Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 189: LEVEL II PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES

Facility

$2,394.20

Service Code	EAPG 00189
Min. Negotiated Rate	$2,302.12
Max. Negotiated Rate	$2,394.20
Rate for Payer: Anthem Medicaid	$2,302.12
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,302.12
Rate for Payer: Dean Health Medicaid	$2,302.12
Rate for Payer: Independent Care Health Plan Medicaid	$2,302.12
Rate for Payer: Managed Health Services Medicaid	$2,394.20
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,302.12
Rate for Payer: United Healthcare Medicaid	$2,302.12
Rate for Payer: WMAP Medicaid	$2,302.12

EAPG 18: COMPLEX WOUND REPAIR AND TREATMENT

Facility

$438.85

Service Code	EAPG 00018
Min. Negotiated Rate	$421.97
Max. Negotiated Rate	$438.85
Rate for Payer: Anthem Medicaid	$421.97
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$421.97
Rate for Payer: Dean Health Medicaid	$421.97
Rate for Payer: Independent Care Health Plan Medicaid	$421.97
Rate for Payer: Managed Health Services Medicaid	$438.85
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$421.97
Rate for Payer: United Healthcare Medicaid	$421.97
Rate for Payer: WMAP Medicaid	$421.97

EAPG 190: ARTIFICIAL FERTILIZATION

Facility

$242.66

Service Code	EAPG 00190
Min. Negotiated Rate	$169.74
Max. Negotiated Rate	$242.66
Rate for Payer: Anthem Medicaid	$169.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$242.66
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$169.74
Rate for Payer: Dean Health Medicaid	$169.74
Rate for Payer: Independent Care Health Plan Medicaid	$169.74
Rate for Payer: Managed Health Services Medicaid	$176.53
Rate for Payer: Molina Healthcare Medicaid	$242.66
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$169.74
Rate for Payer: United Healthcare Medicaid	$169.74
Rate for Payer: WMAP Medicaid	$169.74

EAPG 191: LEVEL I FETAL PROCEDURES

Facility

$193.45

Service Code	EAPG 00191
Min. Negotiated Rate	$80.42
Max. Negotiated Rate	$193.45
Rate for Payer: Anthem Medicaid	$80.42
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$193.45
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$80.42
Rate for Payer: Dean Health Medicaid	$80.42
Rate for Payer: Independent Care Health Plan Medicaid	$80.42
Rate for Payer: Managed Health Services Medicaid	$83.64
Rate for Payer: Molina Healthcare Medicaid	$193.45
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$80.42
Rate for Payer: United Healthcare Medicaid	$80.42
Rate for Payer: WMAP Medicaid	$80.42

EAPG 192: LEVEL II FETAL PROCEDURES

Facility

$668.11

Service Code	EAPG 00192
Min. Negotiated Rate	$414.23
Max. Negotiated Rate	$668.11
Rate for Payer: Anthem Medicaid	$414.23
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$668.11
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$414.23
Rate for Payer: Dean Health Medicaid	$414.23
Rate for Payer: Independent Care Health Plan Medicaid	$414.23
Rate for Payer: Managed Health Services Medicaid	$430.80
Rate for Payer: Molina Healthcare Medicaid	$668.11
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$414.23
Rate for Payer: United Healthcare Medicaid	$414.23
Rate for Payer: WMAP Medicaid	$414.23

EAPG 194: ABORTION AND MISCARRIAGE TREATMENT AND PROCEDURES

Facility

$1,363.27

Service Code	EAPG 00194
Min. Negotiated Rate	$718.51
Max. Negotiated Rate	$1,363.27
Rate for Payer: Anthem Medicaid	$718.51
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,363.27
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$718.51
Rate for Payer: Dean Health Medicaid	$718.51
Rate for Payer: Independent Care Health Plan Medicaid	$718.51
Rate for Payer: Managed Health Services Medicaid	$747.25
Rate for Payer: Molina Healthcare Medicaid	$1,363.27
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$718.51
Rate for Payer: United Healthcare Medicaid	$718.51
Rate for Payer: WMAP Medicaid	$718.51

EAPG 195: VAGINAL DELIVERY PROCEDURES

Facility

$1,490.13

Service Code	EAPG 00195
Min. Negotiated Rate	$894.88
Max. Negotiated Rate	$1,490.13
Rate for Payer: Anthem Medicaid	$894.88
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,490.13
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$894.88
Rate for Payer: Dean Health Medicaid	$894.88
Rate for Payer: Independent Care Health Plan Medicaid	$894.88
Rate for Payer: Managed Health Services Medicaid	$930.68
Rate for Payer: Molina Healthcare Medicaid	$1,490.13
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$894.88
Rate for Payer: United Healthcare Medicaid	$894.88
Rate for Payer: WMAP Medicaid	$894.88

EAPG 19: MOHS MICROGRAPHIC SURGERY

Facility

$407.69

Service Code	EAPG 00019
Min. Negotiated Rate	$392.01
Max. Negotiated Rate	$407.69
Rate for Payer: Anthem Medicaid	$392.01
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$392.01
Rate for Payer: Dean Health Medicaid	$392.01
Rate for Payer: Independent Care Health Plan Medicaid	$392.01
Rate for Payer: Managed Health Services Medicaid	$407.69
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$392.01
Rate for Payer: United Healthcare Medicaid	$392.01
Rate for Payer: WMAP Medicaid	$392.01

EAPG 2016: LEVEL II ALLERGY TESTS

Facility

$20.07

Service Code	EAPG 02016
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$20.07
Rate for Payer: Anthem Medicaid	$19.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$19.30
Rate for Payer: Dean Health Medicaid	$19.30
Rate for Payer: Independent Care Health Plan Medicaid	$19.30
Rate for Payer: Managed Health Services Medicaid	$20.07
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$19.30
Rate for Payer: United Healthcare Medicaid	$19.30
Rate for Payer: WMAP Medicaid	$19.30

EAPG 2020: NONINVASIVE VENTILATION SUPPORT

Facility

$57.46

Service Code	EAPG 02020
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$57.46
Rate for Payer: Anthem Medicaid	$55.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$55.25
Rate for Payer: Dean Health Medicaid	$55.25
Rate for Payer: Independent Care Health Plan Medicaid	$55.25
Rate for Payer: Managed Health Services Medicaid	$57.46
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$55.25
Rate for Payer: United Healthcare Medicaid	$55.25
Rate for Payer: WMAP Medicaid	$55.25

EAPG 202: CESAREAN DELIVERY PROCEDURES

Facility

$1,117.81

Service Code	EAPG 00202
Min. Negotiated Rate	$1,074.82
Max. Negotiated Rate	$1,117.81
Rate for Payer: Anthem Medicaid	$1,074.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,074.82
Rate for Payer: Dean Health Medicaid	$1,074.82
Rate for Payer: Independent Care Health Plan Medicaid	$1,074.82
Rate for Payer: Managed Health Services Medicaid	$1,117.81
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,074.82
Rate for Payer: United Healthcare Medicaid	$1,074.82
Rate for Payer: WMAP Medicaid	$1,074.82

EAPG 2030: MINOR MUSCULOSKELETAL PROCEDURES

Facility

$79.50

Service Code	EAPG 02030
Min. Negotiated Rate	$76.44
Max. Negotiated Rate	$79.50
Rate for Payer: Anthem Medicaid	$76.44
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$76.44
Rate for Payer: Dean Health Medicaid	$76.44
Rate for Payer: Independent Care Health Plan Medicaid	$76.44
Rate for Payer: Managed Health Services Medicaid	$79.50
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$76.44
Rate for Payer: United Healthcare Medicaid	$76.44
Rate for Payer: WMAP Medicaid	$76.44

EAPG 203: GLOBAL ANTEPARTUM AND POSTPARTUM VISITS

Facility

$105.66

Service Code	EAPG 00203
Min. Negotiated Rate	$101.60
Max. Negotiated Rate	$105.66
Rate for Payer: Anthem Medicaid	$101.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$101.60
Rate for Payer: Dean Health Medicaid	$101.60
Rate for Payer: Independent Care Health Plan Medicaid	$101.60
Rate for Payer: Managed Health Services Medicaid	$105.66
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$101.60
Rate for Payer: United Healthcare Medicaid	$101.60
Rate for Payer: WMAP Medicaid	$101.60

EAPG 2040: LEVEL I DRUG SCREENING AND DEFINITIVE TESTS

Facility

$4.88

Service Code	EAPG 02040
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$4.88
Rate for Payer: Anthem Medicaid	$4.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4.69
Rate for Payer: Dean Health Medicaid	$4.69
Rate for Payer: Independent Care Health Plan Medicaid	$4.69
Rate for Payer: Managed Health Services Medicaid	$4.88
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4.69
Rate for Payer: United Healthcare Medicaid	$4.69
Rate for Payer: WMAP Medicaid	$4.69

EAPG 2041: LEVEL II DRUG SCREENING AND DEFINITIVE TESTS

Facility

$24.44

Service Code	EAPG 02041
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$24.44
Rate for Payer: Anthem Medicaid	$23.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$23.50
Rate for Payer: Dean Health Medicaid	$23.50
Rate for Payer: Independent Care Health Plan Medicaid	$23.50
Rate for Payer: Managed Health Services Medicaid	$24.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$23.50
Rate for Payer: United Healthcare Medicaid	$23.50
Rate for Payer: WMAP Medicaid	$23.50

EAPG 2042: LEVEL III DRUG SCREENING AND DEFINITIVE TESTS

Facility

$56.92

Service Code	EAPG 02042
Min. Negotiated Rate	$54.73
Max. Negotiated Rate	$56.92
Rate for Payer: Anthem Medicaid	$54.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.73
Rate for Payer: Dean Health Medicaid	$54.73
Rate for Payer: Independent Care Health Plan Medicaid	$54.73
Rate for Payer: Managed Health Services Medicaid	$56.92
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.73
Rate for Payer: United Healthcare Medicaid	$54.73
Rate for Payer: WMAP Medicaid	$54.73

EAPG 2043: LEVEL III BLOOD AND TISSUE TYPING TESTS

Facility

$56.79

Service Code	EAPG 02043
Min. Negotiated Rate	$54.61
Max. Negotiated Rate	$56.79
Rate for Payer: Anthem Medicaid	$54.61
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.61
Rate for Payer: Dean Health Medicaid	$54.61
Rate for Payer: Independent Care Health Plan Medicaid	$54.61
Rate for Payer: Managed Health Services Medicaid	$56.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.61
Rate for Payer: United Healthcare Medicaid	$54.61
Rate for Payer: WMAP Medicaid	$54.61

EAPG 2044: LEVEL IV COMPLEX LABORATORY, MOLECULAR PATHOLOGY AND GENETIC TESTS

Facility

$229.79

Service Code	EAPG 02044
Min. Negotiated Rate	$220.95
Max. Negotiated Rate	$229.79
Rate for Payer: Anthem Medicaid	$220.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$220.95
Rate for Payer: Dean Health Medicaid	$220.95
Rate for Payer: Independent Care Health Plan Medicaid	$220.95
Rate for Payer: Managed Health Services Medicaid	$229.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$220.95
Rate for Payer: United Healthcare Medicaid	$220.95
Rate for Payer: WMAP Medicaid	$220.95

EAPG 2045: ADVANCED MOLECULAR PATHOLOGY AND GENETIC TESTS

Facility

$816.44

Service Code	EAPG 02045
Min. Negotiated Rate	$785.04
Max. Negotiated Rate	$816.44
Rate for Payer: Anthem Medicaid	$785.04
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$785.04
Rate for Payer: Dean Health Medicaid	$785.04
Rate for Payer: Independent Care Health Plan Medicaid	$785.04
Rate for Payer: Managed Health Services Medicaid	$816.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$785.04
Rate for Payer: United Healthcare Medicaid	$785.04
Rate for Payer: WMAP Medicaid	$785.04

EAPG 204: LEVEL I HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility

$1,778.60

Service Code	EAPG 00204
Min. Negotiated Rate	$1,710.19
Max. Negotiated Rate	$1,778.60
Rate for Payer: Anthem Medicaid	$1,710.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,710.19
Rate for Payer: Dean Health Medicaid	$1,710.19
Rate for Payer: Independent Care Health Plan Medicaid	$1,710.19
Rate for Payer: Managed Health Services Medicaid	$1,778.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,710.19
Rate for Payer: United Healthcare Medicaid	$1,710.19
Rate for Payer: WMAP Medicaid	$1,710.19

EAPG 205: OBSTETRICAL PROCEDURES

Facility

$731.90

Service Code	EAPG 00205
Min. Negotiated Rate	$703.75
Max. Negotiated Rate	$731.90
Rate for Payer: Anthem Medicaid	$703.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$703.75
Rate for Payer: Dean Health Medicaid	$703.75
Rate for Payer: Independent Care Health Plan Medicaid	$703.75
Rate for Payer: Managed Health Services Medicaid	$731.90
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$703.75
Rate for Payer: United Healthcare Medicaid	$703.75
Rate for Payer: WMAP Medicaid	$703.75

EAPG 2061: CLASS I BLOOD PRODUCTS

Facility

$54.13

Service Code	EAPG 02061
Min. Negotiated Rate	$52.05
Max. Negotiated Rate	$54.13
Rate for Payer: Anthem Medicaid	$52.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$52.05
Rate for Payer: Dean Health Medicaid	$52.05
Rate for Payer: Independent Care Health Plan Medicaid	$52.05
Rate for Payer: Managed Health Services Medicaid	$54.13
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$52.05
Rate for Payer: United Healthcare Medicaid	$52.05
Rate for Payer: WMAP Medicaid	$52.05

EAPG 2062: CLASS II BLOOD PRODUCTS

Facility

$119.36

Service Code	EAPG 02062
Min. Negotiated Rate	$114.77
Max. Negotiated Rate	$119.36
Rate for Payer: Anthem Medicaid	$114.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$114.77
Rate for Payer: Dean Health Medicaid	$114.77
Rate for Payer: Independent Care Health Plan Medicaid	$114.77
Rate for Payer: Managed Health Services Medicaid	$119.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$114.77
Rate for Payer: United Healthcare Medicaid	$114.77
Rate for Payer: WMAP Medicaid	$114.77

EAPG 206: LEVEL II HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility

$2,514.72

Service Code	EAPG 00206
Min. Negotiated Rate	$2,418.00
Max. Negotiated Rate	$2,514.72
Rate for Payer: Anthem Medicaid	$2,418.00
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,418.00
Rate for Payer: Dean Health Medicaid	$2,418.00
Rate for Payer: Independent Care Health Plan Medicaid	$2,418.00
Rate for Payer: Managed Health Services Medicaid	$2,514.72
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,418.00
Rate for Payer: United Healthcare Medicaid	$2,418.00
Rate for Payer: WMAP Medicaid	$2,418.00

EAPG 2070: MONTHLY CARE AND CASE MANAGEMENT SERVICES

Facility

$21.29

Service Code	EAPG 02070
Min. Negotiated Rate	$20.47
Max. Negotiated Rate	$21.29
Rate for Payer: Anthem Medicaid	$20.47
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$20.47
Rate for Payer: Dean Health Medicaid	$20.47
Rate for Payer: Independent Care Health Plan Medicaid	$20.47
Rate for Payer: Managed Health Services Medicaid	$21.29
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$20.47
Rate for Payer: United Healthcare Medicaid	$20.47
Rate for Payer: WMAP Medicaid	$20.47

Know your out-of-pocket cost for care.

All Charges