Beloit Memorial Hospital

All Charges

Charge

Type

Price

EAPG 605: SYNCOPE AND COLLAPSE

Facility OP

$179.11

Service Code	EAPG 00605
Min. Negotiated Rate	$119.16
Max. Negotiated Rate	$179.11
Rate for Payer: Anthem Medicaid	$119.16
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$179.11
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$119.16
Rate for Payer: Dean Health Medicaid	$119.16
Rate for Payer: Independent Care Health Plan Medicaid	$119.16
Rate for Payer: Managed Health Services Medicaid	$123.93
Rate for Payer: Molina Healthcare Medicaid	$179.11
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$119.16
Rate for Payer: United Healthcare Medicaid	$119.16
Rate for Payer: WMAP Medicaid	$119.16

EAPG 607: CARDIOMYOPATHY DIAGNOSES

Facility OP

$56.82

Service Code	EAPG 00607
Min. Negotiated Rate	$54.63
Max. Negotiated Rate	$56.82
Rate for Payer: Anthem Medicaid	$54.63
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.63
Rate for Payer: Dean Health Medicaid	$54.63
Rate for Payer: Independent Care Health Plan Medicaid	$54.63
Rate for Payer: Managed Health Services Medicaid	$56.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.63
Rate for Payer: United Healthcare Medicaid	$54.63
Rate for Payer: WMAP Medicaid	$54.63

EAPG 608: ACUTE AND SUBACUTE ENDOCARDITIS

Facility OP

$54.49

Service Code	EAPG 00608
Min. Negotiated Rate	$52.39
Max. Negotiated Rate	$54.49
Rate for Payer: Anthem Medicaid	$52.39
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$52.39
Rate for Payer: Dean Health Medicaid	$52.39
Rate for Payer: Independent Care Health Plan Medicaid	$52.39
Rate for Payer: Managed Health Services Medicaid	$54.49
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$52.39
Rate for Payer: United Healthcare Medicaid	$52.39
Rate for Payer: WMAP Medicaid	$52.39

EAPG 60: PULMONARY FUNCTION TESTS

Facility OP

$180.58

Service Code	EAPG 00060
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$180.58
Rate for Payer: Anthem Medicaid	$42.88
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$180.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$42.88
Rate for Payer: Dean Health Medicaid	$42.88
Rate for Payer: Independent Care Health Plan Medicaid	$42.88
Rate for Payer: Managed Health Services Medicaid	$44.60
Rate for Payer: Molina Healthcare Medicaid	$180.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$42.88
Rate for Payer: United Healthcare Medicaid	$42.88
Rate for Payer: WMAP Medicaid	$42.88

EAPG 610: CONTUSIONS TO EXTERNAL ORGANS OTHER THAN HEAD TRAUMA

Facility OP

$111.77

Service Code	EAPG 00610
Min. Negotiated Rate	$107.47
Max. Negotiated Rate	$111.77
Rate for Payer: Anthem Medicaid	$107.47
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$107.47
Rate for Payer: Dean Health Medicaid	$107.47
Rate for Payer: Independent Care Health Plan Medicaid	$107.47
Rate for Payer: Managed Health Services Medicaid	$111.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$107.47
Rate for Payer: United Healthcare Medicaid	$107.47
Rate for Payer: WMAP Medicaid	$107.47

EAPG 616: DIVERTICULITIS AND DIVERTICULOSIS

Facility OP

$93.46

Service Code	EAPG 00616
Min. Negotiated Rate	$89.87
Max. Negotiated Rate	$93.46
Rate for Payer: Anthem Medicaid	$89.87
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$89.87
Rate for Payer: Dean Health Medicaid	$89.87
Rate for Payer: Independent Care Health Plan Medicaid	$89.87
Rate for Payer: Managed Health Services Medicaid	$93.46
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$89.87
Rate for Payer: United Healthcare Medicaid	$89.87
Rate for Payer: WMAP Medicaid	$89.87

EAPG 617: GASTROINTESTINAL HEMORRHAGE AND RELATED POSTPROCEDURAL HEMORRHAGE DIAGNOSES

Facility OP

$122.26

Service Code	EAPG 00617
Min. Negotiated Rate	$117.56
Max. Negotiated Rate	$122.26
Rate for Payer: Anthem Medicaid	$117.56
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$117.56
Rate for Payer: Dean Health Medicaid	$117.56
Rate for Payer: Independent Care Health Plan Medicaid	$117.56
Rate for Payer: Managed Health Services Medicaid	$122.26
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$117.56
Rate for Payer: United Healthcare Medicaid	$117.56
Rate for Payer: WMAP Medicaid	$117.56

EAPG 618: INTESTINAL OBSTRUCTION DIAGNOSES

Facility OP

$121.99

Service Code	EAPG 00618
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$121.99
Rate for Payer: Anthem Medicaid	$117.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$117.30
Rate for Payer: Dean Health Medicaid	$117.30
Rate for Payer: Independent Care Health Plan Medicaid	$117.30
Rate for Payer: Managed Health Services Medicaid	$121.99
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$117.30
Rate for Payer: United Healthcare Medicaid	$117.30
Rate for Payer: WMAP Medicaid	$117.30

EAPG 619: GASTROINTESTINAL AND PERITONEAL INFECTION DIAGNOSES

Facility OP

$91.87

Service Code	EAPG 00619
Min. Negotiated Rate	$88.34
Max. Negotiated Rate	$91.87
Rate for Payer: Anthem Medicaid	$88.34
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$88.34
Rate for Payer: Dean Health Medicaid	$88.34
Rate for Payer: Independent Care Health Plan Medicaid	$88.34
Rate for Payer: Managed Health Services Medicaid	$91.87
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$88.34
Rate for Payer: United Healthcare Medicaid	$88.34
Rate for Payer: WMAP Medicaid	$88.34

EAPG 620: DIGESTIVE MALIGNANCY

Facility OP

$122.99

Service Code	EAPG 00620
Min. Negotiated Rate	$74.83
Max. Negotiated Rate	$122.99
Rate for Payer: Anthem Medicaid	$74.83
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$122.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$74.83
Rate for Payer: Dean Health Medicaid	$74.83
Rate for Payer: Independent Care Health Plan Medicaid	$74.83
Rate for Payer: Managed Health Services Medicaid	$77.82
Rate for Payer: Molina Healthcare Medicaid	$122.99
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$74.83
Rate for Payer: United Healthcare Medicaid	$74.83
Rate for Payer: WMAP Medicaid	$74.83

EAPG 621: PEPTIC ULCER AND GASTRITIS

Facility OP

$175.88

Service Code	EAPG 00621
Min. Negotiated Rate	$115.58
Max. Negotiated Rate	$175.88
Rate for Payer: Anthem Medicaid	$115.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$175.88
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$115.58
Rate for Payer: Dean Health Medicaid	$115.58
Rate for Payer: Independent Care Health Plan Medicaid	$115.58
Rate for Payer: Managed Health Services Medicaid	$120.20
Rate for Payer: Molina Healthcare Medicaid	$175.88
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$115.58
Rate for Payer: United Healthcare Medicaid	$115.58
Rate for Payer: WMAP Medicaid	$115.58

EAPG 623: ESOPHAGITIS AND OTHER ESOPHAGEAL DIAGNOSES

Facility OP

$117.96

Service Code	EAPG 00623
Min. Negotiated Rate	$65.76
Max. Negotiated Rate	$117.96
Rate for Payer: Anthem Medicaid	$65.76
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$117.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$65.76
Rate for Payer: Dean Health Medicaid	$65.76
Rate for Payer: Independent Care Health Plan Medicaid	$65.76
Rate for Payer: Managed Health Services Medicaid	$68.39
Rate for Payer: Molina Healthcare Medicaid	$117.96
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$65.76
Rate for Payer: United Healthcare Medicaid	$65.76
Rate for Payer: WMAP Medicaid	$65.76

EAPG 624: OTHER GASTROINTESTINAL SYSTEM DIAGNOSES

Facility OP

$114.24

Service Code	EAPG 00624
Min. Negotiated Rate	$75.13
Max. Negotiated Rate	$114.24
Rate for Payer: Anthem Medicaid	$75.13
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$114.24
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$75.13
Rate for Payer: Dean Health Medicaid	$75.13
Rate for Payer: Independent Care Health Plan Medicaid	$75.13
Rate for Payer: Managed Health Services Medicaid	$78.14
Rate for Payer: Molina Healthcare Medicaid	$114.24
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$75.13
Rate for Payer: United Healthcare Medicaid	$75.13
Rate for Payer: WMAP Medicaid	$75.13

EAPG 626: INFLAMMATORY BOWEL DISEASE

Facility OP

$100.15

Service Code	EAPG 00626
Min. Negotiated Rate	$54.92
Max. Negotiated Rate	$100.15
Rate for Payer: Anthem Medicaid	$54.92
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$100.15
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.92
Rate for Payer: Dean Health Medicaid	$54.92
Rate for Payer: Independent Care Health Plan Medicaid	$54.92
Rate for Payer: Managed Health Services Medicaid	$57.12
Rate for Payer: Molina Healthcare Medicaid	$100.15
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.92
Rate for Payer: United Healthcare Medicaid	$54.92
Rate for Payer: WMAP Medicaid	$54.92

EAPG 627: NON-BACTERIAL GASTROENTERITIS, NAUSEA AND VOMITING

Facility OP

$162.13

Service Code	EAPG 00627
Min. Negotiated Rate	$89.42
Max. Negotiated Rate	$162.13
Rate for Payer: Anthem Medicaid	$89.42
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$162.13
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$89.42
Rate for Payer: Dean Health Medicaid	$89.42
Rate for Payer: Independent Care Health Plan Medicaid	$89.42
Rate for Payer: Managed Health Services Medicaid	$93.00
Rate for Payer: Molina Healthcare Medicaid	$162.13
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$89.42
Rate for Payer: United Healthcare Medicaid	$89.42
Rate for Payer: WMAP Medicaid	$89.42

EAPG 628: ABDOMINAL PAIN

Facility OP

$166.83

Service Code	EAPG 00628
Min. Negotiated Rate	$104.10
Max. Negotiated Rate	$166.83
Rate for Payer: Anthem Medicaid	$104.10
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$166.83
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$104.10
Rate for Payer: Dean Health Medicaid	$104.10
Rate for Payer: Independent Care Health Plan Medicaid	$104.10
Rate for Payer: Managed Health Services Medicaid	$108.26
Rate for Payer: Molina Healthcare Medicaid	$166.83
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$104.10
Rate for Payer: United Healthcare Medicaid	$104.10
Rate for Payer: WMAP Medicaid	$104.10

EAPG 629: MALFUNCTION, REACTION AND COMPLICATION OF GI DEVICE OR PROCEDURE

Facility OP

$134.25

Service Code	EAPG 00629
Min. Negotiated Rate	$123.41
Max. Negotiated Rate	$134.25
Rate for Payer: Anthem Medicaid	$123.41
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$134.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$123.41
Rate for Payer: Dean Health Medicaid	$123.41
Rate for Payer: Independent Care Health Plan Medicaid	$123.41
Rate for Payer: Managed Health Services Medicaid	$128.35
Rate for Payer: Molina Healthcare Medicaid	$134.25
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$123.41
Rate for Payer: United Healthcare Medicaid	$123.41
Rate for Payer: WMAP Medicaid	$123.41

EAPG 62: LEVEL I ENDOSCOPY OF THE UPPER AIRWAY

Facility OP

$319.18

Service Code	EAPG 00062
Min. Negotiated Rate	$250.87
Max. Negotiated Rate	$319.18
Rate for Payer: Anthem Medicaid	$250.87
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$319.18
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$250.87
Rate for Payer: Dean Health Medicaid	$250.87
Rate for Payer: Independent Care Health Plan Medicaid	$250.87
Rate for Payer: Managed Health Services Medicaid	$260.90
Rate for Payer: Molina Healthcare Medicaid	$319.18
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$250.87
Rate for Payer: United Healthcare Medicaid	$250.87
Rate for Payer: WMAP Medicaid	$250.87

EAPG 630: CONSTIPATION

Facility OP

$146.77

Service Code	EAPG 00630
Min. Negotiated Rate	$85.01
Max. Negotiated Rate	$146.77
Rate for Payer: Anthem Medicaid	$85.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$146.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$85.01
Rate for Payer: Dean Health Medicaid	$85.01
Rate for Payer: Independent Care Health Plan Medicaid	$85.01
Rate for Payer: Managed Health Services Medicaid	$88.41
Rate for Payer: Molina Healthcare Medicaid	$146.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$85.01
Rate for Payer: United Healthcare Medicaid	$85.01
Rate for Payer: WMAP Medicaid	$85.01

EAPG 631: HERNIA

Facility OP

$104.26

Service Code	EAPG 00631
Min. Negotiated Rate	$65.58
Max. Negotiated Rate	$104.26
Rate for Payer: Anthem Medicaid	$65.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$104.26
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$65.58
Rate for Payer: Dean Health Medicaid	$65.58
Rate for Payer: Independent Care Health Plan Medicaid	$65.58
Rate for Payer: Managed Health Services Medicaid	$68.20
Rate for Payer: Molina Healthcare Medicaid	$104.26
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$65.58
Rate for Payer: United Healthcare Medicaid	$65.58
Rate for Payer: WMAP Medicaid	$65.58

EAPG 632: IRRITABLE BOWEL SYNDROME

Facility OP

$86.99

Service Code	EAPG 00632
Min. Negotiated Rate	$47.78
Max. Negotiated Rate	$86.99
Rate for Payer: Anthem Medicaid	$47.78
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$86.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$47.78
Rate for Payer: Dean Health Medicaid	$47.78
Rate for Payer: Independent Care Health Plan Medicaid	$47.78
Rate for Payer: Managed Health Services Medicaid	$49.69
Rate for Payer: Molina Healthcare Medicaid	$86.99
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$47.78
Rate for Payer: United Healthcare Medicaid	$47.78
Rate for Payer: WMAP Medicaid	$47.78

EAPG 633: ALCOHOLIC LIVER DISEASE

Facility OP

$124.81

Service Code	EAPG 00633
Min. Negotiated Rate	$75.49
Max. Negotiated Rate	$124.81
Rate for Payer: Anthem Medicaid	$75.49
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$124.81
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$75.49
Rate for Payer: Dean Health Medicaid	$75.49
Rate for Payer: Independent Care Health Plan Medicaid	$75.49
Rate for Payer: Managed Health Services Medicaid	$78.51
Rate for Payer: Molina Healthcare Medicaid	$124.81
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$75.49
Rate for Payer: United Healthcare Medicaid	$75.49
Rate for Payer: WMAP Medicaid	$75.49

EAPG 634: MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS

Facility OP

$132.63

Service Code	EAPG 00634
Min. Negotiated Rate	$90.23
Max. Negotiated Rate	$132.63
Rate for Payer: Anthem Medicaid	$90.23
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$132.63
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$90.23
Rate for Payer: Dean Health Medicaid	$90.23
Rate for Payer: Independent Care Health Plan Medicaid	$90.23
Rate for Payer: Managed Health Services Medicaid	$93.84
Rate for Payer: Molina Healthcare Medicaid	$132.63
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$90.23
Rate for Payer: United Healthcare Medicaid	$90.23
Rate for Payer: WMAP Medicaid	$90.23

EAPG 635: PANCREAS DIAGNOSES EXCEPT MALIGNANCY

Facility OP

$135.08

Service Code	EAPG 00635
Min. Negotiated Rate	$86.13
Max. Negotiated Rate	$135.08
Rate for Payer: Anthem Medicaid	$86.13
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$135.08
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$86.13
Rate for Payer: Dean Health Medicaid	$86.13
Rate for Payer: Independent Care Health Plan Medicaid	$86.13
Rate for Payer: Managed Health Services Medicaid	$89.58
Rate for Payer: Molina Healthcare Medicaid	$135.08
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$86.13
Rate for Payer: United Healthcare Medicaid	$86.13
Rate for Payer: WMAP Medicaid	$86.13

EAPG 636: HEPATITIS WITHOUT COMA

Facility OP

$113.41

Service Code	EAPG 00636
Min. Negotiated Rate	$71.90
Max. Negotiated Rate	$113.41
Rate for Payer: Anthem Medicaid	$71.90
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$113.41
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$71.90
Rate for Payer: Dean Health Medicaid	$71.90
Rate for Payer: Independent Care Health Plan Medicaid	$71.90
Rate for Payer: Managed Health Services Medicaid	$74.78
Rate for Payer: Molina Healthcare Medicaid	$113.41
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$71.90
Rate for Payer: United Healthcare Medicaid	$71.90
Rate for Payer: WMAP Medicaid	$71.90

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