Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 157: REPRODUCTIVE PATHOLOGY TESTS

Facility

$42.08

Service Code	EAPG 00157
Min. Negotiated Rate	$40.46
Max. Negotiated Rate	$42.08
Rate for Payer: Anthem Medicaid	$40.46
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$40.46
Rate for Payer: Dean Health Medicaid	$40.46
Rate for Payer: Independent Care Health Plan Medicaid	$40.46
Rate for Payer: Managed Health Services Medicaid	$42.08
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$40.46
Rate for Payer: United Healthcare Medicaid	$40.46
Rate for Payer: WMAP Medicaid	$40.46

EAPG 158: PATHOLOGY CONSULTATION AND INTERPRETATION

Facility

$36.10

Service Code	EAPG 00158
Min. Negotiated Rate	$34.71
Max. Negotiated Rate	$36.10
Rate for Payer: Anthem Medicaid	$34.71
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$34.71
Rate for Payer: Dean Health Medicaid	$34.71
Rate for Payer: Independent Care Health Plan Medicaid	$34.71
Rate for Payer: Managed Health Services Medicaid	$36.10
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$34.71
Rate for Payer: United Healthcare Medicaid	$34.71
Rate for Payer: WMAP Medicaid	$34.71

EAPG 159: MINOR UROLOGY SERVICES

Facility

$37.21

Service Code	EAPG 00159
Min. Negotiated Rate	$35.78
Max. Negotiated Rate	$37.21
Rate for Payer: Anthem Medicaid	$35.78
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$35.78
Rate for Payer: Dean Health Medicaid	$35.78
Rate for Payer: Independent Care Health Plan Medicaid	$35.78
Rate for Payer: Managed Health Services Medicaid	$37.21
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$35.78
Rate for Payer: United Healthcare Medicaid	$35.78
Rate for Payer: WMAP Medicaid	$35.78

EAPG 161: URINARY STUDIES AND PROCEDURES

Facility

$327.79

Service Code	EAPG 00161
Min. Negotiated Rate	$167.66
Max. Negotiated Rate	$327.79
Rate for Payer: Anthem Medicaid	$167.66
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$327.79
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$167.66
Rate for Payer: Dean Health Medicaid	$167.66
Rate for Payer: Independent Care Health Plan Medicaid	$167.66
Rate for Payer: Managed Health Services Medicaid	$174.37
Rate for Payer: Molina Healthcare Medicaid	$327.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$167.66
Rate for Payer: United Healthcare Medicaid	$167.66
Rate for Payer: WMAP Medicaid	$167.66

EAPG 166: LEVEL I URETHRAL PROCEDURES

Facility

$1,238.05

Service Code	EAPG 00166
Min. Negotiated Rate	$1,156.03
Max. Negotiated Rate	$1,238.05
Rate for Payer: Anthem Medicaid	$1,190.43
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,156.03
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,190.43
Rate for Payer: Dean Health Medicaid	$1,190.43
Rate for Payer: Independent Care Health Plan Medicaid	$1,190.43
Rate for Payer: Managed Health Services Medicaid	$1,238.05
Rate for Payer: Molina Healthcare Medicaid	$1,156.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,190.43
Rate for Payer: United Healthcare Medicaid	$1,190.43
Rate for Payer: WMAP Medicaid	$1,190.43

EAPG 167: LEVEL II URETHRAL PROCEDURES

Facility

$3,761.77

Service Code	EAPG 00167
Min. Negotiated Rate	$2,375.53
Max. Negotiated Rate	$3,761.77
Rate for Payer: Anthem Medicaid	$2,375.53
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3,761.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,375.53
Rate for Payer: Dean Health Medicaid	$2,375.53
Rate for Payer: Independent Care Health Plan Medicaid	$2,375.53
Rate for Payer: Managed Health Services Medicaid	$2,470.55
Rate for Payer: Molina Healthcare Medicaid	$3,761.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,375.53
Rate for Payer: United Healthcare Medicaid	$2,375.53
Rate for Payer: WMAP Medicaid	$2,375.53

EAPG 168: DIALYSIS PROCEDURES

Facility

$749.71

Service Code	EAPG 00168
Min. Negotiated Rate	$322.88
Max. Negotiated Rate	$749.71
Rate for Payer: Anthem Medicaid	$322.88
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$749.71
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$322.88
Rate for Payer: Dean Health Medicaid	$322.88
Rate for Payer: Independent Care Health Plan Medicaid	$322.88
Rate for Payer: Managed Health Services Medicaid	$335.80
Rate for Payer: Molina Healthcare Medicaid	$749.71
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$322.88
Rate for Payer: United Healthcare Medicaid	$322.88
Rate for Payer: WMAP Medicaid	$322.88

EAPG 16: SIMPLE WOUND REPAIR AND TREATMENT

Facility

$78.76

Service Code	EAPG 00016
Min. Negotiated Rate	$75.73
Max. Negotiated Rate	$78.76
Rate for Payer: Anthem Medicaid	$75.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$75.73
Rate for Payer: Dean Health Medicaid	$75.73
Rate for Payer: Independent Care Health Plan Medicaid	$75.73
Rate for Payer: Managed Health Services Medicaid	$78.76
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$75.73
Rate for Payer: United Healthcare Medicaid	$75.73
Rate for Payer: WMAP Medicaid	$75.73

EAPG 170: LEVEL I KIDNEY AND URETERAL PROCEDURES

Facility

$632.70

Service Code	EAPG 00170
Min. Negotiated Rate	$608.37
Max. Negotiated Rate	$632.70
Rate for Payer: Anthem Medicaid	$608.37
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$608.37
Rate for Payer: Dean Health Medicaid	$608.37
Rate for Payer: Independent Care Health Plan Medicaid	$608.37
Rate for Payer: Managed Health Services Medicaid	$632.70
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$608.37
Rate for Payer: United Healthcare Medicaid	$608.37
Rate for Payer: WMAP Medicaid	$608.37

EAPG 171: LEVEL II KIDNEY AND URETERAL PROCEDURES

Facility

$1,251.04

Service Code	EAPG 00171
Min. Negotiated Rate	$1,202.92
Max. Negotiated Rate	$1,251.04
Rate for Payer: Anthem Medicaid	$1,202.92
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,202.92
Rate for Payer: Dean Health Medicaid	$1,202.92
Rate for Payer: Independent Care Health Plan Medicaid	$1,202.92
Rate for Payer: Managed Health Services Medicaid	$1,251.04
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,202.92
Rate for Payer: United Healthcare Medicaid	$1,202.92
Rate for Payer: WMAP Medicaid	$1,202.92

EAPG 172: LEVEL III KIDNEY AND URETERAL PROCEDURES

Facility

$2,944.46

Service Code	EAPG 00172
Min. Negotiated Rate	$2,831.21
Max. Negotiated Rate	$2,944.46
Rate for Payer: Anthem Medicaid	$2,831.21
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,831.21
Rate for Payer: Dean Health Medicaid	$2,831.21
Rate for Payer: Independent Care Health Plan Medicaid	$2,831.21
Rate for Payer: Managed Health Services Medicaid	$2,944.46
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,831.21
Rate for Payer: United Healthcare Medicaid	$2,831.21
Rate for Payer: WMAP Medicaid	$2,831.21

EAPG 173: LEVEL I BLADDER AND URETERAL PROCEDURES

Facility

$672.84

Service Code	EAPG 00173
Min. Negotiated Rate	$646.96
Max. Negotiated Rate	$672.84
Rate for Payer: Anthem Medicaid	$646.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$646.96
Rate for Payer: Dean Health Medicaid	$646.96
Rate for Payer: Independent Care Health Plan Medicaid	$646.96
Rate for Payer: Managed Health Services Medicaid	$672.84
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$646.96
Rate for Payer: United Healthcare Medicaid	$646.96
Rate for Payer: WMAP Medicaid	$646.96

EAPG 174: LEVEL II BLADDER AND URETERAL PROCEDURES

Facility

$1,752.05

Service Code	EAPG 00174
Min. Negotiated Rate	$1,684.66
Max. Negotiated Rate	$1,752.05
Rate for Payer: Anthem Medicaid	$1,684.66
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,684.66
Rate for Payer: Dean Health Medicaid	$1,684.66
Rate for Payer: Independent Care Health Plan Medicaid	$1,684.66
Rate for Payer: Managed Health Services Medicaid	$1,752.05
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,684.66
Rate for Payer: United Healthcare Medicaid	$1,684.66
Rate for Payer: WMAP Medicaid	$1,684.66

EAPG 175: LEVEL III BLADDER AND URETERAL PROCEDURES

Facility

$2,112.58

Service Code	EAPG 00175
Min. Negotiated Rate	$2,031.33
Max. Negotiated Rate	$2,112.58
Rate for Payer: Anthem Medicaid	$2,031.33
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,031.33
Rate for Payer: Dean Health Medicaid	$2,031.33
Rate for Payer: Independent Care Health Plan Medicaid	$2,031.33
Rate for Payer: Managed Health Services Medicaid	$2,112.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,031.33
Rate for Payer: United Healthcare Medicaid	$2,031.33
Rate for Payer: WMAP Medicaid	$2,031.33

EAPG 176: LEVEL I PROSTATE PROCEDURES

Facility

$735.65

Service Code	EAPG 00176
Min. Negotiated Rate	$707.36
Max. Negotiated Rate	$735.65
Rate for Payer: Anthem Medicaid	$707.36
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$707.36
Rate for Payer: Dean Health Medicaid	$707.36
Rate for Payer: Independent Care Health Plan Medicaid	$707.36
Rate for Payer: Managed Health Services Medicaid	$735.65
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$707.36
Rate for Payer: United Healthcare Medicaid	$707.36
Rate for Payer: WMAP Medicaid	$707.36

EAPG 177: MINOR DERMATOLOGY SERVICES

Facility

$12.16

Service Code	EAPG 00177
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$12.16
Rate for Payer: Anthem Medicaid	$11.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$11.69
Rate for Payer: Dean Health Medicaid	$11.69
Rate for Payer: Independent Care Health Plan Medicaid	$11.69
Rate for Payer: Managed Health Services Medicaid	$12.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$11.69
Rate for Payer: United Healthcare Medicaid	$11.69
Rate for Payer: WMAP Medicaid	$11.69

EAPG 178: ANTEPARTUM PROCEDURES

Facility

$249.30

Service Code	EAPG 00178
Min. Negotiated Rate	$239.71
Max. Negotiated Rate	$249.30
Rate for Payer: Anthem Medicaid	$239.71
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$239.71
Rate for Payer: Dean Health Medicaid	$239.71
Rate for Payer: Independent Care Health Plan Medicaid	$239.71
Rate for Payer: Managed Health Services Medicaid	$249.30
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$239.71
Rate for Payer: United Healthcare Medicaid	$239.71
Rate for Payer: WMAP Medicaid	$239.71

EAPG 179: ECTOPIC PREGNANCY PROCEDURES

Facility

$1,558.24

Service Code	EAPG 00179
Min. Negotiated Rate	$1,498.31
Max. Negotiated Rate	$1,558.24
Rate for Payer: Anthem Medicaid	$1,498.31
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,498.31
Rate for Payer: Dean Health Medicaid	$1,498.31
Rate for Payer: Independent Care Health Plan Medicaid	$1,498.31
Rate for Payer: Managed Health Services Medicaid	$1,558.24
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,498.31
Rate for Payer: United Healthcare Medicaid	$1,498.31
Rate for Payer: WMAP Medicaid	$1,498.31

EAPG 17: INTERMEDIATE WOUND REPAIR AND TREATMENT

Facility

$164.96

Service Code	EAPG 00017
Min. Negotiated Rate	$158.62
Max. Negotiated Rate	$164.96
Rate for Payer: Anthem Medicaid	$158.62
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$158.62
Rate for Payer: Dean Health Medicaid	$158.62
Rate for Payer: Independent Care Health Plan Medicaid	$158.62
Rate for Payer: Managed Health Services Medicaid	$164.96
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$158.62
Rate for Payer: United Healthcare Medicaid	$158.62
Rate for Payer: WMAP Medicaid	$158.62

EAPG 180: TESTICULAR AND EPIDIDYMAL PROCEDURES

Facility

$1,355.10

Service Code	EAPG 00180
Min. Negotiated Rate	$983.19
Max. Negotiated Rate	$1,355.10
Rate for Payer: Anthem Medicaid	$983.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,355.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$983.19
Rate for Payer: Dean Health Medicaid	$983.19
Rate for Payer: Independent Care Health Plan Medicaid	$983.19
Rate for Payer: Managed Health Services Medicaid	$1,022.52
Rate for Payer: Molina Healthcare Medicaid	$1,355.10
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$983.19
Rate for Payer: United Healthcare Medicaid	$983.19
Rate for Payer: WMAP Medicaid	$983.19

EAPG 182: INSERTION OF PENILE PROSTHESIS

Facility

$9,585.88

Service Code	EAPG 00182
Min. Negotiated Rate	$5,494.89
Max. Negotiated Rate	$9,585.88
Rate for Payer: Anthem Medicaid	$5,494.89
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$9,585.88
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5,494.89
Rate for Payer: Dean Health Medicaid	$5,494.89
Rate for Payer: Independent Care Health Plan Medicaid	$5,494.89
Rate for Payer: Managed Health Services Medicaid	$5,714.69
Rate for Payer: Molina Healthcare Medicaid	$9,585.88
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5,494.89
Rate for Payer: United Healthcare Medicaid	$5,494.89
Rate for Payer: WMAP Medicaid	$5,494.89

EAPG 183: LEVEL I PENILE PROCEDURES

Facility

$1,890.67

Service Code	EAPG 00183
Min. Negotiated Rate	$818.90
Max. Negotiated Rate	$1,890.67
Rate for Payer: Anthem Medicaid	$818.90
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,890.67
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$818.90
Rate for Payer: Dean Health Medicaid	$818.90
Rate for Payer: Independent Care Health Plan Medicaid	$818.90
Rate for Payer: Managed Health Services Medicaid	$851.66
Rate for Payer: Molina Healthcare Medicaid	$1,890.67
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$818.90
Rate for Payer: United Healthcare Medicaid	$818.90
Rate for Payer: WMAP Medicaid	$818.90

EAPG 184: LEVEL II PROSTATE PROCEDURES

Facility

$2,318.36

Service Code	EAPG 00184
Min. Negotiated Rate	$1,828.51
Max. Negotiated Rate	$2,318.36
Rate for Payer: Anthem Medicaid	$1,828.51
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,318.36
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,828.51
Rate for Payer: Dean Health Medicaid	$1,828.51
Rate for Payer: Independent Care Health Plan Medicaid	$1,828.51
Rate for Payer: Managed Health Services Medicaid	$1,901.65
Rate for Payer: Molina Healthcare Medicaid	$2,318.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,828.51
Rate for Payer: United Healthcare Medicaid	$1,828.51
Rate for Payer: WMAP Medicaid	$1,828.51

EAPG 187: LEVEL II PENILE PROCEDURES

Facility

$1,318.95

Service Code	EAPG 00187
Min. Negotiated Rate	$1,268.22
Max. Negotiated Rate	$1,318.95
Rate for Payer: Anthem Medicaid	$1,268.22
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,268.22
Rate for Payer: Dean Health Medicaid	$1,268.22
Rate for Payer: Independent Care Health Plan Medicaid	$1,268.22
Rate for Payer: Managed Health Services Medicaid	$1,318.95
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,268.22
Rate for Payer: United Healthcare Medicaid	$1,268.22
Rate for Payer: WMAP Medicaid	$1,268.22

EAPG 188: LEVEL I PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES

Facility

$1,052.68

Service Code	EAPG 00188
Min. Negotiated Rate	$1,012.19
Max. Negotiated Rate	$1,052.68
Rate for Payer: Anthem Medicaid	$1,012.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,012.19
Rate for Payer: Dean Health Medicaid	$1,012.19
Rate for Payer: Independent Care Health Plan Medicaid	$1,012.19
Rate for Payer: Managed Health Services Medicaid	$1,052.68
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,012.19
Rate for Payer: United Healthcare Medicaid	$1,012.19
Rate for Payer: WMAP Medicaid	$1,012.19

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