Care Health Plan Medicaid	$552.75
Rate for Payer: Managed Health Services Medicaid	$574.86
Rate for Payer: Molina Healthcare Medicaid	$974.22
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$552.75
Rate for Payer: United Healthcare Medicaid	$552.75
Rate for Payer: WMAP Medicaid	$552.75

EAPG 210: EXTENDED EEG STUDIES

Facility OP

$362.43

Service Code	EAPG 00210
Min. Negotiated Rate	$186.20
Max. Negotiated Rate	$362.43
Rate for Payer: Anthem Medicaid	$186.20
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$362.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$186.20
Rate for Payer: Dean Health Medicaid	$186.20
Rate for Payer: Independent Care Health Plan Medicaid	$186.20
Rate for Payer: Managed Health Services Medicaid	$193.65
Rate for Payer: Molina Healthcare Medicaid	$362.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$186.20
Rate for Payer: United Healthcare Medicaid	$186.20
Rate for Payer: WMAP Medicaid	$186.20

EAPG 211: ELECTROENCEPHALOGRAM

Facility OP

$204.65

Service Code	EAPG 00211
Min. Negotiated Rate	$137.69
Max. Negotiated Rate	$204.65
Rate for Payer: Anthem Medicaid	$137.69
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$204.65
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$137.69
Rate for Payer: Dean Health Medicaid	$137.69
Rate for Payer: Independent Care Health Plan Medicaid	$137.69
Rate for Payer: Managed Health Services Medicaid	$143.20
Rate for Payer: Molina Healthcare Medicaid	$204.65
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$137.69
Rate for Payer: United Healthcare Medicaid	$137.69
Rate for Payer: WMAP Medicaid	$137.69

EAPG 212: ELECTROCONVULSIVE THERAPY

Facility OP

$383.12

Service Code	EAPG 00212
Min. Negotiated Rate	$203.70
Max. Negotiated Rate	$383.12
Rate for Payer: Anthem Medicaid	$203.70
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$383.12
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$203.70
Rate for Payer: Dean Health Medicaid	$203.70
Rate for Payer: Independent Care Health Plan Medicaid	$203.70
Rate for Payer: Managed Health Services Medicaid	$211.85
Rate for Payer: Molina Healthcare Medicaid	$383.12
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$203.70
Rate for Payer: United Healthcare Medicaid	$203.70
Rate for Payer: WMAP Medicaid	$203.70

EAPG 213: NERVE AND MUSCLE TESTS

Facility OP

$259.49

Service Code	EAPG 00213
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$259.49
Rate for Payer: Anthem Medicaid	$55.08
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$259.49
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$55.08
Rate for Payer: Dean Health Medicaid	$55.08
Rate for Payer: Independent Care Health Plan Medicaid	$55.08
Rate for Payer: Managed Health Services Medicaid	$57.28
Rate for Payer: Molina Healthcare Medicaid	$259.49
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$55.08
Rate for Payer: United Healthcare Medicaid	$55.08
Rate for Payer: WMAP Medicaid	$55.08

EAPG 214: LEVEL I NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP

Facility OP

$347.56

Service Code	EAPG 00214
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$347.56
Rate for Payer: Anthem Medicaid	$165.75
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$347.56
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$165.75
Rate for Payer: Dean Health Medicaid	$165.75
Rate for Payer: Independent Care Health Plan Medicaid	$165.75
Rate for Payer: Managed Health Services Medicaid	$172.38
Rate for Payer: Molina Healthcare Medicaid	$347.56
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$165.75
Rate for Payer: United Healthcare Medicaid	$165.75
Rate for Payer: WMAP Medicaid	$165.75

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