Beloit Memorial Hospital

All Charges

Charge

Type

Price

EAPG 671: MAJOR SKIN DIAGNOSES

Facility OP

$102.69

Service Code	EAPG 00671
Min. Negotiated Rate	$52.55
Max. Negotiated Rate	$102.69
Rate for Payer: Anthem Medicaid	$52.55
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$102.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$52.55
Rate for Payer: Dean Health Medicaid	$52.55
Rate for Payer: Independent Care Health Plan Medicaid	$52.55
Rate for Payer: Managed Health Services Medicaid	$54.65
Rate for Payer: Molina Healthcare Medicaid	$102.69
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$52.55
Rate for Payer: United Healthcare Medicaid	$52.55
Rate for Payer: WMAP Medicaid	$52.55

EAPG 672: MALIGNANT BREAST DIAGNOSES

Facility OP

$111.55

Service Code	EAPG 00672
Min. Negotiated Rate	$56.37
Max. Negotiated Rate	$111.55
Rate for Payer: Anthem Medicaid	$56.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$111.55
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$56.37
Rate for Payer: Dean Health Medicaid	$56.37
Rate for Payer: Independent Care Health Plan Medicaid	$56.37
Rate for Payer: Managed Health Services Medicaid	$58.62
Rate for Payer: Molina Healthcare Medicaid	$111.55
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$56.37
Rate for Payer: United Healthcare Medicaid	$56.37
Rate for Payer: WMAP Medicaid	$56.37

EAPG 673: CELLULITIS AND OTHER BACTERIAL SKIN INFECTIONS

Facility OP

$112.87

Service Code	EAPG 00673
Min. Negotiated Rate	$77.38
Max. Negotiated Rate	$112.87
Rate for Payer: Anthem Medicaid	$77.38
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$112.87
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$77.38
Rate for Payer: Dean Health Medicaid	$77.38
Rate for Payer: Independent Care Health Plan Medicaid	$77.38
Rate for Payer: Managed Health Services Medicaid	$80.48
Rate for Payer: Molina Healthcare Medicaid	$112.87
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$77.38
Rate for Payer: United Healthcare Medicaid	$77.38
Rate for Payer: WMAP Medicaid	$77.38

EAPG 674: OPEN WOUNDS, PUNCTURES AND OTHER OPEN TRAUMATIC INJURIES

Facility OP

$144.23

Service Code	EAPG 00674
Min. Negotiated Rate	$70.71
Max. Negotiated Rate	$144.23
Rate for Payer: Anthem Medicaid	$70.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$144.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.71
Rate for Payer: Dean Health Medicaid	$70.71
Rate for Payer: Independent Care Health Plan Medicaid	$70.71
Rate for Payer: Managed Health Services Medicaid	$73.54
Rate for Payer: Molina Healthcare Medicaid	$144.23
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.71
Rate for Payer: United Healthcare Medicaid	$70.71
Rate for Payer: WMAP Medicaid	$70.71

EAPG 675: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DIAGNOSES

Facility OP

$92.27

Service Code	EAPG 00675
Min. Negotiated Rate	$44.69
Max. Negotiated Rate	$92.27
Rate for Payer: Anthem Medicaid	$44.69
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$92.27
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$44.69
Rate for Payer: Dean Health Medicaid	$44.69
Rate for Payer: Independent Care Health Plan Medicaid	$44.69
Rate for Payer: Managed Health Services Medicaid	$46.48
Rate for Payer: Molina Healthcare Medicaid	$92.27
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$44.69
Rate for Payer: United Healthcare Medicaid	$44.69
Rate for Payer: WMAP Medicaid	$44.69

EAPG 676: PRESSURE ULCERS

Facility OP

$141.39

Service Code	EAPG 00676
Min. Negotiated Rate	$61.42
Max. Negotiated Rate	$141.39
Rate for Payer: Anthem Medicaid	$61.42
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$141.39
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$61.42
Rate for Payer: Dean Health Medicaid	$61.42
Rate for Payer: Independent Care Health Plan Medicaid	$61.42
Rate for Payer: Managed Health Services Medicaid	$63.88
Rate for Payer: Molina Healthcare Medicaid	$141.39
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$61.42
Rate for Payer: United Healthcare Medicaid	$61.42
Rate for Payer: WMAP Medicaid	$61.42

EAPG 67: VENTILATION ASSISTANCE AND MANAGEMENT

Facility OP

$578.77

Service Code	EAPG 00067
Min. Negotiated Rate	$439.36
Max. Negotiated Rate	$578.77
Rate for Payer: Anthem Medicaid	$439.36
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$578.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$439.36
Rate for Payer: Dean Health Medicaid	$439.36
Rate for Payer: Independent Care Health Plan Medicaid	$439.36
Rate for Payer: Managed Health Services Medicaid	$456.93
Rate for Payer: Molina Healthcare Medicaid	$578.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$439.36
Rate for Payer: United Healthcare Medicaid	$439.36
Rate for Payer: WMAP Medicaid	$439.36

EAPG 68: THORACENTESIS, RELATED BIOPSY AND PLEURAL DRAINAGE PROCEDURES

Facility OP

$430.51

Service Code	EAPG 00068
Min. Negotiated Rate	$413.95
Max. Negotiated Rate	$430.51
Rate for Payer: Anthem Medicaid	$413.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$413.95
Rate for Payer: Dean Health Medicaid	$413.95
Rate for Payer: Independent Care Health Plan Medicaid	$413.95
Rate for Payer: Managed Health Services Medicaid	$430.51
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$413.95
Rate for Payer: United Healthcare Medicaid	$413.95
Rate for Payer: WMAP Medicaid	$413.95

EAPG 690: MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DIAGNOSES

Facility OP

$104.80

Service Code	EAPG 00690
Min. Negotiated Rate	$67.42
Max. Negotiated Rate	$104.80
Rate for Payer: Anthem Medicaid	$67.42
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$104.80
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$67.42
Rate for Payer: Dean Health Medicaid	$67.42
Rate for Payer: Independent Care Health Plan Medicaid	$67.42
Rate for Payer: Managed Health Services Medicaid	$70.12
Rate for Payer: Molina Healthcare Medicaid	$104.80
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$67.42
Rate for Payer: United Healthcare Medicaid	$67.42
Rate for Payer: WMAP Medicaid	$67.42

EAPG 691: INBORN ERRORS OF METABOLISM

Facility OP

$91.34

Service Code	EAPG 00691
Min. Negotiated Rate	$48.68
Max. Negotiated Rate	$91.34
Rate for Payer: Anthem Medicaid	$48.68
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$91.34
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$48.68
Rate for Payer: Dean Health Medicaid	$48.68
Rate for Payer: Independent Care Health Plan Medicaid	$48.68
Rate for Payer: Managed Health Services Medicaid	$50.63
Rate for Payer: Molina Healthcare Medicaid	$91.34
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$48.68
Rate for Payer: United Healthcare Medicaid	$48.68
Rate for Payer: WMAP Medicaid	$48.68

EAPG 692: OTHER ENDOCRINE SYSTEM DIAGNOSES

Facility OP

$97.16

Service Code	EAPG 00692
Min. Negotiated Rate	$59.32
Max. Negotiated Rate	$97.16
Rate for Payer: Anthem Medicaid	$59.32
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$97.16
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$59.32
Rate for Payer: Dean Health Medicaid	$59.32
Rate for Payer: Independent Care Health Plan Medicaid	$59.32
Rate for Payer: Managed Health Services Medicaid	$61.69
Rate for Payer: Molina Healthcare Medicaid	$97.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$59.32
Rate for Payer: United Healthcare Medicaid	$59.32
Rate for Payer: WMAP Medicaid	$59.32

EAPG 694: ELECTROLYTE DISORDERS

Facility OP

$170.89

Service Code	EAPG 00694
Min. Negotiated Rate	$100.24
Max. Negotiated Rate	$170.89
Rate for Payer: Anthem Medicaid	$100.24
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$170.89
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$100.24
Rate for Payer: Dean Health Medicaid	$100.24
Rate for Payer: Independent Care Health Plan Medicaid	$100.24
Rate for Payer: Managed Health Services Medicaid	$104.25
Rate for Payer: Molina Healthcare Medicaid	$170.89
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$100.24
Rate for Payer: United Healthcare Medicaid	$100.24
Rate for Payer: WMAP Medicaid	$100.24

EAPG 695: OBESITY

Facility OP

$97.21

Service Code	EAPG 00695
Min. Negotiated Rate	$47.26
Max. Negotiated Rate	$97.21
Rate for Payer: Anthem Medicaid	$47.26
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$97.21
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$47.26
Rate for Payer: Dean Health Medicaid	$47.26
Rate for Payer: Independent Care Health Plan Medicaid	$47.26
Rate for Payer: Managed Health Services Medicaid	$49.15
Rate for Payer: Molina Healthcare Medicaid	$97.21
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$47.26
Rate for Payer: United Healthcare Medicaid	$47.26
Rate for Payer: WMAP Medicaid	$47.26

EAPG 696: THYROID AND PARATHYROID DIAGNOSES

Facility OP

$56.74

Service Code	EAPG 00696
Min. Negotiated Rate	$54.56
Max. Negotiated Rate	$56.74
Rate for Payer: Anthem Medicaid	$54.56
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.56
Rate for Payer: Dean Health Medicaid	$54.56
Rate for Payer: Independent Care Health Plan Medicaid	$54.56
Rate for Payer: Managed Health Services Medicaid	$56.74
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.56
Rate for Payer: United Healthcare Medicaid	$54.56
Rate for Payer: WMAP Medicaid	$54.56

EAPG 69: LEVEL I THORACIC AND CHEST PROCEDURES

Facility OP

$1,000.55

Service Code	EAPG 00069
Min. Negotiated Rate	$962.07
Max. Negotiated Rate	$1,000.55
Rate for Payer: Anthem Medicaid	$962.07
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$962.07
Rate for Payer: Dean Health Medicaid	$962.07
Rate for Payer: Independent Care Health Plan Medicaid	$962.07
Rate for Payer: Managed Health Services Medicaid	$1,000.55
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$962.07
Rate for Payer: United Healthcare Medicaid	$962.07
Rate for Payer: WMAP Medicaid	$962.07

EAPG 70: LEVEL II THORACIC AND CHEST PROCEDURES

Facility OP

$2,182.16

Service Code	EAPG 00070
Min. Negotiated Rate	$2,098.23
Max. Negotiated Rate	$2,182.16
Rate for Payer: Anthem Medicaid	$2,098.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,098.23
Rate for Payer: Dean Health Medicaid	$2,098.23
Rate for Payer: Independent Care Health Plan Medicaid	$2,098.23
Rate for Payer: Managed Health Services Medicaid	$2,182.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,098.23
Rate for Payer: United Healthcare Medicaid	$2,098.23
Rate for Payer: WMAP Medicaid	$2,098.23

EAPG 710: DIABETES WITH OPHTHALMIC MANIFESTATIONS

Facility OP

$97.85

Service Code	EAPG 00710
Min. Negotiated Rate	$77.04
Max. Negotiated Rate	$97.85
Rate for Payer: Anthem Medicaid	$77.04
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$97.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$77.04
Rate for Payer: Dean Health Medicaid	$77.04
Rate for Payer: Independent Care Health Plan Medicaid	$77.04
Rate for Payer: Managed Health Services Medicaid	$80.12
Rate for Payer: Molina Healthcare Medicaid	$97.85
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$77.04
Rate for Payer: United Healthcare Medicaid	$77.04
Rate for Payer: WMAP Medicaid	$77.04

EAPG 711: DIABETES WITH OTHER MANIFESTATIONS AND COMPLICATIONS

Facility OP

$123.53

Service Code	EAPG 00711
Min. Negotiated Rate	$66.82
Max. Negotiated Rate	$123.53
Rate for Payer: Anthem Medicaid	$66.82
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$123.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$66.82
Rate for Payer: Dean Health Medicaid	$66.82
Rate for Payer: Independent Care Health Plan Medicaid	$66.82
Rate for Payer: Managed Health Services Medicaid	$69.49
Rate for Payer: Molina Healthcare Medicaid	$123.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$66.82
Rate for Payer: United Healthcare Medicaid	$66.82
Rate for Payer: WMAP Medicaid	$66.82

EAPG 712: DIABETES WITH NEUROLOGIC MANIFESTATIONS

Facility OP

$101.08

Service Code	EAPG 00712
Min. Negotiated Rate	$53.08
Max. Negotiated Rate	$101.08
Rate for Payer: Anthem Medicaid	$53.08
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$101.08
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$53.08
Rate for Payer: Dean Health Medicaid	$53.08
Rate for Payer: Independent Care Health Plan Medicaid	$53.08
Rate for Payer: Managed Health Services Medicaid	$55.20
Rate for Payer: Molina Healthcare Medicaid	$101.08
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$53.08
Rate for Payer: United Healthcare Medicaid	$53.08
Rate for Payer: WMAP Medicaid	$53.08

EAPG 713: DIABETES WITHOUT COMPLICATIONS

Facility OP

$94.86

Service Code	EAPG 00713
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$94.86
Rate for Payer: Anthem Medicaid	$49.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$94.86
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$49.35
Rate for Payer: Dean Health Medicaid	$49.35
Rate for Payer: Independent Care Health Plan Medicaid	$49.35
Rate for Payer: Managed Health Services Medicaid	$51.32
Rate for Payer: Molina Healthcare Medicaid	$94.86
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$49.35
Rate for Payer: United Healthcare Medicaid	$49.35
Rate for Payer: WMAP Medicaid	$49.35

EAPG 714: DIABETES WITH RENAL MANIFESTATIONS

Facility OP

$99.46

Service Code	EAPG 00714
Min. Negotiated Rate	$55.68
Max. Negotiated Rate	$99.46
Rate for Payer: Anthem Medicaid	$55.68
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$99.46
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$55.68
Rate for Payer: Dean Health Medicaid	$55.68
Rate for Payer: Independent Care Health Plan Medicaid	$55.68
Rate for Payer: Managed Health Services Medicaid	$57.91
Rate for Payer: Molina Healthcare Medicaid	$99.46
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$55.68
Rate for Payer: United Healthcare Medicaid	$55.68
Rate for Payer: WMAP Medicaid	$55.68

EAPG 715: DIABETES WITH VASCULAR COMPLICATIONS INCLUDING FOOT AND OTHER SKIN ULCERS

Facility OP

$58.71

Service Code	EAPG 00715
Min. Negotiated Rate	$56.45
Max. Negotiated Rate	$58.71
Rate for Payer: Anthem Medicaid	$56.45
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$56.45
Rate for Payer: Dean Health Medicaid	$56.45
Rate for Payer: Independent Care Health Plan Medicaid	$56.45
Rate for Payer: Managed Health Services Medicaid	$58.71
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$56.45
Rate for Payer: United Healthcare Medicaid	$56.45
Rate for Payer: WMAP Medicaid	$56.45

EAPG 71: LEVEL II LOWER AIRWAY ENDOSCOPY

Facility OP

$1,577.88

Service Code	EAPG 00071
Min. Negotiated Rate	$1,517.19
Max. Negotiated Rate	$1,577.88
Rate for Payer: Anthem Medicaid	$1,517.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,517.19
Rate for Payer: Dean Health Medicaid	$1,517.19
Rate for Payer: Independent Care Health Plan Medicaid	$1,517.19
Rate for Payer: Managed Health Services Medicaid	$1,577.88
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,517.19
Rate for Payer: United Healthcare Medicaid	$1,517.19
Rate for Payer: WMAP Medicaid	$1,517.19

EAPG 720: CHRONIC KIDNEY DISEASE

Facility OP

$111.69

Service Code	EAPG 00720
Min. Negotiated Rate	$61.17
Max. Negotiated Rate	$111.69
Rate for Payer: Anthem Medicaid	$61.17
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$111.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$61.17
Rate for Payer: Dean Health Medicaid	$61.17
Rate for Payer: Independent Care Health Plan Medicaid	$61.17
Rate for Payer: Managed Health Services Medicaid	$63.62
Rate for Payer: Molina Healthcare Medicaid	$111.69
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$61.17
Rate for Payer: United Healthcare Medicaid	$61.17
Rate for Payer: WMAP Medicaid	$61.17

EAPG 721: KIDNEY AND URINARY TRACT MALIGNANCY

Facility OP

$119.91

Service Code	EAPG 00721
Min. Negotiated Rate	$57.28
Max. Negotiated Rate	$119.91
Rate for Payer: Anthem Medicaid	$57.28
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$119.91
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$57.28
Rate for Payer: Dean Health Medicaid	$57.28
Rate for Payer: Independent Care Health Plan Medicaid	$57.28
Rate for Payer: Managed Health Services Medicaid	$59.57
Rate for Payer: Molina Healthcare Medicaid	$119.91
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$57.28
Rate for Payer: United Healthcare Medicaid	$57.28
Rate for Payer: WMAP Medicaid	$57.28

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