Beloit Memorial Hospital

All Charges

Charge

Type

Price

EAPG 217: LEVEL I PERIPHERAL NERVE PROCEDURES

Facility OP

$845.60

Service Code	EAPG 00217
Min. Negotiated Rate	$559.46
Max. Negotiated Rate	$845.60
Rate for Payer: Anthem Medicaid	$559.46
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$845.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$559.46
Rate for Payer: Dean Health Medicaid	$559.46
Rate for Payer: Independent Care Health Plan Medicaid	$559.46
Rate for Payer: Managed Health Services Medicaid	$581.84
Rate for Payer: Molina Healthcare Medicaid	$845.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$559.46
Rate for Payer: United Healthcare Medicaid	$559.46
Rate for Payer: WMAP Medicaid	$559.46

EAPG 218: LEVEL II PERIPHERAL NERVE PROCEDURES

Facility OP

$3,874.98

Service Code	EAPG 00218
Min. Negotiated Rate	$1,984.74
Max. Negotiated Rate	$3,874.98
Rate for Payer: Anthem Medicaid	$1,984.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3,874.98
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,984.74
Rate for Payer: Dean Health Medicaid	$1,984.74
Rate for Payer: Independent Care Health Plan Medicaid	$1,984.74
Rate for Payer: Managed Health Services Medicaid	$2,064.13
Rate for Payer: Molina Healthcare Medicaid	$3,874.98
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,984.74
Rate for Payer: United Healthcare Medicaid	$1,984.74
Rate for Payer: WMAP Medicaid	$1,984.74

EAPG 21: LEVEL I MASTECTOMY AND RECONSTRUCTIVE BREAST PROCEDURES

Facility OP

$2,230.35

Service Code	EAPG 00021
Min. Negotiated Rate	$1,351.65
Max. Negotiated Rate	$2,230.35
Rate for Payer: Anthem Medicaid	$1,351.65
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,230.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,351.65
Rate for Payer: Dean Health Medicaid	$1,351.65
Rate for Payer: Independent Care Health Plan Medicaid	$1,351.65
Rate for Payer: Managed Health Services Medicaid	$1,405.72
Rate for Payer: Molina Healthcare Medicaid	$2,230.35
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,351.65
Rate for Payer: United Healthcare Medicaid	$1,351.65
Rate for Payer: WMAP Medicaid	$1,351.65

EAPG 220: LEVEL II NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP

Facility OP

$630.34

Service Code	EAPG 00220
Min. Negotiated Rate	$531.68
Max. Negotiated Rate	$630.34
Rate for Payer: Anthem Medicaid	$531.68
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$630.34
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$531.68
Rate for Payer: Dean Health Medicaid	$531.68
Rate for Payer: Independent Care Health Plan Medicaid	$531.68
Rate for Payer: Managed Health Services Medicaid	$552.95
Rate for Payer: Molina Healthcare Medicaid	$630.34
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$531.68
Rate for Payer: United Healthcare Medicaid	$531.68
Rate for Payer: WMAP Medicaid	$531.68

EAPG 222: SLEEP STUDIES ATTENDED

Facility OP

$606.41

Service Code	EAPG 00222
Min. Negotiated Rate	$328.43
Max. Negotiated Rate	$606.41
Rate for Payer: Anthem Medicaid	$328.43
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$606.41
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$328.43
Rate for Payer: Dean Health Medicaid	$328.43
Rate for Payer: Independent Care Health Plan Medicaid	$328.43
Rate for Payer: Managed Health Services Medicaid	$341.57
Rate for Payer: Molina Healthcare Medicaid	$606.41
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$328.43
Rate for Payer: United Healthcare Medicaid	$328.43
Rate for Payer: WMAP Medicaid	$328.43

EAPG 223: LEVEL I NEUROSTIMULATOR AND RELATED DEVICE IMPLANTATION

Facility OP

$9,838.23

Service Code	EAPG 00223
Min. Negotiated Rate	$2,540.67
Max. Negotiated Rate	$9,838.23
Rate for Payer: Anthem Medicaid	$2,540.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$9,838.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,540.67
Rate for Payer: Dean Health Medicaid	$2,540.67
Rate for Payer: Independent Care Health Plan Medicaid	$2,540.67
Rate for Payer: Managed Health Services Medicaid	$2,642.30
Rate for Payer: Molina Healthcare Medicaid	$9,838.23
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,540.67
Rate for Payer: United Healthcare Medicaid	$2,540.67
Rate for Payer: WMAP Medicaid	$2,540.67

EAPG 224: LEVEL II NEUROSTIMULATOR AND RELATED DEVICE IMPLANTATION

Facility OP

$17,808.78

Service Code	EAPG 00224
Min. Negotiated Rate	$7,840.45
Max. Negotiated Rate	$17,808.78
Rate for Payer: Anthem Medicaid	$7,840.45
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$17,808.78
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$7,840.45
Rate for Payer: Dean Health Medicaid	$7,840.45
Rate for Payer: Independent Care Health Plan Medicaid	$7,840.45
Rate for Payer: Managed Health Services Medicaid	$8,154.07
Rate for Payer: Molina Healthcare Medicaid	$17,808.78
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$7,840.45
Rate for Payer: United Healthcare Medicaid	$7,840.45
Rate for Payer: WMAP Medicaid	$7,840.45

EAPG 225: OTHER INTRACRANIAL NEUROSURGERY PROCEDURES

Facility OP

$1,636.66

Service Code	EAPG 00225
Min. Negotiated Rate	$1,573.71
Max. Negotiated Rate	$1,636.66
Rate for Payer: Anthem Medicaid	$1,573.71
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,573.71
Rate for Payer: Dean Health Medicaid	$1,573.71
Rate for Payer: Independent Care Health Plan Medicaid	$1,573.71
Rate for Payer: Managed Health Services Medicaid	$1,636.66
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,573.71
Rate for Payer: United Healthcare Medicaid	$1,573.71
Rate for Payer: WMAP Medicaid	$1,573.71

EAPG 226: SLEEP STUDIES UNATTENDED

Facility OP

$65.60

Service Code	EAPG 00226
Min. Negotiated Rate	$63.08
Max. Negotiated Rate	$65.60
Rate for Payer: Anthem Medicaid	$63.08
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$63.08
Rate for Payer: Dean Health Medicaid	$63.08
Rate for Payer: Independent Care Health Plan Medicaid	$63.08
Rate for Payer: Managed Health Services Medicaid	$65.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$63.08
Rate for Payer: United Healthcare Medicaid	$63.08
Rate for Payer: WMAP Medicaid	$63.08

EAPG 227: LEVEL I CRANIOFACIAL BONE PROCEDURES

Facility OP

$1,129.75

Service Code	EAPG 00227
Min. Negotiated Rate	$1,086.30
Max. Negotiated Rate	$1,129.75
Rate for Payer: Anthem Medicaid	$1,086.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,086.30
Rate for Payer: Dean Health Medicaid	$1,086.30
Rate for Payer: Independent Care Health Plan Medicaid	$1,086.30
Rate for Payer: Managed Health Services Medicaid	$1,129.75
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,086.30
Rate for Payer: United Healthcare Medicaid	$1,086.30
Rate for Payer: WMAP Medicaid	$1,086.30

EAPG 228: LEVEL II CRANIOFACIAL BONE PROCEDURES

Facility OP

$2,154.76

Service Code	EAPG 00228
Min. Negotiated Rate	$2,071.88
Max. Negotiated Rate	$2,154.76
Rate for Payer: WMAP Medicaid	$2,071.88
Rate for Payer: Anthem Medicaid	$2,071.88
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,071.88
Rate for Payer: Dean Health Medicaid	$2,071.88
Rate for Payer: Independent Care Health Plan Medicaid	$2,071.88
Rate for Payer: Managed Health Services Medicaid	$2,154.76
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,071.88
Rate for Payer: United Healthcare Medicaid	$2,071.88

EAPG 229: MINOR AUDIOMETRY TESTS AND AUDIOLOGY SCREENING SERVICES

Facility OP

$13.20

Service Code	EAPG 00229
Min. Negotiated Rate	$12.69
Max. Negotiated Rate	$13.20
Rate for Payer: Anthem Medicaid	$12.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$12.69
Rate for Payer: Dean Health Medicaid	$12.69
Rate for Payer: Independent Care Health Plan Medicaid	$12.69
Rate for Payer: Managed Health Services Medicaid	$13.20
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$12.69
Rate for Payer: United Healthcare Medicaid	$12.69
Rate for Payer: WMAP Medicaid	$12.69

EAPG 22: LEVEL II MASTECTOMY AND RECONSTRUCTIVE BREAST PROCEDURES

Facility OP

$4,107.32

Service Code	EAPG 00022
Min. Negotiated Rate	$3,001.19
Max. Negotiated Rate	$4,107.32
Rate for Payer: Anthem Medicaid	$3,001.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$4,107.32
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$3,001.19
Rate for Payer: Dean Health Medicaid	$3,001.19
Rate for Payer: Independent Care Health Plan Medicaid	$3,001.19
Rate for Payer: Managed Health Services Medicaid	$3,121.24
Rate for Payer: Molina Healthcare Medicaid	$4,107.32
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$3,001.19
Rate for Payer: United Healthcare Medicaid	$3,001.19
Rate for Payer: WMAP Medicaid	$3,001.19

EAPG 230: MINOR OPHTHALMOLOGICAL PROCEDURES AND DIAGNOSTIC SERVICES

Facility OP

$277.99

Service Code	EAPG 00230
Min. Negotiated Rate	$120.05
Max. Negotiated Rate	$277.99
Rate for Payer: Anthem Medicaid	$120.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$277.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$120.05
Rate for Payer: Dean Health Medicaid	$120.05
Rate for Payer: Independent Care Health Plan Medicaid	$120.05
Rate for Payer: Managed Health Services Medicaid	$124.85
Rate for Payer: Molina Healthcare Medicaid	$277.99
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$120.05
Rate for Payer: United Healthcare Medicaid	$120.05
Rate for Payer: WMAP Medicaid	$120.05

EAPG 233: CATARACT AND OTHER INTRAOCULAR LENS PROCEDURES

Facility OP

$1,282.69

Service Code	EAPG 00233
Min. Negotiated Rate	$709.18
Max. Negotiated Rate	$1,282.69
Rate for Payer: Anthem Medicaid	$709.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,282.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$709.18
Rate for Payer: Dean Health Medicaid	$709.18
Rate for Payer: Independent Care Health Plan Medicaid	$709.18
Rate for Payer: Managed Health Services Medicaid	$737.55
Rate for Payer: Molina Healthcare Medicaid	$1,282.69
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$709.18
Rate for Payer: United Healthcare Medicaid	$709.18
Rate for Payer: WMAP Medicaid	$709.18

EAPG 234: LEVEL I ANTERIOR CHAMBER EYE PROCEDURES

Facility OP

$1,041.45

Service Code	EAPG 00234
Min. Negotiated Rate	$418.72
Max. Negotiated Rate	$1,041.45
Rate for Payer: Anthem Medicaid	$418.72
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,041.45
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$418.72
Rate for Payer: Dean Health Medicaid	$418.72
Rate for Payer: Independent Care Health Plan Medicaid	$418.72
Rate for Payer: Managed Health Services Medicaid	$435.47
Rate for Payer: Molina Healthcare Medicaid	$1,041.45
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$418.72
Rate for Payer: United Healthcare Medicaid	$418.72
Rate for Payer: WMAP Medicaid	$418.72

EAPG 235: LEVEL II ANTERIOR CHAMBER EYE PROCEDURES

Facility OP

$1,660.24

Service Code	EAPG 00235
Min. Negotiated Rate	$1,381.69
Max. Negotiated Rate	$1,660.24
Rate for Payer: Anthem Medicaid	$1,381.69
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,660.24
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,381.69
Rate for Payer: Dean Health Medicaid	$1,381.69
Rate for Payer: Independent Care Health Plan Medicaid	$1,381.69
Rate for Payer: Managed Health Services Medicaid	$1,436.96
Rate for Payer: Molina Healthcare Medicaid	$1,660.24
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,381.69
Rate for Payer: United Healthcare Medicaid	$1,381.69
Rate for Payer: WMAP Medicaid	$1,381.69

EAPG 237: LEVEL I INTRAVITREAL, RETINAL AND OTHER POSTERIOR CHAMBER EYE PROCEDURES

Facility OP

$1,681.03

Service Code	EAPG 00237
Min. Negotiated Rate	$426.21
Max. Negotiated Rate	$1,681.03
Rate for Payer: Anthem Medicaid	$426.21
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,681.03
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$426.21
Rate for Payer: Dean Health Medicaid	$426.21
Rate for Payer: Independent Care Health Plan Medicaid	$426.21
Rate for Payer: Managed Health Services Medicaid	$443.26
Rate for Payer: Molina Healthcare Medicaid	$1,681.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$426.21
Rate for Payer: United Healthcare Medicaid	$426.21
Rate for Payer: WMAP Medicaid	$426.21

EAPG 238: LEVEL II INTRAVITREAL, RETINAL AND OTHER POSTERIOR CHAMBER EYE PROCEDURES

Facility OP

$2,342.43

Service Code	EAPG 00238
Min. Negotiated Rate	$1,298.03
Max. Negotiated Rate	$2,342.43
Rate for Payer: Anthem Medicaid	$1,298.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,342.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,298.03
Rate for Payer: Dean Health Medicaid	$1,298.03
Rate for Payer: Independent Care Health Plan Medicaid	$1,298.03
Rate for Payer: Managed Health Services Medicaid	$1,349.95
Rate for Payer: Molina Healthcare Medicaid	$2,342.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,298.03
Rate for Payer: United Healthcare Medicaid	$1,298.03
Rate for Payer: WMAP Medicaid	$1,298.03

EAPG 239: EXTRAOCULAR MUSCLE PROCEDURES

Facility OP

$1,505.44

Service Code	EAPG 00239
Min. Negotiated Rate	$879.89
Max. Negotiated Rate	$1,505.44
Rate for Payer: Anthem Medicaid	$879.89
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,505.44
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$879.89
Rate for Payer: Dean Health Medicaid	$879.89
Rate for Payer: Independent Care Health Plan Medicaid	$879.89
Rate for Payer: Managed Health Services Medicaid	$915.09
Rate for Payer: Molina Healthcare Medicaid	$1,505.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$879.89
Rate for Payer: United Healthcare Medicaid	$879.89
Rate for Payer: WMAP Medicaid	$879.89

EAPG 23: LEVEL I FOREARM AND WRIST PROCEDURES

Facility OP

$734.20

Service Code	EAPG 00023
Min. Negotiated Rate	$705.96
Max. Negotiated Rate	$734.20
Rate for Payer: Anthem Medicaid	$705.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$705.96
Rate for Payer: Dean Health Medicaid	$705.96
Rate for Payer: Independent Care Health Plan Medicaid	$705.96
Rate for Payer: Managed Health Services Medicaid	$734.20
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$705.96
Rate for Payer: United Healthcare Medicaid	$705.96
Rate for Payer: WMAP Medicaid	$705.96

EAPG 241: OCULAR RECONSTRUCTIVE PROCEDURES W OR W/O OCULAR DEVICE

Facility OP

$1,282.74

Service Code	EAPG 00241
Min. Negotiated Rate	$1,169.95
Max. Negotiated Rate	$1,282.74
Rate for Payer: Anthem Medicaid	$1,169.95
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,282.74
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,169.95
Rate for Payer: Dean Health Medicaid	$1,169.95
Rate for Payer: Independent Care Health Plan Medicaid	$1,169.95
Rate for Payer: Managed Health Services Medicaid	$1,216.75
Rate for Payer: Molina Healthcare Medicaid	$1,282.74
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,169.95
Rate for Payer: United Healthcare Medicaid	$1,169.95
Rate for Payer: WMAP Medicaid	$1,169.95

EAPG 244: CLASS II THERAPEUTIC RADIOPHARMACEUTICALS

Facility OP

$172.60

Service Code	EAPG 00244
Min. Negotiated Rate	$165.96
Max. Negotiated Rate	$172.60
Rate for Payer: Anthem Medicaid	$165.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$165.96
Rate for Payer: Dean Health Medicaid	$165.96
Rate for Payer: Independent Care Health Plan Medicaid	$165.96
Rate for Payer: Managed Health Services Medicaid	$172.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$165.96
Rate for Payer: United Healthcare Medicaid	$165.96
Rate for Payer: WMAP Medicaid	$165.96

EAPG 245: CLASS III THERAPEUTIC RADIOPHARMACEUTICALS

Facility OP

$5,330.01

Service Code	EAPG 00245
Min. Negotiated Rate	$5,125.01
Max. Negotiated Rate	$5,330.01
Rate for Payer: Anthem Medicaid	$5,125.01
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5,125.01
Rate for Payer: Dean Health Medicaid	$5,125.01
Rate for Payer: Independent Care Health Plan Medicaid	$5,125.01
Rate for Payer: Managed Health Services Medicaid	$5,330.01
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5,125.01
Rate for Payer: United Healthcare Medicaid	$5,125.01
Rate for Payer: WMAP Medicaid	$5,125.01

EAPG 246: CLASS IV THERAPEUTIC RADIOPHARMACEUTICALS

Facility OP

$15,547.22

Service Code	EAPG 00246
Min. Negotiated Rate	$14,949.25
Max. Negotiated Rate	$15,547.22
Rate for Payer: Anthem Medicaid	$14,949.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$14,949.25
Rate for Payer: Dean Health Medicaid	$14,949.25
Rate for Payer: Independent Care Health Plan Medicaid	$14,949.25
Rate for Payer: Managed Health Services Medicaid	$15,547.22
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$14,949.25
Rate for Payer: United Healthcare Medicaid	$14,949.25
Rate for Payer: WMAP Medicaid	$14,949.25

Price Transparency.

All Charges