Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$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

$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

$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

$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

$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

$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

$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

$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

$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

$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

$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

EAPG 106: MAJOR OPEN ABDOMINAL AND THORACIC VASCULAR PROCEDURES

Facility

$4,117.12

Service Code	EAPG 00106
Min. Negotiated Rate	$3,958.77
Max. Negotiated Rate	$4,117.12
Rate for Payer: Anthem Medicaid	$3,958.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$3,958.77
Rate for Payer: Dean Health Medicaid	$3,958.77
Rate for Payer: Independent Care Health Plan Medicaid	$3,958.77
Rate for Payer: Managed Health Services Medicaid	$4,117.12
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$3,958.77
Rate for Payer: United Healthcare Medicaid	$3,958.77
Rate for Payer: WMAP Medicaid	$3,958.77

EAPG 107: CHOLECYSTECTOMY AND RELATED BILIARY PROCEDURES

Facility

$1,483.68

Service Code	EAPG 00107
Min. Negotiated Rate	$1,426.62
Max. Negotiated Rate	$1,483.68
Rate for Payer: Anthem Medicaid	$1,426.62
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,426.62
Rate for Payer: Dean Health Medicaid	$1,426.62
Rate for Payer: Independent Care Health Plan Medicaid	$1,426.62
Rate for Payer: Managed Health Services Medicaid	$1,483.68
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,426.62
Rate for Payer: United Healthcare Medicaid	$1,426.62
Rate for Payer: WMAP Medicaid	$1,426.62

EAPG 108: OTHER INTRA-ABDOMINAL AND INTRAPERITONEAL SURGICAL PROCEDURES

Facility

$1,579.51

Service Code	EAPG 00108
Min. Negotiated Rate	$1,518.76
Max. Negotiated Rate	$1,579.51
Rate for Payer: Anthem Medicaid	$1,518.76
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,518.76
Rate for Payer: Dean Health Medicaid	$1,518.76
Rate for Payer: Independent Care Health Plan Medicaid	$1,518.76
Rate for Payer: Managed Health Services Medicaid	$1,579.51
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,518.76
Rate for Payer: United Healthcare Medicaid	$1,518.76
Rate for Payer: WMAP Medicaid	$1,518.76

EAPG 109: ANCILLARY DRUG ADMINISTRATION

Facility

$20.01

Service Code	EAPG 00109
Min. Negotiated Rate	$19.24
Max. Negotiated Rate	$20.01
Rate for Payer: Anthem Medicaid	$19.24
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$19.24
Rate for Payer: Dean Health Medicaid	$19.24
Rate for Payer: Independent Care Health Plan Medicaid	$19.24
Rate for Payer: Managed Health Services Medicaid	$20.01
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$19.24
Rate for Payer: United Healthcare Medicaid	$19.24
Rate for Payer: WMAP Medicaid	$19.24

EAPG 10: LEVEL II SKIN EXCISIONS, BIOPSIES, AND REPAIRS

Facility

$1,018.60

Service Code	EAPG 00010
Min. Negotiated Rate	$502.50
Max. Negotiated Rate	$1,018.60
Rate for Payer: Anthem Medicaid	$502.50
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,018.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$502.50
Rate for Payer: Dean Health Medicaid	$502.50
Rate for Payer: Independent Care Health Plan Medicaid	$502.50
Rate for Payer: Managed Health Services Medicaid	$522.60
Rate for Payer: Molina Healthcare Medicaid	$1,018.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$502.50
Rate for Payer: United Healthcare Medicaid	$502.50
Rate for Payer: WMAP Medicaid	$502.50

EAPG 110: PHARMACOTHERAPY BY EXTENDED INFUSION

Facility

$386.55

Service Code	EAPG 00110
Min. Negotiated Rate	$191.73
Max. Negotiated Rate	$386.55
Rate for Payer: Anthem Medicaid	$191.73
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$386.55
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$191.73
Rate for Payer: Dean Health Medicaid	$191.73
Rate for Payer: Independent Care Health Plan Medicaid	$191.73
Rate for Payer: Managed Health Services Medicaid	$199.40
Rate for Payer: Molina Healthcare Medicaid	$386.55
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$191.73
Rate for Payer: United Healthcare Medicaid	$191.73
Rate for Payer: WMAP Medicaid	$191.73

EAPG 111: PHARMACOTHERAPY EXCEPT BY EXTENDED INFUSION

Facility

$247.26

Service Code	EAPG 00111
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$247.26
Rate for Payer: Anthem Medicaid	$122.40
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$247.26
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$122.40
Rate for Payer: Dean Health Medicaid	$122.40
Rate for Payer: Independent Care Health Plan Medicaid	$122.40
Rate for Payer: Managed Health Services Medicaid	$127.30
Rate for Payer: Molina Healthcare Medicaid	$247.26
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$122.40
Rate for Payer: United Healthcare Medicaid	$122.40
Rate for Payer: WMAP Medicaid	$122.40

EAPG 113: LEVEL I BLOOD PRODUCT EXCHANGE SERVICES

Facility

$524.61

Service Code	EAPG 00113
Min. Negotiated Rate	$167.79
Max. Negotiated Rate	$524.61
Rate for Payer: Anthem Medicaid	$167.79
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$524.61
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$167.79
Rate for Payer: Dean Health Medicaid	$167.79
Rate for Payer: Independent Care Health Plan Medicaid	$167.79
Rate for Payer: Managed Health Services Medicaid	$174.50
Rate for Payer: Molina Healthcare Medicaid	$524.61
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$167.79
Rate for Payer: United Healthcare Medicaid	$167.79
Rate for Payer: WMAP Medicaid	$167.79

EAPG 114: LEVEL II BLOOD PRODUCT EXCHANGE SERVICES

Facility

$2,043.75

Service Code	EAPG 00114
Min. Negotiated Rate	$679.51
Max. Negotiated Rate	$2,043.75
Rate for Payer: Anthem Medicaid	$679.51
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,043.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$679.51
Rate for Payer: Dean Health Medicaid	$679.51
Rate for Payer: Independent Care Health Plan Medicaid	$679.51
Rate for Payer: Managed Health Services Medicaid	$706.69
Rate for Payer: Molina Healthcare Medicaid	$2,043.75
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$679.51
Rate for Payer: United Healthcare Medicaid	$679.51
Rate for Payer: WMAP Medicaid	$679.51

EAPG 115: DEEP LYMPH STRUCTURE PROCEDURES

Facility

$1,912.68

Service Code	EAPG 00115
Min. Negotiated Rate	$1,320.44
Max. Negotiated Rate	$1,912.68
Rate for Payer: Anthem Medicaid	$1,320.44
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,912.68
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,320.44
Rate for Payer: Dean Health Medicaid	$1,320.44
Rate for Payer: Independent Care Health Plan Medicaid	$1,320.44
Rate for Payer: Managed Health Services Medicaid	$1,373.26
Rate for Payer: Molina Healthcare Medicaid	$1,912.68
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,320.44
Rate for Payer: United Healthcare Medicaid	$1,320.44
Rate for Payer: WMAP Medicaid	$1,320.44

EAPG 116: LEVEL I ALLERGY TESTS

Facility

$31.16

Service Code	EAPG 00116
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$31.16
Rate for Payer: Anthem Medicaid	$14.46
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$31.16
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$14.46
Rate for Payer: Dean Health Medicaid	$14.46
Rate for Payer: Independent Care Health Plan Medicaid	$14.46
Rate for Payer: Managed Health Services Medicaid	$15.04
Rate for Payer: Molina Healthcare Medicaid	$31.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$14.46
Rate for Payer: United Healthcare Medicaid	$14.46
Rate for Payer: WMAP Medicaid	$14.46

EAPG 118: NUTRITION THERAPY

Facility

$138.80

Service Code	EAPG 00118
Min. Negotiated Rate	$68.98
Max. Negotiated Rate	$138.80
Rate for Payer: Anthem Medicaid	$68.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$138.80
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$68.98
Rate for Payer: Dean Health Medicaid	$68.98
Rate for Payer: Independent Care Health Plan Medicaid	$68.98
Rate for Payer: Managed Health Services Medicaid	$71.74
Rate for Payer: Molina Healthcare Medicaid	$138.80
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$68.98
Rate for Payer: United Healthcare Medicaid	$68.98
Rate for Payer: WMAP Medicaid	$68.98

EAPG 119: CAR T-CELL IMMUNOTHERAPY PREPARATION SERVICES

Facility

$258.87

Service Code	EAPG 00119
Min. Negotiated Rate	$248.91
Max. Negotiated Rate	$258.87
Rate for Payer: Anthem Medicaid	$248.91
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$248.91
Rate for Payer: Dean Health Medicaid	$248.91
Rate for Payer: Independent Care Health Plan Medicaid	$248.91
Rate for Payer: Managed Health Services Medicaid	$258.87
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$248.91
Rate for Payer: United Healthcare Medicaid	$248.91
Rate for Payer: WMAP Medicaid	$248.91

EAPG 11: LEVEL III SKIN EXCISIONS, BIOPSIES, AND REPAIRS

Facility

$2,484.70

Service Code	EAPG 00011
Min. Negotiated Rate	$742.79
Max. Negotiated Rate	$2,484.70
Rate for Payer: Anthem Medicaid	$742.79
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,484.70
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$742.79
Rate for Payer: Dean Health Medicaid	$742.79
Rate for Payer: Independent Care Health Plan Medicaid	$742.79
Rate for Payer: Managed Health Services Medicaid	$772.50
Rate for Payer: Molina Healthcare Medicaid	$2,484.70
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$742.79
Rate for Payer: United Healthcare Medicaid	$742.79
Rate for Payer: WMAP Medicaid	$742.79

Know your out-of-pocket cost for care.

All Charges