Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 233: CATARACT AND OTHER INTRAOCULAR LENS PROCEDURES

Facility

$1,282.69

Service Code	EAPG 00233
Min. Negotiated Rate	$709.18
Max. Negotiated Rate	$1,282.69
Rate for Payer: Anthem Medicaid	$709.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,282.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$709.18
Rate for Payer: Dean Health Medicaid	$709.18
Rate for Payer: Independent Care Health Plan Medicaid	$709.18
Rate for Payer: Managed Health Services Medicaid	$737.55
Rate for Payer: Molina Healthcare Medicaid	$1,282.69
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$709.18
Rate for Payer: United Healthcare Medicaid	$709.18
Rate for Payer: WMAP Medicaid	$709.18

EAPG 234: LEVEL I ANTERIOR CHAMBER EYE PROCEDURES

Facility

$1,041.45

Service Code	EAPG 00234
Min. Negotiated Rate	$418.72
Max. Negotiated Rate	$1,041.45
Rate for Payer: Anthem Medicaid	$418.72
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,041.45
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$418.72
Rate for Payer: Dean Health Medicaid	$418.72
Rate for Payer: Independent Care Health Plan Medicaid	$418.72
Rate for Payer: Managed Health Services Medicaid	$435.47
Rate for Payer: Molina Healthcare Medicaid	$1,041.45
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$418.72
Rate for Payer: United Healthcare Medicaid	$418.72
Rate for Payer: WMAP Medicaid	$418.72

EAPG 235: LEVEL II ANTERIOR CHAMBER EYE PROCEDURES

Facility

$1,660.24

Service Code	EAPG 00235
Min. Negotiated Rate	$1,381.69
Max. Negotiated Rate	$1,660.24
Rate for Payer: Anthem Medicaid	$1,381.69
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,660.24
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,381.69
Rate for Payer: Dean Health Medicaid	$1,381.69
Rate for Payer: Independent Care Health Plan Medicaid	$1,381.69
Rate for Payer: Managed Health Services Medicaid	$1,436.96
Rate for Payer: Molina Healthcare Medicaid	$1,660.24
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,381.69
Rate for Payer: United Healthcare Medicaid	$1,381.69
Rate for Payer: WMAP Medicaid	$1,381.69

EAPG 237: LEVEL I INTRAVITREAL, RETINAL AND OTHER POSTERIOR CHAMBER EYE PROCEDURES

Facility

$1,681.03

Service Code	EAPG 00237
Min. Negotiated Rate	$426.21
Max. Negotiated Rate	$1,681.03
Rate for Payer: Anthem Medicaid	$426.21
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,681.03
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$426.21
Rate for Payer: Dean Health Medicaid	$426.21
Rate for Payer: Independent Care Health Plan Medicaid	$426.21
Rate for Payer: Managed Health Services Medicaid	$443.26
Rate for Payer: Molina Healthcare Medicaid	$1,681.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$426.21
Rate for Payer: United Healthcare Medicaid	$426.21
Rate for Payer: WMAP Medicaid	$426.21

EAPG 238: LEVEL II INTRAVITREAL, RETINAL AND OTHER POSTERIOR CHAMBER EYE PROCEDURES

Facility

$2,342.43

Service Code	EAPG 00238
Min. Negotiated Rate	$1,298.03
Max. Negotiated Rate	$2,342.43
Rate for Payer: Anthem Medicaid	$1,298.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,342.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,298.03
Rate for Payer: Dean Health Medicaid	$1,298.03
Rate for Payer: Independent Care Health Plan Medicaid	$1,298.03
Rate for Payer: Managed Health Services Medicaid	$1,349.95
Rate for Payer: Molina Healthcare Medicaid	$2,342.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,298.03
Rate for Payer: United Healthcare Medicaid	$1,298.03
Rate for Payer: WMAP Medicaid	$1,298.03

EAPG 239: EXTRAOCULAR MUSCLE PROCEDURES

Facility

$1,505.44

Service Code	EAPG 00239
Min. Negotiated Rate	$879.89
Max. Negotiated Rate	$1,505.44
Rate for Payer: Anthem Medicaid	$879.89
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,505.44
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$879.89
Rate for Payer: Dean Health Medicaid	$879.89
Rate for Payer: Independent Care Health Plan Medicaid	$879.89
Rate for Payer: Managed Health Services Medicaid	$915.09
Rate for Payer: Molina Healthcare Medicaid	$1,505.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$879.89
Rate for Payer: United Healthcare Medicaid	$879.89
Rate for Payer: WMAP Medicaid	$879.89

EAPG 23: LEVEL I FOREARM AND WRIST PROCEDURES

Facility

$734.20

Service Code	EAPG 00023
Min. Negotiated Rate	$705.96
Max. Negotiated Rate	$734.20
Rate for Payer: Anthem Medicaid	$705.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$705.96
Rate for Payer: Dean Health Medicaid	$705.96
Rate for Payer: Independent Care Health Plan Medicaid	$705.96
Rate for Payer: Managed Health Services Medicaid	$734.20
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$705.96
Rate for Payer: United Healthcare Medicaid	$705.96
Rate for Payer: WMAP Medicaid	$705.96

EAPG 241: OCULAR RECONSTRUCTIVE PROCEDURES W OR W/O OCULAR DEVICE

Facility

$1,282.74

Service Code	EAPG 00241
Min. Negotiated Rate	$1,169.95
Max. Negotiated Rate	$1,282.74
Rate for Payer: Anthem Medicaid	$1,169.95
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,282.74
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,169.95
Rate for Payer: Dean Health Medicaid	$1,169.95
Rate for Payer: Independent Care Health Plan Medicaid	$1,169.95
Rate for Payer: Managed Health Services Medicaid	$1,216.75
Rate for Payer: Molina Healthcare Medicaid	$1,282.74
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,169.95
Rate for Payer: United Healthcare Medicaid	$1,169.95
Rate for Payer: WMAP Medicaid	$1,169.95

EAPG 244: CLASS II THERAPEUTIC RADIOPHARMACEUTICALS

Facility

$172.60

Service Code	EAPG 00244
Min. Negotiated Rate	$165.96
Max. Negotiated Rate	$172.60
Rate for Payer: Anthem Medicaid	$165.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$165.96
Rate for Payer: Dean Health Medicaid	$165.96
Rate for Payer: Independent Care Health Plan Medicaid	$165.96
Rate for Payer: Managed Health Services Medicaid	$172.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$165.96
Rate for Payer: United Healthcare Medicaid	$165.96
Rate for Payer: WMAP Medicaid	$165.96

EAPG 245: CLASS III THERAPEUTIC RADIOPHARMACEUTICALS

Facility

$5,330.01

Service Code	EAPG 00245
Min. Negotiated Rate	$5,125.01
Max. Negotiated Rate	$5,330.01
Rate for Payer: Anthem Medicaid	$5,125.01
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5,125.01
Rate for Payer: Dean Health Medicaid	$5,125.01
Rate for Payer: Independent Care Health Plan Medicaid	$5,125.01
Rate for Payer: Managed Health Services Medicaid	$5,330.01
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5,125.01
Rate for Payer: United Healthcare Medicaid	$5,125.01
Rate for Payer: WMAP Medicaid	$5,125.01

EAPG 246: CLASS IV THERAPEUTIC RADIOPHARMACEUTICALS

Facility

$15,547.22

Service Code	EAPG 00246
Min. Negotiated Rate	$14,949.25
Max. Negotiated Rate	$15,547.22
Rate for Payer: Anthem Medicaid	$14,949.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$14,949.25
Rate for Payer: Dean Health Medicaid	$14,949.25
Rate for Payer: Independent Care Health Plan Medicaid	$14,949.25
Rate for Payer: Managed Health Services Medicaid	$15,547.22
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$14,949.25
Rate for Payer: United Healthcare Medicaid	$14,949.25
Rate for Payer: WMAP Medicaid	$14,949.25

EAPG 247: LEVEL I CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES

Facility

$245.90

Service Code	EAPG 00247
Min. Negotiated Rate	$236.44
Max. Negotiated Rate	$245.90
Rate for Payer: Anthem Medicaid	$236.44
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$236.44
Rate for Payer: Dean Health Medicaid	$236.44
Rate for Payer: Independent Care Health Plan Medicaid	$236.44
Rate for Payer: Managed Health Services Medicaid	$245.90
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$236.44
Rate for Payer: United Healthcare Medicaid	$236.44
Rate for Payer: WMAP Medicaid	$236.44

EAPG 248: LEVEL II CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES

Facility

$1,372.40

Service Code	EAPG 00248
Min. Negotiated Rate	$1,319.62
Max. Negotiated Rate	$1,372.40
Rate for Payer: Anthem Medicaid	$1,319.62
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,319.62
Rate for Payer: Dean Health Medicaid	$1,319.62
Rate for Payer: Independent Care Health Plan Medicaid	$1,319.62
Rate for Payer: Managed Health Services Medicaid	$1,372.40
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,319.62
Rate for Payer: United Healthcare Medicaid	$1,319.62
Rate for Payer: WMAP Medicaid	$1,319.62

EAPG 249: MINOR EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$73.20

Service Code	EAPG 00249
Min. Negotiated Rate	$70.38
Max. Negotiated Rate	$73.20
Rate for Payer: Anthem Medicaid	$70.38
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.38
Rate for Payer: Dean Health Medicaid	$70.38
Rate for Payer: Independent Care Health Plan Medicaid	$70.38
Rate for Payer: Managed Health Services Medicaid	$73.20
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.38
Rate for Payer: United Healthcare Medicaid	$70.38
Rate for Payer: WMAP Medicaid	$70.38

EAPG 24: LEVEL II FOREARM AND WRIST PROCEDURES

Facility

$2,368.17

Service Code	EAPG 00024
Min. Negotiated Rate	$2,277.09
Max. Negotiated Rate	$2,368.17
Rate for Payer: Anthem Medicaid	$2,277.09
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,277.09
Rate for Payer: Dean Health Medicaid	$2,277.09
Rate for Payer: Independent Care Health Plan Medicaid	$2,277.09
Rate for Payer: Managed Health Services Medicaid	$2,368.17
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,277.09
Rate for Payer: United Healthcare Medicaid	$2,277.09
Rate for Payer: WMAP Medicaid	$2,277.09

EAPG 250: COCHLEAR DEVICE IMPLANTATION

Facility

$21,522.50

Service Code	EAPG 00250
Min. Negotiated Rate	$9,884.63
Max. Negotiated Rate	$21,522.50
Rate for Payer: Anthem Medicaid	$9,884.63
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$21,522.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$9,884.63
Rate for Payer: Dean Health Medicaid	$9,884.63
Rate for Payer: Independent Care Health Plan Medicaid	$9,884.63
Rate for Payer: Managed Health Services Medicaid	$10,280.02
Rate for Payer: Molina Healthcare Medicaid	$21,522.50
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$9,884.63
Rate for Payer: United Healthcare Medicaid	$9,884.63
Rate for Payer: WMAP Medicaid	$9,884.63

EAPG 251: OTORHINOLARYNGOLOGIC FUNCTION TESTS

Facility

$172.36

Service Code	EAPG 00251
Min. Negotiated Rate	$57.21
Max. Negotiated Rate	$172.36
Rate for Payer: Anthem Medicaid	$57.21
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$172.36
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$57.21
Rate for Payer: Dean Health Medicaid	$57.21
Rate for Payer: Independent Care Health Plan Medicaid	$57.21
Rate for Payer: Managed Health Services Medicaid	$59.50
Rate for Payer: Molina Healthcare Medicaid	$172.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$57.21
Rate for Payer: United Healthcare Medicaid	$57.21
Rate for Payer: WMAP Medicaid	$57.21

EAPG 252: LEVEL I EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$1,011.41

Service Code	EAPG 00252
Min. Negotiated Rate	$581.20
Max. Negotiated Rate	$1,011.41
Rate for Payer: Anthem Medicaid	$581.20
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,011.41
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$581.20
Rate for Payer: Dean Health Medicaid	$581.20
Rate for Payer: Independent Care Health Plan Medicaid	$581.20
Rate for Payer: Managed Health Services Medicaid	$604.45
Rate for Payer: Molina Healthcare Medicaid	$1,011.41
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$581.20
Rate for Payer: United Healthcare Medicaid	$581.20
Rate for Payer: WMAP Medicaid	$581.20

EAPG 253: LEVEL II EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$1,778.49

Service Code	EAPG 00253
Min. Negotiated Rate	$1,052.77
Max. Negotiated Rate	$1,778.49
Rate for Payer: Anthem Medicaid	$1,052.77
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,778.49
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,052.77
Rate for Payer: Dean Health Medicaid	$1,052.77
Rate for Payer: Independent Care Health Plan Medicaid	$1,052.77
Rate for Payer: Managed Health Services Medicaid	$1,094.88
Rate for Payer: Molina Healthcare Medicaid	$1,778.49
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,052.77
Rate for Payer: United Healthcare Medicaid	$1,052.77
Rate for Payer: WMAP Medicaid	$1,052.77

EAPG 254: LEVEL III EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$2,107.55

Service Code	EAPG 00254
Min. Negotiated Rate	$1,376.17
Max. Negotiated Rate	$2,107.55
Rate for Payer: Anthem Medicaid	$1,376.17
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,107.55
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,376.17
Rate for Payer: Dean Health Medicaid	$1,376.17
Rate for Payer: Independent Care Health Plan Medicaid	$1,376.17
Rate for Payer: Managed Health Services Medicaid	$1,431.22
Rate for Payer: Molina Healthcare Medicaid	$2,107.55
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,376.17
Rate for Payer: United Healthcare Medicaid	$1,376.17
Rate for Payer: WMAP Medicaid	$1,376.17

EAPG 255: LEVEL IV EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$3,106.53

Service Code	EAPG 00255
Min. Negotiated Rate	$1,824.70
Max. Negotiated Rate	$3,106.53
Rate for Payer: Anthem Medicaid	$1,824.70
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3,106.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,824.70
Rate for Payer: Dean Health Medicaid	$1,824.70
Rate for Payer: Independent Care Health Plan Medicaid	$1,824.70
Rate for Payer: Managed Health Services Medicaid	$1,897.69
Rate for Payer: Molina Healthcare Medicaid	$3,106.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,824.70
Rate for Payer: United Healthcare Medicaid	$1,824.70
Rate for Payer: WMAP Medicaid	$1,824.70

EAPG 256: TONSIL AND ADENOID PROCEDURES

Facility

$1,424.28

Service Code	EAPG 00256
Min. Negotiated Rate	$824.68
Max. Negotiated Rate	$1,424.28
Rate for Payer: Anthem Medicaid	$824.68
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,424.28
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$824.68
Rate for Payer: Dean Health Medicaid	$824.68
Rate for Payer: Independent Care Health Plan Medicaid	$824.68
Rate for Payer: Managed Health Services Medicaid	$857.67
Rate for Payer: Molina Healthcare Medicaid	$1,424.28
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$824.68
Rate for Payer: United Healthcare Medicaid	$824.68
Rate for Payer: WMAP Medicaid	$824.68

EAPG 257: AUDIOMETRY

Facility

$109.10

Service Code	EAPG 00257
Min. Negotiated Rate	$33.19
Max. Negotiated Rate	$109.10
Rate for Payer: Anthem Medicaid	$33.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$109.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$33.19
Rate for Payer: Dean Health Medicaid	$33.19
Rate for Payer: Independent Care Health Plan Medicaid	$33.19
Rate for Payer: Managed Health Services Medicaid	$34.52
Rate for Payer: Molina Healthcare Medicaid	$109.10
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$33.19
Rate for Payer: United Healthcare Medicaid	$33.19
Rate for Payer: WMAP Medicaid	$33.19

EAPG 258: LEVEL I EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES

Facility

$571.51

Service Code	EAPG 00258
Min. Negotiated Rate	$549.53
Max. Negotiated Rate	$571.51
Rate for Payer: Anthem Medicaid	$549.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$549.53
Rate for Payer: Dean Health Medicaid	$549.53
Rate for Payer: Independent Care Health Plan Medicaid	$549.53
Rate for Payer: Managed Health Services Medicaid	$571.51
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$549.53
Rate for Payer: United Healthcare Medicaid	$549.53
Rate for Payer: WMAP Medicaid	$549.53

EAPG 259: LEVEL II EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES

Facility

$740.62

Service Code	EAPG 00259
Min. Negotiated Rate	$712.13
Max. Negotiated Rate	$740.62
Rate for Payer: Anthem Medicaid	$712.13
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$712.13
Rate for Payer: Dean Health Medicaid	$712.13
Rate for Payer: Independent Care Health Plan Medicaid	$712.13
Rate for Payer: Managed Health Services Medicaid	$740.62
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$712.13
Rate for Payer: United Healthcare Medicaid	$712.13
Rate for Payer: WMAP Medicaid	$712.13

Know your out-of-pocket cost for care.

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