Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 00236: LEVEL III ANTERIOR SEGMENT EYE PROCEDURES

Facility

$2,166.60

Service Code	EAPG 00236
Min. Negotiated Rate	$2,166.60
Max. Negotiated Rate	$2,166.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,166.60
Rate for Payer: Molina Healthcare Medicaid	$2,166.60

EAPG 00240: LEVEL I REPAIR AND PLASTIC PROCEDURES OF EYE

Facility

$479.31

Service Code	EAPG 00240
Min. Negotiated Rate	$479.31
Max. Negotiated Rate	$479.31
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$479.31
Rate for Payer: Molina Healthcare Medicaid	$479.31

EAPG 00273: MANIPULATION THERAPY

Facility

$36.64

Service Code	EAPG 00273
Min. Negotiated Rate	$36.64
Max. Negotiated Rate	$36.64
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$36.64
Rate for Payer: Molina Healthcare Medicaid	$36.64

EAPG 00274: OCCUPATIONAL/PHYSICAL THERAPY, GROUP

Facility

$87.13

Service Code	EAPG 00274
Min. Negotiated Rate	$87.13
Max. Negotiated Rate	$87.13
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$87.13
Rate for Payer: Molina Healthcare Medicaid	$87.13

EAPG 00275: SPEECH THERAPY & EVALUATION, GROUP

Facility

$58.32

Service Code	EAPG 00275
Min. Negotiated Rate	$58.32
Max. Negotiated Rate	$58.32
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$58.32
Rate for Payer: Molina Healthcare Medicaid	$58.32

EAPG 00311: FULL DAY PARTIAL HOSPITALIZATION FOR SUBSTANCE ABUSE

Facility

$85.08

Service Code	EAPG 00311
Min. Negotiated Rate	$85.08
Max. Negotiated Rate	$85.08
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$85.08
Rate for Payer: Molina Healthcare Medicaid	$85.08

EAPG 00351: LEVEL II ADJUNCTIVE GENERAL DENTAL SERVICES

Facility

$216.49

Service Code	EAPG 00351
Min. Negotiated Rate	$216.49
Max. Negotiated Rate	$216.49
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$216.49
Rate for Payer: Molina Healthcare Medicaid	$216.49

EAPG 00370: LEVEL IV ORAL AND MAXILLOFACIAL SURGERY

Facility

$625.35

Service Code	EAPG 00370
Min. Negotiated Rate	$625.35
Max. Negotiated Rate	$625.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$625.35
Rate for Payer: Molina Healthcare Medicaid	$625.35

EAPG 00416: LEVEL III IMMUNIZATION

Facility

$181.56

Service Code	EAPG 00416
Min. Negotiated Rate	$181.56
Max. Negotiated Rate	$181.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$181.56
Rate for Payer: Molina Healthcare Medicaid	$181.56

EAPG 00421: TUBE REPLACEMENT, REVISION OR REMOVAL

Facility

$165.17

Service Code	EAPG 00421
Min. Negotiated Rate	$165.17
Max. Negotiated Rate	$165.17
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$165.17
Rate for Payer: Molina Healthcare Medicaid	$165.17

EAPG 00424: DRESSINGS AND OTHER MINOR PROCEDURES

Facility

$112.28

Service Code	EAPG 00424
Min. Negotiated Rate	$112.28
Max. Negotiated Rate	$112.28
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$112.28
Rate for Payer: Molina Healthcare Medicaid	$112.28

EAPG 00425: LEVEL I OTHER MISCELLANEOUS ANCILLARY SERVICES

Facility

$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

$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

$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

$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

$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

$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

$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

$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

$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

$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

$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

$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

$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

$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

Know your out-of-pocket cost for care.

All Charges