Beloit Memorial Hospital

All Charges

Charge

Type

Price

EAPG 767: COMPLICATIONS OF TREATMENT AFFECTING PREGNANCY

Facility OP

$165.91

Service Code	EAPG 00767
Min. Negotiated Rate	$159.53
Max. Negotiated Rate	$165.91
Rate for Payer: Anthem Medicaid	$159.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$159.53
Rate for Payer: Dean Health Medicaid	$159.53
Rate for Payer: Independent Care Health Plan Medicaid	$159.53
Rate for Payer: Managed Health Services Medicaid	$165.91
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$159.53
Rate for Payer: United Healthcare Medicaid	$159.53
Rate for Payer: WMAP Medicaid	$159.53

EAPG 768: ANTEPARTUM ENCOUNTERS FOR NON-ROUTINE AND ABNORMAL FINDINGS

Facility OP

$103.72

Service Code	EAPG 00768
Min. Negotiated Rate	$99.73
Max. Negotiated Rate	$103.72
Rate for Payer: Anthem Medicaid	$99.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$99.73
Rate for Payer: Dean Health Medicaid	$99.73
Rate for Payer: Independent Care Health Plan Medicaid	$99.73
Rate for Payer: Managed Health Services Medicaid	$103.72
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$99.73
Rate for Payer: United Healthcare Medicaid	$99.73
Rate for Payer: WMAP Medicaid	$99.73

EAPG 76: REVISION, REPAIR OR REMOVAL OF CENTRAL VENOUS ACCESS DEVICE

Facility OP

$318.51

Service Code	EAPG 00076
Min. Negotiated Rate	$306.26
Max. Negotiated Rate	$318.51
Rate for Payer: Anthem Medicaid	$306.26
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$306.26
Rate for Payer: Dean Health Medicaid	$306.26
Rate for Payer: Independent Care Health Plan Medicaid	$306.26
Rate for Payer: Managed Health Services Medicaid	$318.51
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$306.26
Rate for Payer: United Healthcare Medicaid	$306.26
Rate for Payer: WMAP Medicaid	$306.26

EAPG 770: NORMAL NEONATE

Facility OP

$101.76

Service Code	EAPG 00770
Min. Negotiated Rate	$57.35
Max. Negotiated Rate	$101.76
Rate for Payer: Anthem Medicaid	$57.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$101.76
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$57.35
Rate for Payer: Dean Health Medicaid	$57.35
Rate for Payer: Independent Care Health Plan Medicaid	$57.35
Rate for Payer: Managed Health Services Medicaid	$59.64
Rate for Payer: Molina Healthcare Medicaid	$101.76
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$57.35
Rate for Payer: United Healthcare Medicaid	$57.35
Rate for Payer: WMAP Medicaid	$57.35

EAPG 771: NEONATAL DIAGNOSES

Facility OP

$103.72

Service Code	EAPG 00771
Min. Negotiated Rate	$97.58
Max. Negotiated Rate	$103.72
Rate for Payer: Anthem Medicaid	$97.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$103.72
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$97.58
Rate for Payer: Dean Health Medicaid	$97.58
Rate for Payer: Independent Care Health Plan Medicaid	$97.58
Rate for Payer: Managed Health Services Medicaid	$101.48
Rate for Payer: Molina Healthcare Medicaid	$103.72
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$97.58
Rate for Payer: United Healthcare Medicaid	$97.58
Rate for Payer: WMAP Medicaid	$97.58

EAPG 777: SUPERFICIAL INJURY TO SKIN AND SUBCUTANEOUS TISSUE

Facility OP

$84.49

Service Code	EAPG 00777
Min. Negotiated Rate	$81.24
Max. Negotiated Rate	$84.49
Rate for Payer: Anthem Medicaid	$81.24
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$81.24
Rate for Payer: Dean Health Medicaid	$81.24
Rate for Payer: Independent Care Health Plan Medicaid	$81.24
Rate for Payer: Managed Health Services Medicaid	$84.49
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$81.24
Rate for Payer: United Healthcare Medicaid	$81.24
Rate for Payer: WMAP Medicaid	$81.24

EAPG 77: LEVEL I PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility OP

$1,592.08

Service Code	EAPG 00077
Min. Negotiated Rate	$1,530.85
Max. Negotiated Rate	$1,592.08
Rate for Payer: Anthem Medicaid	$1,530.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,530.85
Rate for Payer: Dean Health Medicaid	$1,530.85
Rate for Payer: Independent Care Health Plan Medicaid	$1,530.85
Rate for Payer: Managed Health Services Medicaid	$1,592.08
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,530.85
Rate for Payer: United Healthcare Medicaid	$1,530.85
Rate for Payer: WMAP Medicaid	$1,530.85

EAPG 780: OTHER HEMATOLOGICAL DIAGNOSES

Facility OP

$128.52

Service Code	EAPG 00780
Min. Negotiated Rate	$97.05
Max. Negotiated Rate	$128.52
Rate for Payer: Anthem Medicaid	$97.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$128.52
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$97.05
Rate for Payer: Dean Health Medicaid	$97.05
Rate for Payer: Independent Care Health Plan Medicaid	$97.05
Rate for Payer: Managed Health Services Medicaid	$100.93
Rate for Payer: Molina Healthcare Medicaid	$128.52
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$97.05
Rate for Payer: United Healthcare Medicaid	$97.05
Rate for Payer: WMAP Medicaid	$97.05

EAPG 781: COAGULATION AND PLATELET DISORDERS AND CONGENITAL FACTOR DEFICIENCIES

Facility OP

$113.80

Service Code	EAPG 00781
Min. Negotiated Rate	$60.04
Max. Negotiated Rate	$113.80
Rate for Payer: Anthem Medicaid	$60.04
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$113.80
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$60.04
Rate for Payer: Dean Health Medicaid	$60.04
Rate for Payer: Independent Care Health Plan Medicaid	$60.04
Rate for Payer: Managed Health Services Medicaid	$62.44
Rate for Payer: Molina Healthcare Medicaid	$113.80
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$60.04
Rate for Payer: United Healthcare Medicaid	$60.04
Rate for Payer: WMAP Medicaid	$60.04

EAPG 783: SICKLE CELL ANEMIA CRISIS

Facility OP

$287.82

Service Code	EAPG 00783
Min. Negotiated Rate	$117.25
Max. Negotiated Rate	$287.82
Rate for Payer: Anthem Medicaid	$117.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$287.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$117.25
Rate for Payer: Dean Health Medicaid	$117.25
Rate for Payer: Independent Care Health Plan Medicaid	$117.25
Rate for Payer: Managed Health Services Medicaid	$121.94
Rate for Payer: Molina Healthcare Medicaid	$287.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$117.25
Rate for Payer: United Healthcare Medicaid	$117.25
Rate for Payer: WMAP Medicaid	$117.25

EAPG 785: ANEMIA, BLOOD AND BLOOD-FORMING ORGAN DISORDERS

Facility OP

$120.84

Service Code	EAPG 00785
Min. Negotiated Rate	$72.56
Max. Negotiated Rate	$120.84
Rate for Payer: Anthem Medicaid	$72.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$120.84
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$72.56
Rate for Payer: Dean Health Medicaid	$72.56
Rate for Payer: Independent Care Health Plan Medicaid	$72.56
Rate for Payer: Managed Health Services Medicaid	$75.46
Rate for Payer: Molina Healthcare Medicaid	$120.84
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$72.56
Rate for Payer: United Healthcare Medicaid	$72.56
Rate for Payer: WMAP Medicaid	$72.56

EAPG 787: AFTERCARE, BURNS, CORROSIONS, OTHER INJURIES RELATED TO THE SKIN AND SUB TIS

Facility OP

$55.48

Service Code	EAPG 00787
Min. Negotiated Rate	$53.35
Max. Negotiated Rate	$55.48
Rate for Payer: Anthem Medicaid	$53.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$53.35
Rate for Payer: Dean Health Medicaid	$53.35
Rate for Payer: Independent Care Health Plan Medicaid	$53.35
Rate for Payer: Managed Health Services Medicaid	$55.48
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$53.35
Rate for Payer: United Healthcare Medicaid	$53.35
Rate for Payer: WMAP Medicaid	$53.35

EAPG 78: LEVEL I PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION

Facility OP

$1,628.09

Service Code	EAPG 00078
Min. Negotiated Rate	$870.29
Max. Negotiated Rate	$1,628.09
Rate for Payer: Anthem Medicaid	$870.29
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,628.09
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$870.29
Rate for Payer: Dean Health Medicaid	$870.29
Rate for Payer: Independent Care Health Plan Medicaid	$870.29
Rate for Payer: Managed Health Services Medicaid	$905.10
Rate for Payer: Molina Healthcare Medicaid	$1,628.09
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$870.29
Rate for Payer: United Healthcare Medicaid	$870.29
Rate for Payer: WMAP Medicaid	$870.29

EAPG 79: LEVEL II PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility OP

$3,910.79

Service Code	EAPG 00079
Min. Negotiated Rate	$2,567.08
Max. Negotiated Rate	$3,910.79
Rate for Payer: Anthem Medicaid	$2,567.08
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3,910.79
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,567.08
Rate for Payer: Dean Health Medicaid	$2,567.08
Rate for Payer: Independent Care Health Plan Medicaid	$2,567.08
Rate for Payer: Managed Health Services Medicaid	$2,669.76
Rate for Payer: Molina Healthcare Medicaid	$3,910.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,567.08
Rate for Payer: United Healthcare Medicaid	$2,567.08
Rate for Payer: WMAP Medicaid	$2,567.08

EAPG 800: ACUTE LEUKEMIA

Facility OP

$160.37

Service Code	EAPG 00800
Min. Negotiated Rate	$108.72
Max. Negotiated Rate	$160.37
Rate for Payer: Anthem Medicaid	$108.72
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$160.37
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$108.72
Rate for Payer: Dean Health Medicaid	$108.72
Rate for Payer: Independent Care Health Plan Medicaid	$108.72
Rate for Payer: Managed Health Services Medicaid	$113.07
Rate for Payer: Molina Healthcare Medicaid	$160.37
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$108.72
Rate for Payer: United Healthcare Medicaid	$108.72
Rate for Payer: WMAP Medicaid	$108.72

EAPG 801: LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA

Facility OP

$134.49

Service Code	EAPG 00801
Min. Negotiated Rate	$79.63
Max. Negotiated Rate	$134.49
Rate for Payer: Anthem Medicaid	$79.63
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$134.49
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$79.63
Rate for Payer: Dean Health Medicaid	$79.63
Rate for Payer: Independent Care Health Plan Medicaid	$79.63
Rate for Payer: Managed Health Services Medicaid	$82.82
Rate for Payer: Molina Healthcare Medicaid	$134.49
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$79.63
Rate for Payer: United Healthcare Medicaid	$79.63
Rate for Payer: WMAP Medicaid	$79.63

EAPG 802: RADIOTHERAPY

Facility OP

$145.84

Service Code	EAPG 00802
Min. Negotiated Rate	$55.34
Max. Negotiated Rate	$145.84
Rate for Payer: Anthem Medicaid	$55.34
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$145.84
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$55.34
Rate for Payer: Dean Health Medicaid	$55.34
Rate for Payer: Independent Care Health Plan Medicaid	$55.34
Rate for Payer: Managed Health Services Medicaid	$57.55
Rate for Payer: Molina Healthcare Medicaid	$145.84
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$55.34
Rate for Payer: United Healthcare Medicaid	$55.34
Rate for Payer: WMAP Medicaid	$55.34

EAPG 803: CHEMOTHERAPY

Facility OP

$147.75

Service Code	EAPG 00803
Min. Negotiated Rate	$89.18
Max. Negotiated Rate	$147.75
Rate for Payer: Anthem Medicaid	$89.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$147.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$89.18
Rate for Payer: Dean Health Medicaid	$89.18
Rate for Payer: Independent Care Health Plan Medicaid	$89.18
Rate for Payer: Managed Health Services Medicaid	$92.75
Rate for Payer: Molina Healthcare Medicaid	$147.75
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$89.18
Rate for Payer: United Healthcare Medicaid	$89.18
Rate for Payer: WMAP Medicaid	$89.18

EAPG 804: LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility OP

$129.84

Service Code	EAPG 00804
Min. Negotiated Rate	$70.88
Max. Negotiated Rate	$129.84
Rate for Payer: Anthem Medicaid	$70.88
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$129.84
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.88
Rate for Payer: Dean Health Medicaid	$70.88
Rate for Payer: Independent Care Health Plan Medicaid	$70.88
Rate for Payer: Managed Health Services Medicaid	$73.72
Rate for Payer: Molina Healthcare Medicaid	$129.84
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.88
Rate for Payer: United Healthcare Medicaid	$70.88
Rate for Payer: WMAP Medicaid	$70.88

EAPG 805: SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility OP

$251.32

Service Code	EAPG 00805
Min. Negotiated Rate	$232.34
Max. Negotiated Rate	$251.32
Rate for Payer: Anthem Medicaid	$241.65
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$232.34
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$241.65
Rate for Payer: Dean Health Medicaid	$241.65
Rate for Payer: Independent Care Health Plan Medicaid	$241.65
Rate for Payer: Managed Health Services Medicaid	$251.32
Rate for Payer: Molina Healthcare Medicaid	$232.34
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$241.65
Rate for Payer: United Healthcare Medicaid	$241.65
Rate for Payer: WMAP Medicaid	$241.65

EAPG 806: INTRAOPERATIVE, POST-OPERATIVE OR POST-TRAUMATIC INFECTIONS AND COMPLICATIONS

Facility OP

$127.69

Service Code	EAPG 00806
Min. Negotiated Rate	$84.10
Max. Negotiated Rate	$127.69
Rate for Payer: Anthem Medicaid	$84.10
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$127.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$84.10
Rate for Payer: Dean Health Medicaid	$84.10
Rate for Payer: Independent Care Health Plan Medicaid	$84.10
Rate for Payer: Managed Health Services Medicaid	$87.46
Rate for Payer: Molina Healthcare Medicaid	$127.69
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$84.10
Rate for Payer: United Healthcare Medicaid	$84.10
Rate for Payer: WMAP Medicaid	$84.10

EAPG 807: FEVER AND OTHER INFLAMMATORY CONDITIONS

Facility OP

$158.61

Service Code	EAPG 00807
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$158.61
Rate for Payer: Anthem Medicaid	$142.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$158.61
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$142.19
Rate for Payer: Dean Health Medicaid	$142.19
Rate for Payer: Independent Care Health Plan Medicaid	$142.19
Rate for Payer: Managed Health Services Medicaid	$147.88
Rate for Payer: Molina Healthcare Medicaid	$158.61
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$142.19
Rate for Payer: United Healthcare Medicaid	$142.19
Rate for Payer: WMAP Medicaid	$142.19

EAPG 808: VIRAL ILLNESS

Facility OP

$160.52

Service Code	EAPG 00808
Min. Negotiated Rate	$125.84
Max. Negotiated Rate	$160.52
Rate for Payer: Anthem Medicaid	$125.84
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$160.52
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$125.84
Rate for Payer: Dean Health Medicaid	$125.84
Rate for Payer: Independent Care Health Plan Medicaid	$125.84
Rate for Payer: Managed Health Services Medicaid	$130.87
Rate for Payer: Molina Healthcare Medicaid	$160.52
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$125.84
Rate for Payer: United Healthcare Medicaid	$125.84
Rate for Payer: WMAP Medicaid	$125.84

EAPG 809: OTHER INFECTIOUS AND PARASITIC DISEASES

Facility OP

$104.35

Service Code	EAPG 00809
Min. Negotiated Rate	$63.80
Max. Negotiated Rate	$104.35
Rate for Payer: Anthem Medicaid	$63.80
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$104.35
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	$104.35
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 80: EXERCISE TOLERANCE TESTS

Facility OP

$241.24

Service Code	EAPG 00080
Min. Negotiated Rate	$68.86
Max. Negotiated Rate	$241.24
Rate for Payer: Anthem Medicaid	$68.86
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$241.24
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$68.86
Rate for Payer: Dean Health Medicaid	$68.86
Rate for Payer: Independent Care Health Plan Medicaid	$68.86
Rate for Payer: Managed Health Services Medicaid	$71.61
Rate for Payer: Molina Healthcare Medicaid	$241.24
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$68.86
Rate for Payer: United Healthcare Medicaid	$68.86
Rate for Payer: WMAP Medicaid	$68.86

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