Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 120: CAR T-CELL IMMUNOTHERAPY

Facility

$19,377.73

Service Code	EAPG 00120
Min. Negotiated Rate	$18,632.43
Max. Negotiated Rate	$19,377.73
Rate for Payer: Anthem Medicaid	$18,632.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$18,632.43
Rate for Payer: Dean Health Medicaid	$18,632.43
Rate for Payer: Independent Care Health Plan Medicaid	$18,632.43
Rate for Payer: Managed Health Services Medicaid	$19,377.73
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$18,632.43
Rate for Payer: United Healthcare Medicaid	$18,632.43
Rate for Payer: WMAP Medicaid	$18,632.43

EAPG 121: LEVEL II PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES

Facility

$6,234.55

Service Code	EAPG 00121
Min. Negotiated Rate	$5,994.76
Max. Negotiated Rate	$6,234.55
Rate for Payer: Anthem Medicaid	$5,994.76
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5,994.76
Rate for Payer: Dean Health Medicaid	$5,994.76
Rate for Payer: Independent Care Health Plan Medicaid	$5,994.76
Rate for Payer: Managed Health Services Medicaid	$6,234.55
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5,994.76
Rate for Payer: United Healthcare Medicaid	$5,994.76
Rate for Payer: WMAP Medicaid	$5,994.76

EAPG 122: PERCUTANEOUS INTRA-ABDOMINAL OR INTRATHORACIC VASCULAR PROCEDURES

Facility

$7,093.61

Service Code	EAPG 00122
Min. Negotiated Rate	$6,820.78
Max. Negotiated Rate	$7,093.61
Rate for Payer: Anthem Medicaid	$6,820.78
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$6,820.78
Rate for Payer: Dean Health Medicaid	$6,820.78
Rate for Payer: Independent Care Health Plan Medicaid	$6,820.78
Rate for Payer: Managed Health Services Medicaid	$7,093.61
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$6,820.78
Rate for Payer: United Healthcare Medicaid	$6,820.78
Rate for Payer: WMAP Medicaid	$6,820.78

EAPG 123: PERIPHERAL VASCULAR BYPASS PROCEDURES

Facility

$2,390.63

Service Code	EAPG 00123
Min. Negotiated Rate	$2,298.68
Max. Negotiated Rate	$2,390.63
Rate for Payer: Anthem Medicaid	$2,298.68
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,298.68
Rate for Payer: Dean Health Medicaid	$2,298.68
Rate for Payer: Independent Care Health Plan Medicaid	$2,298.68
Rate for Payer: Managed Health Services Medicaid	$2,390.63
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,298.68
Rate for Payer: United Healthcare Medicaid	$2,298.68
Rate for Payer: WMAP Medicaid	$2,298.68

EAPG 124: BONE MARROW BIOPSIES

Facility

$715.88

Service Code	EAPG 00124
Min. Negotiated Rate	$688.35
Max. Negotiated Rate	$715.88
Rate for Payer: Anthem Medicaid	$688.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$688.35
Rate for Payer: Dean Health Medicaid	$688.35
Rate for Payer: Independent Care Health Plan Medicaid	$688.35
Rate for Payer: Managed Health Services Medicaid	$715.88
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$688.35
Rate for Payer: United Healthcare Medicaid	$688.35
Rate for Payer: WMAP Medicaid	$688.35

EAPG 125: LEVEL I ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES

Facility

$1,403.72

Service Code	EAPG 00125
Min. Negotiated Rate	$1,349.73
Max. Negotiated Rate	$1,403.72
Rate for Payer: Anthem Medicaid	$1,349.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,349.73
Rate for Payer: Dean Health Medicaid	$1,349.73
Rate for Payer: Independent Care Health Plan Medicaid	$1,349.73
Rate for Payer: Managed Health Services Medicaid	$1,403.72
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,349.73
Rate for Payer: United Healthcare Medicaid	$1,349.73
Rate for Payer: WMAP Medicaid	$1,349.73

EAPG 126: LEVEL II ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES

Facility

$1,531.28

Service Code	EAPG 00126
Min. Negotiated Rate	$1,472.38
Max. Negotiated Rate	$1,531.28
Rate for Payer: Anthem Medicaid	$1,472.38
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,472.38
Rate for Payer: Dean Health Medicaid	$1,472.38
Rate for Payer: Independent Care Health Plan Medicaid	$1,472.38
Rate for Payer: Managed Health Services Medicaid	$1,531.28
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,472.38
Rate for Payer: United Healthcare Medicaid	$1,472.38
Rate for Payer: WMAP Medicaid	$1,472.38

EAPG 127: LEVEL I SMALL AND LARGE INTESTINE SURGICAL PROCEDURES

Facility

$890.72

Service Code	EAPG 00127
Min. Negotiated Rate	$856.46
Max. Negotiated Rate	$890.72
Rate for Payer: Anthem Medicaid	$856.46
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$856.46
Rate for Payer: Dean Health Medicaid	$856.46
Rate for Payer: Independent Care Health Plan Medicaid	$856.46
Rate for Payer: Managed Health Services Medicaid	$890.72
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$856.46
Rate for Payer: United Healthcare Medicaid	$856.46
Rate for Payer: WMAP Medicaid	$856.46

EAPG 128: LEVEL II SMALL AND LARGE INTESTINE SURGICAL PROCEDURES

Facility

$1,649.43

Service Code	EAPG 00128
Min. Negotiated Rate	$1,585.99
Max. Negotiated Rate	$1,649.43
Rate for Payer: Anthem Medicaid	$1,585.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,585.99
Rate for Payer: Dean Health Medicaid	$1,585.99
Rate for Payer: Independent Care Health Plan Medicaid	$1,585.99
Rate for Payer: Managed Health Services Medicaid	$1,649.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,585.99
Rate for Payer: United Healthcare Medicaid	$1,585.99
Rate for Payer: WMAP Medicaid	$1,585.99

EAPG 129: ESOPHAGOGASTRIC RESTRICTIVE PROCEDURES AND GASTRIC FUNDOPLICATION

Facility

$2,172.28

Service Code	EAPG 00129
Min. Negotiated Rate	$2,088.73
Max. Negotiated Rate	$2,172.28
Rate for Payer: Anthem Medicaid	$2,088.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,088.73
Rate for Payer: Dean Health Medicaid	$2,088.73
Rate for Payer: Independent Care Health Plan Medicaid	$2,088.73
Rate for Payer: Managed Health Services Medicaid	$2,172.28
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,088.73
Rate for Payer: United Healthcare Medicaid	$2,088.73
Rate for Payer: WMAP Medicaid	$2,088.73

EAPG 130: MINOR GASTROINTESTINAL PROCEDURES INCLUDING TUBE INSERTION OR PLACEMENT

Facility

$475.88

Service Code	EAPG 00130
Min. Negotiated Rate	$161.62
Max. Negotiated Rate	$475.88
Rate for Payer: Anthem Medicaid	$161.62
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$475.88
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$161.62
Rate for Payer: Dean Health Medicaid	$161.62
Rate for Payer: Independent Care Health Plan Medicaid	$161.62
Rate for Payer: Managed Health Services Medicaid	$168.08
Rate for Payer: Molina Healthcare Medicaid	$475.88
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$161.62
Rate for Payer: United Healthcare Medicaid	$161.62
Rate for Payer: WMAP Medicaid	$161.62

EAPG 134: LEVEL I UPPER GI ENDOSCOPY

Facility

$618.55

Service Code	EAPG 00134
Min. Negotiated Rate	$400.73
Max. Negotiated Rate	$618.55
Rate for Payer: Anthem Medicaid	$400.73
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$618.55
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$400.73
Rate for Payer: Dean Health Medicaid	$400.73
Rate for Payer: Independent Care Health Plan Medicaid	$400.73
Rate for Payer: Managed Health Services Medicaid	$416.76
Rate for Payer: Molina Healthcare Medicaid	$618.55
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$400.73
Rate for Payer: United Healthcare Medicaid	$400.73
Rate for Payer: WMAP Medicaid	$400.73

EAPG 135: LEVEL II UPPER GI ENDOSCOPY

Facility

$866.50

Service Code	EAPG 00135
Min. Negotiated Rate	$833.17
Max. Negotiated Rate	$866.50
Rate for Payer: Anthem Medicaid	$833.17
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$853.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$833.17
Rate for Payer: Dean Health Medicaid	$833.17
Rate for Payer: Independent Care Health Plan Medicaid	$833.17
Rate for Payer: Managed Health Services Medicaid	$866.50
Rate for Payer: Molina Healthcare Medicaid	$853.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$833.17
Rate for Payer: United Healthcare Medicaid	$833.17
Rate for Payer: WMAP Medicaid	$833.17

EAPG 136: LEVEL I LOWER GI ENDOSCOPY

Facility

$592.96

Service Code	EAPG 00136
Min. Negotiated Rate	$409.48
Max. Negotiated Rate	$592.96
Rate for Payer: Anthem Medicaid	$409.48
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$592.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$409.48
Rate for Payer: Dean Health Medicaid	$409.48
Rate for Payer: Independent Care Health Plan Medicaid	$409.48
Rate for Payer: Managed Health Services Medicaid	$425.86
Rate for Payer: Molina Healthcare Medicaid	$592.96
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$409.48
Rate for Payer: United Healthcare Medicaid	$409.48
Rate for Payer: WMAP Medicaid	$409.48

EAPG 137: LEVEL II LOWER GI ENDOSCOPY

Facility

$875.48

Service Code	EAPG 00137
Min. Negotiated Rate	$659.89
Max. Negotiated Rate	$875.48
Rate for Payer: Anthem Medicaid	$841.81
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$659.89
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$841.81
Rate for Payer: Dean Health Medicaid	$841.81
Rate for Payer: Independent Care Health Plan Medicaid	$841.81
Rate for Payer: Managed Health Services Medicaid	$875.48
Rate for Payer: Molina Healthcare Medicaid	$659.89
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$841.81
Rate for Payer: United Healthcare Medicaid	$841.81
Rate for Payer: WMAP Medicaid	$841.81

EAPG 138: LEVEL I ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility

$1,805.44

Service Code	EAPG 00138
Min. Negotiated Rate	$1,064.14
Max. Negotiated Rate	$1,805.44
Rate for Payer: Anthem Medicaid	$1,064.14
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,805.44
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,064.14
Rate for Payer: Dean Health Medicaid	$1,064.14
Rate for Payer: Independent Care Health Plan Medicaid	$1,064.14
Rate for Payer: Managed Health Services Medicaid	$1,106.71
Rate for Payer: Molina Healthcare Medicaid	$1,805.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,064.14
Rate for Payer: United Healthcare Medicaid	$1,064.14
Rate for Payer: WMAP Medicaid	$1,064.14

EAPG 141: LEVEL I ANAL AND RECTAL PROCEDURES

Facility

$1,107.15

Service Code	EAPG 00141
Min. Negotiated Rate	$597.55
Max. Negotiated Rate	$1,107.15
Rate for Payer: Anthem Medicaid	$597.55
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,107.15
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$597.55
Rate for Payer: Dean Health Medicaid	$597.55
Rate for Payer: Independent Care Health Plan Medicaid	$597.55
Rate for Payer: Managed Health Services Medicaid	$621.45
Rate for Payer: Molina Healthcare Medicaid	$1,107.15
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$597.55
Rate for Payer: United Healthcare Medicaid	$597.55
Rate for Payer: WMAP Medicaid	$597.55

EAPG 142: LEVEL II ANAL AND RECTAL PROCEDURES

Facility

$1,565.81

Service Code	EAPG 00142
Min. Negotiated Rate	$934.71
Max. Negotiated Rate	$1,565.81
Rate for Payer: Anthem Medicaid	$934.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,565.81
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$934.71
Rate for Payer: Dean Health Medicaid	$934.71
Rate for Payer: Independent Care Health Plan Medicaid	$934.71
Rate for Payer: Managed Health Services Medicaid	$972.10
Rate for Payer: Molina Healthcare Medicaid	$1,565.81
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$934.71
Rate for Payer: United Healthcare Medicaid	$934.71
Rate for Payer: WMAP Medicaid	$934.71

EAPG 150: ABDOMINAL PARACENTESIS AND RELATED PERITONEAL DRAINAGE PROCEDURES

Facility

$311.78

Service Code	EAPG 00150
Min. Negotiated Rate	$299.79
Max. Negotiated Rate	$311.78
Rate for Payer: Anthem Medicaid	$299.79
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$299.79
Rate for Payer: Dean Health Medicaid	$299.79
Rate for Payer: Independent Care Health Plan Medicaid	$299.79
Rate for Payer: Managed Health Services Medicaid	$311.78
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$299.79
Rate for Payer: United Healthcare Medicaid	$299.79
Rate for Payer: WMAP Medicaid	$299.79

EAPG 151: LEVEL I HEPATOBILIARY AND PANCREAS PROCEDURES

Facility

$957.21

Service Code	EAPG 00151
Min. Negotiated Rate	$920.39
Max. Negotiated Rate	$957.21
Rate for Payer: Anthem Medicaid	$920.39
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$920.39
Rate for Payer: Dean Health Medicaid	$920.39
Rate for Payer: Independent Care Health Plan Medicaid	$920.39
Rate for Payer: Managed Health Services Medicaid	$957.21
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$920.39
Rate for Payer: United Healthcare Medicaid	$920.39
Rate for Payer: WMAP Medicaid	$920.39

EAPG 152: LEVEL II HEPATOBILIARY AND PANCREAS PROCEDURES

Facility

$2,342.89

Service Code	EAPG 00152
Min. Negotiated Rate	$2,252.78
Max. Negotiated Rate	$2,342.89
Rate for Payer: Anthem Medicaid	$2,252.78
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,252.78
Rate for Payer: Dean Health Medicaid	$2,252.78
Rate for Payer: Independent Care Health Plan Medicaid	$2,252.78
Rate for Payer: Managed Health Services Medicaid	$2,342.89
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,252.78
Rate for Payer: United Healthcare Medicaid	$2,252.78
Rate for Payer: WMAP Medicaid	$2,252.78

EAPG 153: LEVEL II ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility

$1,841.00

Service Code	EAPG 00153
Min. Negotiated Rate	$1,770.19
Max. Negotiated Rate	$1,841.00
Rate for Payer: Anthem Medicaid	$1,770.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,770.19
Rate for Payer: Dean Health Medicaid	$1,770.19
Rate for Payer: Independent Care Health Plan Medicaid	$1,770.19
Rate for Payer: Managed Health Services Medicaid	$1,841.00
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,770.19
Rate for Payer: United Healthcare Medicaid	$1,770.19
Rate for Payer: WMAP Medicaid	$1,770.19

EAPG 154: LEVEL III UPPER GI ENDOSCOPY

Facility

$1,621.58

Service Code	EAPG 00154
Min. Negotiated Rate	$1,559.21
Max. Negotiated Rate	$1,621.58
Rate for Payer: Anthem Medicaid	$1,559.21
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,559.21
Rate for Payer: Dean Health Medicaid	$1,559.21
Rate for Payer: Independent Care Health Plan Medicaid	$1,559.21
Rate for Payer: Managed Health Services Medicaid	$1,621.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,559.21
Rate for Payer: United Healthcare Medicaid	$1,559.21
Rate for Payer: WMAP Medicaid	$1,559.21

EAPG 155: LEVEL III BLOOD PRODUCT EXCHANGE SERVICES

Facility

$1,917.36

Service Code	EAPG 00155
Min. Negotiated Rate	$1,843.62
Max. Negotiated Rate	$1,917.36
Rate for Payer: Anthem Medicaid	$1,843.62
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,843.62
Rate for Payer: Dean Health Medicaid	$1,843.62
Rate for Payer: Independent Care Health Plan Medicaid	$1,843.62
Rate for Payer: Managed Health Services Medicaid	$1,917.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,843.62
Rate for Payer: United Healthcare Medicaid	$1,843.62
Rate for Payer: WMAP Medicaid	$1,843.62

EAPG 156: OCULAR IMAGING AND RELATED SERVICES

Facility

$24.19

Service Code	EAPG 00156
Min. Negotiated Rate	$23.26
Max. Negotiated Rate	$24.19
Rate for Payer: Anthem Medicaid	$23.26
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$23.26
Rate for Payer: Dean Health Medicaid	$23.26
Rate for Payer: Independent Care Health Plan Medicaid	$23.26
Rate for Payer: Managed Health Services Medicaid	$24.19
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$23.26
Rate for Payer: United Healthcare Medicaid	$23.26
Rate for Payer: WMAP Medicaid	$23.26

Know your out-of-pocket cost for care.

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