Beloit Memorial Hospital

All Charges

Charge

Type

Price

EAPG 722: NEPHRITIS AND NEPHROSIS

Facility OP

$115.66

Service Code	EAPG 00722
Min. Negotiated Rate	$69.24
Max. Negotiated Rate	$115.66
Rate for Payer: Anthem Medicaid	$69.24
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$115.66
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$69.24
Rate for Payer: Dean Health Medicaid	$69.24
Rate for Payer: Independent Care Health Plan Medicaid	$69.24
Rate for Payer: Managed Health Services Medicaid	$72.01
Rate for Payer: Molina Healthcare Medicaid	$115.66
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$69.24
Rate for Payer: United Healthcare Medicaid	$69.24
Rate for Payer: WMAP Medicaid	$69.24

EAPG 723: COMPLEX KIDNEY AND URINARY TRACT INFECTIONS

Facility OP

$142.81

Service Code	EAPG 00723
Min. Negotiated Rate	$104.13
Max. Negotiated Rate	$142.81
Rate for Payer: Anthem Medicaid	$104.13
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$142.81
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$104.13
Rate for Payer: Dean Health Medicaid	$104.13
Rate for Payer: Independent Care Health Plan Medicaid	$104.13
Rate for Payer: Managed Health Services Medicaid	$108.30
Rate for Payer: Molina Healthcare Medicaid	$142.81
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$104.13
Rate for Payer: United Healthcare Medicaid	$104.13
Rate for Payer: WMAP Medicaid	$104.13

EAPG 724: URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility OP

$116.73

Service Code	EAPG 00724
Min. Negotiated Rate	$70.25
Max. Negotiated Rate	$116.73
Rate for Payer: Anthem Medicaid	$70.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$116.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.25
Rate for Payer: Dean Health Medicaid	$70.25
Rate for Payer: Independent Care Health Plan Medicaid	$70.25
Rate for Payer: Managed Health Services Medicaid	$73.06
Rate for Payer: Molina Healthcare Medicaid	$116.73
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.25
Rate for Payer: United Healthcare Medicaid	$70.25
Rate for Payer: WMAP Medicaid	$70.25

EAPG 725: MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC

Facility OP

$155.87

Service Code	EAPG 00725
Min. Negotiated Rate	$100.67
Max. Negotiated Rate	$155.87
Rate for Payer: Anthem Medicaid	$100.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$155.87
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$100.67
Rate for Payer: Dean Health Medicaid	$100.67
Rate for Payer: Independent Care Health Plan Medicaid	$100.67
Rate for Payer: Managed Health Services Medicaid	$104.70
Rate for Payer: Molina Healthcare Medicaid	$155.87
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$100.67
Rate for Payer: United Healthcare Medicaid	$100.67
Rate for Payer: WMAP Medicaid	$100.67

EAPG 726: OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS

Facility OP

$118.20

Service Code	EAPG 00726
Min. Negotiated Rate	$68.46
Max. Negotiated Rate	$118.20
Rate for Payer: Anthem Medicaid	$68.46
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$118.20
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$68.46
Rate for Payer: Dean Health Medicaid	$68.46
Rate for Payer: Independent Care Health Plan Medicaid	$68.46
Rate for Payer: Managed Health Services Medicaid	$71.20
Rate for Payer: Molina Healthcare Medicaid	$118.20
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$68.46
Rate for Payer: United Healthcare Medicaid	$68.46
Rate for Payer: WMAP Medicaid	$68.46

EAPG 727: ACUTE LOWER URINARY TRACT INFECTIONS

Facility OP

$151.42

Service Code	EAPG 00727
Min. Negotiated Rate	$96.98
Max. Negotiated Rate	$151.42
Rate for Payer: Anthem Medicaid	$96.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$151.42
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$96.98
Rate for Payer: Dean Health Medicaid	$96.98
Rate for Payer: Independent Care Health Plan Medicaid	$96.98
Rate for Payer: Managed Health Services Medicaid	$100.86
Rate for Payer: Molina Healthcare Medicaid	$151.42
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$96.98
Rate for Payer: United Healthcare Medicaid	$96.98
Rate for Payer: WMAP Medicaid	$96.98

EAPG 729: ACUTE KIDNEY INJURY

Facility OP

$117.61

Service Code	EAPG 00729
Min. Negotiated Rate	$113.09
Max. Negotiated Rate	$117.61
Rate for Payer: Anthem Medicaid	$113.09
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$113.09
Rate for Payer: Dean Health Medicaid	$113.09
Rate for Payer: Independent Care Health Plan Medicaid	$113.09
Rate for Payer: Managed Health Services Medicaid	$117.61
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$113.09
Rate for Payer: United Healthcare Medicaid	$113.09
Rate for Payer: WMAP Medicaid	$113.09

EAPG 72: TRACHEOSTOMY AND RELATED TRACHEAL PROCEDURES

Facility OP

$888.39

Service Code	EAPG 00072
Min. Negotiated Rate	$854.22
Max. Negotiated Rate	$888.39
Rate for Payer: Anthem Medicaid	$854.22
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$854.22
Rate for Payer: Dean Health Medicaid	$854.22
Rate for Payer: Independent Care Health Plan Medicaid	$854.22
Rate for Payer: Managed Health Services Medicaid	$888.39
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$854.22
Rate for Payer: United Healthcare Medicaid	$854.22
Rate for Payer: WMAP Medicaid	$854.22

EAPG 73: DIAPHRAGMATIC PROCEDURES AND RELATED HERNIA REPAIR

Facility OP

$2,772.63

Service Code	EAPG 00073
Min. Negotiated Rate	$2,665.99
Max. Negotiated Rate	$2,772.63
Rate for Payer: Anthem Medicaid	$2,665.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,665.99
Rate for Payer: Dean Health Medicaid	$2,665.99
Rate for Payer: Independent Care Health Plan Medicaid	$2,665.99
Rate for Payer: Managed Health Services Medicaid	$2,772.63
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,665.99
Rate for Payer: United Healthcare Medicaid	$2,665.99
Rate for Payer: WMAP Medicaid	$2,665.99

EAPG 740: MALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility OP

$114.24

Service Code	EAPG 00740
Min. Negotiated Rate	$58.67
Max. Negotiated Rate	$114.24
Rate for Payer: Anthem Medicaid	$58.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$114.24
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$58.67
Rate for Payer: Dean Health Medicaid	$58.67
Rate for Payer: Independent Care Health Plan Medicaid	$58.67
Rate for Payer: Managed Health Services Medicaid	$61.02
Rate for Payer: Molina Healthcare Medicaid	$114.24
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$58.67
Rate for Payer: United Healthcare Medicaid	$58.67
Rate for Payer: WMAP Medicaid	$58.67

EAPG 741: OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES

Facility OP

$104.65

Service Code	EAPG 00741
Min. Negotiated Rate	$64.53
Max. Negotiated Rate	$104.65
Rate for Payer: Anthem Medicaid	$64.53
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$104.65
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$64.53
Rate for Payer: Dean Health Medicaid	$64.53
Rate for Payer: Independent Care Health Plan Medicaid	$64.53
Rate for Payer: Managed Health Services Medicaid	$67.11
Rate for Payer: Molina Healthcare Medicaid	$104.65
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$64.53
Rate for Payer: United Healthcare Medicaid	$64.53
Rate for Payer: WMAP Medicaid	$64.53

EAPG 743: PROSTATITIS

Facility OP

$100.64

Service Code	EAPG 00743
Min. Negotiated Rate	$53.05
Max. Negotiated Rate	$100.64
Rate for Payer: Anthem Medicaid	$53.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$100.64
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$53.05
Rate for Payer: Dean Health Medicaid	$53.05
Rate for Payer: Independent Care Health Plan Medicaid	$53.05
Rate for Payer: Managed Health Services Medicaid	$55.17
Rate for Payer: Molina Healthcare Medicaid	$100.64
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$53.05
Rate for Payer: United Healthcare Medicaid	$53.05
Rate for Payer: WMAP Medicaid	$53.05

EAPG 744: MALE REPRODUCTIVE SYSTEM INFECTIONS

Facility OP

$115.12

Service Code	EAPG 00744
Min. Negotiated Rate	$63.80
Max. Negotiated Rate	$115.12
Rate for Payer: Anthem Medicaid	$63.80
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$115.12
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$63.80
Rate for Payer: Dean Health Medicaid	$63.80
Rate for Payer: Independent Care Health Plan Medicaid	$63.80
Rate for Payer: Managed Health Services Medicaid	$66.35
Rate for Payer: Molina Healthcare Medicaid	$115.12
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$63.80
Rate for Payer: United Healthcare Medicaid	$63.80
Rate for Payer: WMAP Medicaid	$63.80

EAPG 74: REVISION, REPLACEMENT OR REMOVAL OF CARDIAC DEVICE COMPONENT

Facility OP

$677.80

Service Code	EAPG 00074
Min. Negotiated Rate	$651.73
Max. Negotiated Rate	$677.80
Rate for Payer: Anthem Medicaid	$651.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$651.73
Rate for Payer: Dean Health Medicaid	$651.73
Rate for Payer: Independent Care Health Plan Medicaid	$651.73
Rate for Payer: Managed Health Services Medicaid	$677.80
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$651.73
Rate for Payer: United Healthcare Medicaid	$651.73
Rate for Payer: WMAP Medicaid	$651.73

EAPG 750: FEMALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility OP

$114.04

Service Code	EAPG 00750
Min. Negotiated Rate	$66.91
Max. Negotiated Rate	$114.04
Rate for Payer: Anthem Medicaid	$66.91
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$114.04
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$66.91
Rate for Payer: Dean Health Medicaid	$66.91
Rate for Payer: Independent Care Health Plan Medicaid	$66.91
Rate for Payer: Managed Health Services Medicaid	$69.59
Rate for Payer: Molina Healthcare Medicaid	$114.04
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$66.91
Rate for Payer: United Healthcare Medicaid	$66.91
Rate for Payer: WMAP Medicaid	$66.91

EAPG 751: FEMALE REPRODUCTIVE SYSTEM INFECTIONS

Facility OP

$120.06

Service Code	EAPG 00751
Min. Negotiated Rate	$73.17
Max. Negotiated Rate	$120.06
Rate for Payer: Anthem Medicaid	$73.17
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$120.06
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$73.17
Rate for Payer: Dean Health Medicaid	$73.17
Rate for Payer: Independent Care Health Plan Medicaid	$73.17
Rate for Payer: Managed Health Services Medicaid	$76.10
Rate for Payer: Molina Healthcare Medicaid	$120.06
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$73.17
Rate for Payer: United Healthcare Medicaid	$73.17
Rate for Payer: WMAP Medicaid	$73.17

EAPG 752: OTHER FEMALE REPRODUCTIVE SYSTEM AND MENSTRUAL DIAGNOSES

Facility OP

$110.37

Service Code	EAPG 00752
Min. Negotiated Rate	$59.37
Max. Negotiated Rate	$110.37
Rate for Payer: Anthem Medicaid	$59.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$110.37
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$59.37
Rate for Payer: Dean Health Medicaid	$59.37
Rate for Payer: Independent Care Health Plan Medicaid	$59.37
Rate for Payer: Managed Health Services Medicaid	$61.74
Rate for Payer: Molina Healthcare Medicaid	$110.37
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$59.37
Rate for Payer: United Healthcare Medicaid	$59.37
Rate for Payer: WMAP Medicaid	$59.37

EAPG 75: LEVEL I CENTRAL VENOUS ACCESS PROCEDURES

Facility OP

$474.14

Service Code	EAPG 00075
Min. Negotiated Rate	$455.90
Max. Negotiated Rate	$474.14
Rate for Payer: Anthem Medicaid	$455.90
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$455.90
Rate for Payer: Dean Health Medicaid	$455.90
Rate for Payer: Independent Care Health Plan Medicaid	$455.90
Rate for Payer: Managed Health Services Medicaid	$474.14
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$455.90
Rate for Payer: United Healthcare Medicaid	$455.90
Rate for Payer: WMAP Medicaid	$455.90

EAPG 760: LABOR AND DELIVERY RELATED DIAGNOSES

Facility OP

$175.39

Service Code	EAPG 00760
Min. Negotiated Rate	$102.24
Max. Negotiated Rate	$175.39
Rate for Payer: Anthem Medicaid	$102.24
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$175.39
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$102.24
Rate for Payer: Dean Health Medicaid	$102.24
Rate for Payer: Independent Care Health Plan Medicaid	$102.24
Rate for Payer: Managed Health Services Medicaid	$106.33
Rate for Payer: Molina Healthcare Medicaid	$175.39
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$102.24
Rate for Payer: United Healthcare Medicaid	$102.24
Rate for Payer: WMAP Medicaid	$102.24

EAPG 761: POSTPARTUM AND POST ABORTION DIAGNOSES

Facility OP

$138.75

Service Code	EAPG 00761
Min. Negotiated Rate	$88.60
Max. Negotiated Rate	$138.75
Rate for Payer: Anthem Medicaid	$88.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$138.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$88.60
Rate for Payer: Dean Health Medicaid	$88.60
Rate for Payer: Independent Care Health Plan Medicaid	$88.60
Rate for Payer: Managed Health Services Medicaid	$92.14
Rate for Payer: Molina Healthcare Medicaid	$138.75
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$88.60
Rate for Payer: United Healthcare Medicaid	$88.60
Rate for Payer: WMAP Medicaid	$88.60

EAPG 762: PRETERM LABOR DIAGNOSES

Facility OP

$212.13

Service Code	EAPG 00762
Min. Negotiated Rate	$151.19
Max. Negotiated Rate	$212.13
Rate for Payer: Anthem Medicaid	$151.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$212.13
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$151.19
Rate for Payer: Dean Health Medicaid	$151.19
Rate for Payer: Independent Care Health Plan Medicaid	$151.19
Rate for Payer: Managed Health Services Medicaid	$157.24
Rate for Payer: Molina Healthcare Medicaid	$212.13
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$151.19
Rate for Payer: United Healthcare Medicaid	$151.19
Rate for Payer: WMAP Medicaid	$151.19

EAPG 763: ABORTION RELATED DIAGNOSES

Facility OP

$203.77

Service Code	EAPG 00763
Min. Negotiated Rate	$141.31
Max. Negotiated Rate	$203.77
Rate for Payer: Anthem Medicaid	$141.31
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$203.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$141.31
Rate for Payer: Dean Health Medicaid	$141.31
Rate for Payer: Independent Care Health Plan Medicaid	$141.31
Rate for Payer: Managed Health Services Medicaid	$146.96
Rate for Payer: Molina Healthcare Medicaid	$203.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$141.31
Rate for Payer: United Healthcare Medicaid	$141.31
Rate for Payer: WMAP Medicaid	$141.31

EAPG 764: FALSE LABOR

Facility OP

$198.14

Service Code	EAPG 00764
Min. Negotiated Rate	$89.30
Max. Negotiated Rate	$198.14
Rate for Payer: Anthem Medicaid	$89.30
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$198.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$89.30
Rate for Payer: Dean Health Medicaid	$89.30
Rate for Payer: Independent Care Health Plan Medicaid	$89.30
Rate for Payer: Managed Health Services Medicaid	$92.87
Rate for Payer: Molina Healthcare Medicaid	$198.14
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$89.30
Rate for Payer: United Healthcare Medicaid	$89.30
Rate for Payer: WMAP Medicaid	$89.30

EAPG 765: OTHER ANTEPARTUM COMPLICATION DIAGNOSES

Facility OP

$155.43

Service Code	EAPG 00765
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$155.43
Rate for Payer: Anthem Medicaid	$107.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$155.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$107.25
Rate for Payer: Dean Health Medicaid	$107.25
Rate for Payer: Independent Care Health Plan Medicaid	$107.25
Rate for Payer: Managed Health Services Medicaid	$111.54
Rate for Payer: Molina Healthcare Medicaid	$155.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$107.25
Rate for Payer: United Healthcare Medicaid	$107.25
Rate for Payer: WMAP Medicaid	$107.25

EAPG 766: ROUTINE PRENATAL CARE

Facility OP

$116.83

Service Code	EAPG 00766
Min. Negotiated Rate	$78.32
Max. Negotiated Rate	$116.83
Rate for Payer: Anthem Medicaid	$78.32
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$116.83
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$78.32
Rate for Payer: Dean Health Medicaid	$78.32
Rate for Payer: Independent Care Health Plan Medicaid	$78.32
Rate for Payer: Managed Health Services Medicaid	$81.45
Rate for Payer: Molina Healthcare Medicaid	$116.83
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$78.32
Rate for Payer: United Healthcare Medicaid	$78.32
Rate for Payer: WMAP Medicaid	$78.32

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