Beloit Memorial Hospital

All Charges

Charge

Type

Price

EAPG 57: LEVEL III SPINE PROCEDURES

Facility OP

$7,192.79

Service Code	EAPG 00057
Min. Negotiated Rate	$6,916.14
Max. Negotiated Rate	$7,192.79
Rate for Payer: Anthem Medicaid	$6,916.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$6,916.14
Rate for Payer: Dean Health Medicaid	$6,916.14
Rate for Payer: Independent Care Health Plan Medicaid	$6,916.14
Rate for Payer: Managed Health Services Medicaid	$7,192.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$6,916.14
Rate for Payer: United Healthcare Medicaid	$6,916.14
Rate for Payer: WMAP Medicaid	$6,916.14

EAPG 580: MAJOR CHEST AND RESPIRATORY TRAUMA

Facility OP

$167.08

Service Code	EAPG 00580
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$167.08
Rate for Payer: Anthem Medicaid	$160.65
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$160.65
Rate for Payer: Dean Health Medicaid	$160.65
Rate for Payer: Independent Care Health Plan Medicaid	$160.65
Rate for Payer: Managed Health Services Medicaid	$167.08
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$160.65
Rate for Payer: United Healthcare Medicaid	$160.65
Rate for Payer: WMAP Medicaid	$160.65

EAPG 581: PULMONARY INFECTION DIAGNOSES INCLUDING PNEUMONIA

Facility OP

$131.84

Service Code	EAPG 00581
Min. Negotiated Rate	$126.77
Max. Negotiated Rate	$131.84
Rate for Payer: Anthem Medicaid	$126.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$126.77
Rate for Payer: Dean Health Medicaid	$126.77
Rate for Payer: Independent Care Health Plan Medicaid	$126.77
Rate for Payer: Managed Health Services Medicaid	$131.84
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$126.77
Rate for Payer: United Healthcare Medicaid	$126.77
Rate for Payer: WMAP Medicaid	$126.77

EAPG 582: INTERSTITIAL AND ALVEOLAR LUNG DIAGNOSES

Facility OP

$85.70

Service Code	EAPG 00582
Min. Negotiated Rate	$82.40
Max. Negotiated Rate	$85.70
Rate for Payer: Anthem Medicaid	$82.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$82.40
Rate for Payer: Dean Health Medicaid	$82.40
Rate for Payer: Independent Care Health Plan Medicaid	$82.40
Rate for Payer: Managed Health Services Medicaid	$85.70
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$82.40
Rate for Payer: United Healthcare Medicaid	$82.40
Rate for Payer: WMAP Medicaid	$82.40

EAPG 583: MALFUNCTION, REACTION, OR COMPLICATION OF PULMONARY DEVICE OR PROCEDURE

Facility OP

$128.70

Service Code	EAPG 00583
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$128.70
Rate for Payer: Anthem Medicaid	$123.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$123.75
Rate for Payer: Dean Health Medicaid	$123.75
Rate for Payer: Independent Care Health Plan Medicaid	$123.75
Rate for Payer: Managed Health Services Medicaid	$128.70
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$123.75
Rate for Payer: United Healthcare Medicaid	$123.75
Rate for Payer: WMAP Medicaid	$123.75

EAPG 584: ACUTE BRONCHITIS

Facility OP

$114.33

Service Code	EAPG 00584
Min. Negotiated Rate	$109.93
Max. Negotiated Rate	$114.33
Rate for Payer: Anthem Medicaid	$109.93
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$109.93
Rate for Payer: Dean Health Medicaid	$109.93
Rate for Payer: Independent Care Health Plan Medicaid	$109.93
Rate for Payer: Managed Health Services Medicaid	$114.33
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$109.93
Rate for Payer: United Healthcare Medicaid	$109.93
Rate for Payer: WMAP Medicaid	$109.93

EAPG 585: AFTERCARE, OPEN WOUNDS AND OTHER TRAUMATIC INJURIES

Facility OP

$51.99

Service Code	EAPG 00585
Min. Negotiated Rate	$49.99
Max. Negotiated Rate	$51.99
Rate for Payer: Anthem Medicaid	$49.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$49.99
Rate for Payer: Dean Health Medicaid	$49.99
Rate for Payer: Independent Care Health Plan Medicaid	$49.99
Rate for Payer: Managed Health Services Medicaid	$51.99
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$49.99
Rate for Payer: United Healthcare Medicaid	$49.99
Rate for Payer: WMAP Medicaid	$49.99

EAPG 586: PULMONARY EMBOLISM

Facility OP

$79.16

Service Code	EAPG 00586
Min. Negotiated Rate	$76.12
Max. Negotiated Rate	$79.16
Rate for Payer: Anthem Medicaid	$76.12
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$76.12
Rate for Payer: Dean Health Medicaid	$76.12
Rate for Payer: Independent Care Health Plan Medicaid	$76.12
Rate for Payer: Managed Health Services Medicaid	$79.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$76.12
Rate for Payer: United Healthcare Medicaid	$76.12
Rate for Payer: WMAP Medicaid	$76.12

EAPG 587: RESPIRATORY FAILURE

Facility OP

$175.22

Service Code	EAPG 00587
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$175.22
Rate for Payer: Anthem Medicaid	$168.48
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$168.48
Rate for Payer: Dean Health Medicaid	$168.48
Rate for Payer: Independent Care Health Plan Medicaid	$168.48
Rate for Payer: Managed Health Services Medicaid	$175.22
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$168.48
Rate for Payer: United Healthcare Medicaid	$168.48
Rate for Payer: WMAP Medicaid	$168.48

EAPG 589: MALFUNCTION, REACTION, OR COMPLICATION OF CARDIOVASCULAR DEVICE OR PROC

Facility OP

$107.03

Service Code	EAPG 00589
Min. Negotiated Rate	$102.91
Max. Negotiated Rate	$107.03
Rate for Payer: Anthem Medicaid	$102.91
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$102.91
Rate for Payer: Dean Health Medicaid	$102.91
Rate for Payer: Independent Care Health Plan Medicaid	$102.91
Rate for Payer: Managed Health Services Medicaid	$107.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$102.91
Rate for Payer: United Healthcare Medicaid	$102.91
Rate for Payer: WMAP Medicaid	$102.91

EAPG 58: LEVEL II SHOULDER AND UPPER ARM PROCEDURES

Facility OP

$3,862.36

Service Code	EAPG 00058
Min. Negotiated Rate	$3,713.81
Max. Negotiated Rate	$3,862.36
Rate for Payer: Anthem Medicaid	$3,713.81
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$3,713.81
Rate for Payer: Dean Health Medicaid	$3,713.81
Rate for Payer: Independent Care Health Plan Medicaid	$3,713.81
Rate for Payer: Managed Health Services Medicaid	$3,862.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$3,713.81
Rate for Payer: United Healthcare Medicaid	$3,713.81
Rate for Payer: WMAP Medicaid	$3,713.81

EAPG 591: ACUTE MYOCARDIAL INFARCTION

Facility OP

$278.92

Service Code	EAPG 00591
Min. Negotiated Rate	$179.93
Max. Negotiated Rate	$278.92
Rate for Payer: Anthem Medicaid	$179.93
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$278.92
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$179.93
Rate for Payer: Dean Health Medicaid	$179.93
Rate for Payer: Independent Care Health Plan Medicaid	$179.93
Rate for Payer: Managed Health Services Medicaid	$187.13
Rate for Payer: Molina Healthcare Medicaid	$278.92
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$179.93
Rate for Payer: United Healthcare Medicaid	$179.93
Rate for Payer: WMAP Medicaid	$179.93

EAPG 592: OTHER CARDIOVASCULAR SYSTEM DIAGNOSES

Facility OP

$126.52

Service Code	EAPG 00592
Min. Negotiated Rate	$79.07
Max. Negotiated Rate	$126.52
Rate for Payer: Anthem Medicaid	$79.07
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$126.52
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$79.07
Rate for Payer: Dean Health Medicaid	$79.07
Rate for Payer: Independent Care Health Plan Medicaid	$79.07
Rate for Payer: Managed Health Services Medicaid	$82.23
Rate for Payer: Molina Healthcare Medicaid	$126.52
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$79.07
Rate for Payer: United Healthcare Medicaid	$79.07
Rate for Payer: WMAP Medicaid	$79.07

EAPG 594: HEART FAILURE

Facility OP

$146.09

Service Code	EAPG 00594
Min. Negotiated Rate	$85.97
Max. Negotiated Rate	$146.09
Rate for Payer: Anthem Medicaid	$85.97
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$146.09
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$85.97
Rate for Payer: Dean Health Medicaid	$85.97
Rate for Payer: Independent Care Health Plan Medicaid	$85.97
Rate for Payer: Managed Health Services Medicaid	$89.41
Rate for Payer: Molina Healthcare Medicaid	$146.09
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$85.97
Rate for Payer: United Healthcare Medicaid	$85.97
Rate for Payer: WMAP Medicaid	$85.97

EAPG 595: CARDIAC ARREST OR OTHER CAUSES OF MORTALITY

Facility OP

$238.70

Service Code	EAPG 00595
Min. Negotiated Rate	$87.06
Max. Negotiated Rate	$238.70
Rate for Payer: Anthem Medicaid	$87.06
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$238.70
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$87.06
Rate for Payer: Dean Health Medicaid	$87.06
Rate for Payer: Independent Care Health Plan Medicaid	$87.06
Rate for Payer: Managed Health Services Medicaid	$90.54
Rate for Payer: Molina Healthcare Medicaid	$238.70
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$87.06
Rate for Payer: United Healthcare Medicaid	$87.06
Rate for Payer: WMAP Medicaid	$87.06

EAPG 596: PERIPHERAL AND OTHER VASCULAR DIAGNOSES

Facility OP

$109.25

Service Code	EAPG 00596
Min. Negotiated Rate	$63.03
Max. Negotiated Rate	$109.25
Rate for Payer: Anthem Medicaid	$63.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$109.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$63.03
Rate for Payer: Dean Health Medicaid	$63.03
Rate for Payer: Independent Care Health Plan Medicaid	$63.03
Rate for Payer: Managed Health Services Medicaid	$65.55
Rate for Payer: Molina Healthcare Medicaid	$109.25
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$63.03
Rate for Payer: United Healthcare Medicaid	$63.03
Rate for Payer: WMAP Medicaid	$63.03

EAPG 597: PHLEBITIS

Facility OP

$92.61

Service Code	EAPG 00597
Min. Negotiated Rate	$89.05
Max. Negotiated Rate	$92.61
Rate for Payer: Anthem Medicaid	$89.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$92.32
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$89.05
Rate for Payer: Dean Health Medicaid	$89.05
Rate for Payer: Independent Care Health Plan Medicaid	$89.05
Rate for Payer: Managed Health Services Medicaid	$92.61
Rate for Payer: Molina Healthcare Medicaid	$92.32
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$89.05
Rate for Payer: United Healthcare Medicaid	$89.05
Rate for Payer: WMAP Medicaid	$89.05

EAPG 598: ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility OP

$90.02

Service Code	EAPG 00598
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$90.02
Rate for Payer: Anthem Medicaid	$55.00
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$90.02
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$55.00
Rate for Payer: Dean Health Medicaid	$55.00
Rate for Payer: Independent Care Health Plan Medicaid	$55.00
Rate for Payer: Managed Health Services Medicaid	$57.20
Rate for Payer: Molina Healthcare Medicaid	$90.02
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$55.00
Rate for Payer: United Healthcare Medicaid	$55.00
Rate for Payer: WMAP Medicaid	$55.00

EAPG 599: HYPERTENSION

Facility OP

$98.19

Service Code	EAPG 00599
Min. Negotiated Rate	$57.45
Max. Negotiated Rate	$98.19
Rate for Payer: Anthem Medicaid	$57.45
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$98.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$57.45
Rate for Payer: Dean Health Medicaid	$57.45
Rate for Payer: Independent Care Health Plan Medicaid	$57.45
Rate for Payer: Managed Health Services Medicaid	$59.75
Rate for Payer: Molina Healthcare Medicaid	$98.19
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$57.45
Rate for Payer: United Healthcare Medicaid	$57.45
Rate for Payer: WMAP Medicaid	$57.45

EAPG 59: ARTERIOVENOUS FISTULA CREATION OR REVISION FOR HEMODIALYSIS

Facility OP

$1,520.46

Service Code	EAPG 00059
Min. Negotiated Rate	$1,461.98
Max. Negotiated Rate	$1,520.46
Rate for Payer: Anthem Medicaid	$1,461.98
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,461.98
Rate for Payer: Dean Health Medicaid	$1,461.98
Rate for Payer: Independent Care Health Plan Medicaid	$1,461.98
Rate for Payer: Managed Health Services Medicaid	$1,520.46
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,461.98
Rate for Payer: United Healthcare Medicaid	$1,461.98
Rate for Payer: WMAP Medicaid	$1,461.98

EAPG 5: NAIL PROCEDURES

Facility OP

$64.82

Service Code	EAPG 00005
Min. Negotiated Rate	$27.63
Max. Negotiated Rate	$64.82
Rate for Payer: Anthem Medicaid	$27.63
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$64.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$27.63
Rate for Payer: Dean Health Medicaid	$27.63
Rate for Payer: Independent Care Health Plan Medicaid	$27.63
Rate for Payer: Managed Health Services Medicaid	$28.74
Rate for Payer: Molina Healthcare Medicaid	$64.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$27.63
Rate for Payer: United Healthcare Medicaid	$27.63
Rate for Payer: WMAP Medicaid	$27.63

EAPG 600: CARDIAC STRUCTURAL AND VALVULAR DIAGNOSES

Facility OP

$89.53

Service Code	EAPG 00600
Min. Negotiated Rate	$55.67
Max. Negotiated Rate	$89.53
Rate for Payer: Anthem Medicaid	$55.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$89.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$55.67
Rate for Payer: Dean Health Medicaid	$55.67
Rate for Payer: Independent Care Health Plan Medicaid	$55.67
Rate for Payer: Managed Health Services Medicaid	$57.90
Rate for Payer: Molina Healthcare Medicaid	$89.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$55.67
Rate for Payer: United Healthcare Medicaid	$55.67
Rate for Payer: WMAP Medicaid	$55.67

EAPG 601: CARDIAC ARRHYTHMIA AND CONDUCTION DIAGNOSES

Facility OP

$110.03

Service Code	EAPG 00601
Min. Negotiated Rate	$79.82
Max. Negotiated Rate	$110.03
Rate for Payer: Anthem Medicaid	$79.82
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$110.03
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$79.82
Rate for Payer: Dean Health Medicaid	$79.82
Rate for Payer: Independent Care Health Plan Medicaid	$79.82
Rate for Payer: Managed Health Services Medicaid	$83.01
Rate for Payer: Molina Healthcare Medicaid	$110.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$79.82
Rate for Payer: United Healthcare Medicaid	$79.82
Rate for Payer: WMAP Medicaid	$79.82

EAPG 602: ATRIAL FIBRILLATION

Facility OP

$91.93

Service Code	EAPG 00602
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$91.93
Rate for Payer: Anthem Medicaid	$60.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$91.93
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$60.25
Rate for Payer: Dean Health Medicaid	$60.25
Rate for Payer: Independent Care Health Plan Medicaid	$60.25
Rate for Payer: Managed Health Services Medicaid	$62.66
Rate for Payer: Molina Healthcare Medicaid	$91.93
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$60.25
Rate for Payer: United Healthcare Medicaid	$60.25
Rate for Payer: WMAP Medicaid	$60.25

EAPG 604: CHEST PAIN

Facility OP

$241.78

Service Code	EAPG 00604
Min. Negotiated Rate	$157.84
Max. Negotiated Rate	$241.78
Rate for Payer: Anthem Medicaid	$157.84
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$241.78
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$157.84
Rate for Payer: Dean Health Medicaid	$157.84
Rate for Payer: Independent Care Health Plan Medicaid	$157.84
Rate for Payer: Managed Health Services Medicaid	$164.15
Rate for Payer: Molina Healthcare Medicaid	$241.78
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$157.84
Rate for Payer: United Healthcare Medicaid	$157.84
Rate for Payer: WMAP Medicaid	$157.84

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