Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 00139: LEVEL I HERNIA REPAIR

Facility

$1,843.95

Service Code	EAPG 00139
Min. Negotiated Rate	$1,843.95
Max. Negotiated Rate	$1,843.95
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,843.95
Rate for Payer: Molina Healthcare Medicaid	$1,843.95

EAPG 00140: LEVEL II HERNIA REPAIR

Facility

$2,215.52

Service Code	EAPG 00140
Min. Negotiated Rate	$2,215.52
Max. Negotiated Rate	$2,215.52
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,215.52
Rate for Payer: Molina Healthcare Medicaid	$2,215.52

EAPG 00143: LEVEL I GASTROINTESTINAL PROCEDURES

Facility

$1,330.49

Service Code	EAPG 00143
Min. Negotiated Rate	$1,330.49
Max. Negotiated Rate	$1,330.49
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,330.49
Rate for Payer: Molina Healthcare Medicaid	$1,330.49

EAPG 00144: LEVEL II GASTROINTESTINAL PROCEDURES

Facility

$3,602.23

Service Code	EAPG 00144
Min. Negotiated Rate	$3,602.23
Max. Negotiated Rate	$3,602.23
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3,602.23
Rate for Payer: Molina Healthcare Medicaid	$3,602.23

EAPG 00145: LEVEL I LAPAROSCOPY

Facility

$2,296.35

Service Code	EAPG 00145
Min. Negotiated Rate	$2,296.35
Max. Negotiated Rate	$2,296.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,296.35
Rate for Payer: Molina Healthcare Medicaid	$2,296.35

EAPG 00146: LEVEL II LAPAROSCOPY

Facility

$2,916.02

Service Code	EAPG 00146
Min. Negotiated Rate	$2,916.02
Max. Negotiated Rate	$2,916.02
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,916.02
Rate for Payer: Molina Healthcare Medicaid	$2,916.02

EAPG 00147: LEVEL III LAPAROSCOPY

Facility

$3,656.34

Service Code	EAPG 00147
Min. Negotiated Rate	$3,656.34
Max. Negotiated Rate	$3,656.34
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3,656.34
Rate for Payer: Molina Healthcare Medicaid	$3,656.34

EAPG 00148: LEVEL IV LAPAROSCOPY

Facility

$5,338.24

Service Code	EAPG 00148
Min. Negotiated Rate	$5,338.24
Max. Negotiated Rate	$5,338.24
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$5,338.24
Rate for Payer: Molina Healthcare Medicaid	$5,338.24

EAPG 00149: SCREENING COLORECTAL SERVICES

Facility

$536.35

Service Code	EAPG 00149
Min. Negotiated Rate	$536.35
Max. Negotiated Rate	$536.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$536.35
Rate for Payer: Molina Healthcare Medicaid	$536.35

EAPG 00160: EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

Facility

$2,035.24

Service Code	EAPG 00160
Min. Negotiated Rate	$2,035.24
Max. Negotiated Rate	$2,035.24
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,035.24
Rate for Payer: Molina Healthcare Medicaid	$2,035.24

EAPG 00162: URINARY DILATATION

Facility

$221.72

Service Code	EAPG 00162
Min. Negotiated Rate	$221.72
Max. Negotiated Rate	$221.72
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$221.72
Rate for Payer: Molina Healthcare Medicaid	$221.72

EAPG 00163: LEVEL I BLADDER AND KIDNEY PROCEDURES

Facility

$857.83

Service Code	EAPG 00163
Min. Negotiated Rate	$857.83
Max. Negotiated Rate	$857.83
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$857.83
Rate for Payer: Molina Healthcare Medicaid	$857.83

EAPG 00164: LEVEL II BLADDER AND KIDNEY PROCEDURES

Facility

$1,824.72

Service Code	EAPG 00164
Min. Negotiated Rate	$1,824.72
Max. Negotiated Rate	$1,824.72
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,824.72
Rate for Payer: Molina Healthcare Medicaid	$1,824.72

EAPG 00165: LEVEL III BLADDER AND KIDNEY PROCEDURES

Facility

$2,868.81

Service Code	EAPG 00165
Min. Negotiated Rate	$2,868.81
Max. Negotiated Rate	$2,868.81
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,868.81
Rate for Payer: Molina Healthcare Medicaid	$2,868.81

EAPG 00169: PERITONEAL DIALYSIS

Facility

$744.67

Service Code	EAPG 00169
Min. Negotiated Rate	$744.67
Max. Negotiated Rate	$744.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$744.67
Rate for Payer: Molina Healthcare Medicaid	$744.67

EAPG 00181: CIRCUMCISION

Facility

$1,184.65

Service Code	EAPG 00181
Min. Negotiated Rate	$1,184.65
Max. Negotiated Rate	$1,184.65
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,184.65
Rate for Payer: Molina Healthcare Medicaid	$1,184.65

EAPG 00185: PROSTATE NEEDLE AND PUNCH BIOPSY

Facility

$912.58

Service Code	EAPG 00185
Min. Negotiated Rate	$912.58
Max. Negotiated Rate	$912.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$912.58
Rate for Payer: Molina Healthcare Medicaid	$912.58

EAPG 00193: TREATMENT OF INCOMPLETE ABORTION

Facility

$1,194.97

Service Code	EAPG 00193
Min. Negotiated Rate	$1,194.97
Max. Negotiated Rate	$1,194.97
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,194.97
Rate for Payer: Molina Healthcare Medicaid	$1,194.97

EAPG 00196: LEVEL I FEMALE REPRODUCTIVE PROCEDURES

Facility

$1,019.43

Service Code	EAPG 00196
Min. Negotiated Rate	$1,019.43
Max. Negotiated Rate	$1,019.43
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,019.43
Rate for Payer: Molina Healthcare Medicaid	$1,019.43

EAPG 00197: LEVEL II FEMALE REPRODUCTIVE PROCEDURES

Facility

$2,214.84

Service Code	EAPG 00197
Min. Negotiated Rate	$2,214.84
Max. Negotiated Rate	$2,214.84
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,214.84
Rate for Payer: Molina Healthcare Medicaid	$2,214.84

EAPG 00198: LEVEL III FEMALE REPRODUCTIVE PROCEDURES

Facility

$3,117.73

Service Code	EAPG 00198
Min. Negotiated Rate	$3,117.73
Max. Negotiated Rate	$3,117.73
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3,117.73
Rate for Payer: Molina Healthcare Medicaid	$3,117.73

EAPG 00199: DILATION AND CURETTAGE

Facility

$1,163.22

Service Code	EAPG 00199
Min. Negotiated Rate	$1,163.22
Max. Negotiated Rate	$1,163.22
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,163.22
Rate for Payer: Molina Healthcare Medicaid	$1,163.22

EAPG 00200: HYSTEROSCOPY

Facility

$1,621.24

Service Code	EAPG 00200
Min. Negotiated Rate	$1,621.24
Max. Negotiated Rate	$1,621.24
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,621.24
Rate for Payer: Molina Healthcare Medicaid	$1,621.24

EAPG 00201: COLPOSCOPY

Facility

$423.83

Service Code	EAPG 00201
Min. Negotiated Rate	$423.83
Max. Negotiated Rate	$423.83
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$423.83
Rate for Payer: Molina Healthcare Medicaid	$423.83

EAPG 00232: LASER EYE PROCEDURES

Facility

$432.73

Service Code	EAPG 00232
Min. Negotiated Rate	$432.73
Max. Negotiated Rate	$432.73
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$432.73
Rate for Payer: Molina Healthcare Medicaid	$432.73

Know your out-of-pocket cost for care.

All Charges