Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 25: LEVEL I SHOULDER AND UPPER ARM PROCEDURES

Facility

$2,028.58

Service Code	EAPG 00025
Min. Negotiated Rate	$1,950.56
Max. Negotiated Rate	$2,028.58
Rate for Payer: Anthem Medicaid	$1,950.56
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,950.56
Rate for Payer: Dean Health Medicaid	$1,950.56
Rate for Payer: Independent Care Health Plan Medicaid	$1,950.56
Rate for Payer: Managed Health Services Medicaid	$2,028.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,950.56
Rate for Payer: United Healthcare Medicaid	$1,950.56
Rate for Payer: WMAP Medicaid	$1,950.56

EAPG 260: CASE MANAGEMENT AND CARE PLANNING SERVICES

Facility

$96.14

Service Code	EAPG 00260
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$96.14
Rate for Payer: Anthem Medicaid	$45.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$96.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$45.19
Rate for Payer: Dean Health Medicaid	$45.19
Rate for Payer: Independent Care Health Plan Medicaid	$45.19
Rate for Payer: Managed Health Services Medicaid	$47.00
Rate for Payer: Molina Healthcare Medicaid	$96.14
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$45.19
Rate for Payer: United Healthcare Medicaid	$45.19
Rate for Payer: WMAP Medicaid	$45.19

EAPG 261: ESRD MONTHLY CASE MANAGEMENT

Facility

$257.50

Service Code	EAPG 00261
Min. Negotiated Rate	$247.60
Max. Negotiated Rate	$257.50
Rate for Payer: Anthem Medicaid	$247.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$247.60
Rate for Payer: Dean Health Medicaid	$247.60
Rate for Payer: Independent Care Health Plan Medicaid	$247.60
Rate for Payer: Managed Health Services Medicaid	$257.50
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$247.60
Rate for Payer: United Healthcare Medicaid	$247.60
Rate for Payer: WMAP Medicaid	$247.60

EAPG 262: CLEFT LIP AND PALATE REPAIR

Facility

$1,153.15

Service Code	EAPG 00262
Min. Negotiated Rate	$1,108.80
Max. Negotiated Rate	$1,153.15
Rate for Payer: Anthem Medicaid	$1,108.80
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,108.80
Rate for Payer: Dean Health Medicaid	$1,108.80
Rate for Payer: Independent Care Health Plan Medicaid	$1,108.80
Rate for Payer: Managed Health Services Medicaid	$1,153.15
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,108.80
Rate for Payer: United Healthcare Medicaid	$1,108.80
Rate for Payer: WMAP Medicaid	$1,108.80

EAPG 263: THYROID AND PARATHYROID PROCEDURES

Facility

$1,866.26

Service Code	EAPG 00263
Min. Negotiated Rate	$1,794.48
Max. Negotiated Rate	$1,866.26
Rate for Payer: Anthem Medicaid	$1,794.48
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,794.48
Rate for Payer: Dean Health Medicaid	$1,794.48
Rate for Payer: Independent Care Health Plan Medicaid	$1,794.48
Rate for Payer: Managed Health Services Medicaid	$1,866.26
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,794.48
Rate for Payer: United Healthcare Medicaid	$1,794.48
Rate for Payer: WMAP Medicaid	$1,794.48

EAPG 264: MAJOR CRANIOTOMY AND CRANIECTOMY SURGICAL PROCEDURES

Facility

$1,616.70

Service Code	EAPG 00264
Min. Negotiated Rate	$1,554.52
Max. Negotiated Rate	$1,616.70
Rate for Payer: Anthem Medicaid	$1,554.52
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,554.52
Rate for Payer: Dean Health Medicaid	$1,554.52
Rate for Payer: Independent Care Health Plan Medicaid	$1,554.52
Rate for Payer: Managed Health Services Medicaid	$1,616.70
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,554.52
Rate for Payer: United Healthcare Medicaid	$1,554.52
Rate for Payer: WMAP Medicaid	$1,554.52

EAPG 265: PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$6,075.42

Service Code	EAPG 00265
Min. Negotiated Rate	$5,841.75
Max. Negotiated Rate	$6,075.42
Rate for Payer: Anthem Medicaid	$5,841.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5,841.75
Rate for Payer: Dean Health Medicaid	$5,841.75
Rate for Payer: Independent Care Health Plan Medicaid	$5,841.75
Rate for Payer: Managed Health Services Medicaid	$6,075.42
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5,841.75
Rate for Payer: United Healthcare Medicaid	$5,841.75
Rate for Payer: WMAP Medicaid	$5,841.75

EAPG 266: OPEN INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$1,795.58

Service Code	EAPG 00266
Min. Negotiated Rate	$1,726.52
Max. Negotiated Rate	$1,795.58
Rate for Payer: Anthem Medicaid	$1,726.52
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,726.52
Rate for Payer: Dean Health Medicaid	$1,726.52
Rate for Payer: Independent Care Health Plan Medicaid	$1,726.52
Rate for Payer: Managed Health Services Medicaid	$1,795.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,726.52
Rate for Payer: United Healthcare Medicaid	$1,726.52
Rate for Payer: WMAP Medicaid	$1,726.52

EAPG 267: OTHER CRANIOTOMY PROCEDURES INCLUDING CRANIOPLASTY

Facility

$2,304.71

Service Code	EAPG 00267
Min. Negotiated Rate	$2,216.07
Max. Negotiated Rate	$2,304.71
Rate for Payer: Anthem Medicaid	$2,216.07
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,216.07
Rate for Payer: Dean Health Medicaid	$2,216.07
Rate for Payer: Independent Care Health Plan Medicaid	$2,216.07
Rate for Payer: Managed Health Services Medicaid	$2,304.71
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,216.07
Rate for Payer: United Healthcare Medicaid	$2,216.07
Rate for Payer: WMAP Medicaid	$2,216.07

EAPG 268: CRANIAL AND SPINAL SHUNT PROCEDURES

Facility

$2,486.85

Service Code	EAPG 00268
Min. Negotiated Rate	$2,391.20
Max. Negotiated Rate	$2,486.85
Rate for Payer: Anthem Medicaid	$2,391.20
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,391.20
Rate for Payer: Dean Health Medicaid	$2,391.20
Rate for Payer: Independent Care Health Plan Medicaid	$2,391.20
Rate for Payer: Managed Health Services Medicaid	$2,486.85
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,391.20
Rate for Payer: United Healthcare Medicaid	$2,391.20
Rate for Payer: WMAP Medicaid	$2,391.20

EAPG 269: LEVEL II ANCILLARY THERAPEUTIC SERVICES

Facility

$15.57

Service Code	EAPG 00269
Min. Negotiated Rate	$14.97
Max. Negotiated Rate	$15.57
Rate for Payer: Anthem Medicaid	$14.97
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$14.97
Rate for Payer: Dean Health Medicaid	$14.97
Rate for Payer: Independent Care Health Plan Medicaid	$14.97
Rate for Payer: Managed Health Services Medicaid	$15.57
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$14.97
Rate for Payer: United Healthcare Medicaid	$14.97
Rate for Payer: WMAP Medicaid	$14.97

EAPG 26: LEVEL I KNEE AND LOWER LEG PROCEDURES

Facility

$1,351.79

Service Code	EAPG 00026
Min. Negotiated Rate	$1,299.80
Max. Negotiated Rate	$1,351.79
Rate for Payer: Anthem Medicaid	$1,299.80
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,299.80
Rate for Payer: Dean Health Medicaid	$1,299.80
Rate for Payer: Independent Care Health Plan Medicaid	$1,299.80
Rate for Payer: Managed Health Services Medicaid	$1,351.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,299.80
Rate for Payer: United Healthcare Medicaid	$1,299.80
Rate for Payer: WMAP Medicaid	$1,299.80

EAPG 270: OCCUPATIONAL THERAPY

Facility

$424.86

Service Code	EAPG 00270
Min. Negotiated Rate	$86.26
Max. Negotiated Rate	$424.86
Rate for Payer: Anthem Medicaid	$86.26
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$424.86
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$86.26
Rate for Payer: Dean Health Medicaid	$86.26
Rate for Payer: Independent Care Health Plan Medicaid	$86.26
Rate for Payer: Managed Health Services Medicaid	$89.71
Rate for Payer: Molina Healthcare Medicaid	$424.86
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$86.26
Rate for Payer: United Healthcare Medicaid	$86.26
Rate for Payer: WMAP Medicaid	$86.26

EAPG 271: PHYSICAL THERAPY

Facility

$267.08

Service Code	EAPG 00271
Min. Negotiated Rate	$78.73
Max. Negotiated Rate	$267.08
Rate for Payer: Anthem Medicaid	$78.73
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$267.08
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$78.73
Rate for Payer: Dean Health Medicaid	$78.73
Rate for Payer: Independent Care Health Plan Medicaid	$78.73
Rate for Payer: Managed Health Services Medicaid	$81.88
Rate for Payer: Molina Healthcare Medicaid	$267.08
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$78.73
Rate for Payer: United Healthcare Medicaid	$78.73
Rate for Payer: WMAP Medicaid	$78.73

EAPG 272: SPEECH THERAPY AND EVALUATION

Facility

$197.41

Service Code	EAPG 00272
Min. Negotiated Rate	$94.65
Max. Negotiated Rate	$197.41
Rate for Payer: United Healthcare Medicaid	$94.65
Rate for Payer: WMAP Medicaid	$94.65
Rate for Payer: Anthem Medicaid	$94.65
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$197.41
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$94.65
Rate for Payer: Dean Health Medicaid	$94.65
Rate for Payer: Independent Care Health Plan Medicaid	$94.65
Rate for Payer: Managed Health Services Medicaid	$98.44
Rate for Payer: Molina Healthcare Medicaid	$197.41
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$94.65

EAPG 276: PROCEDURES FOR REVISION OR REMOVAL OF NEUROSTIMULATOR DEVICES

Facility

$1,442.03

Service Code	EAPG 00276
Min. Negotiated Rate	$1,386.57
Max. Negotiated Rate	$1,442.03
Rate for Payer: Anthem Medicaid	$1,386.57
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,386.57
Rate for Payer: Dean Health Medicaid	$1,386.57
Rate for Payer: Independent Care Health Plan Medicaid	$1,386.57
Rate for Payer: Managed Health Services Medicaid	$1,442.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,386.57
Rate for Payer: United Healthcare Medicaid	$1,386.57
Rate for Payer: WMAP Medicaid	$1,386.57

EAPG 277: LEVEL I VASCULAR RADIOLOGICAL PROCEDURES

Facility

$464.16

Service Code	EAPG 00277
Min. Negotiated Rate	$446.31
Max. Negotiated Rate	$464.16
Rate for Payer: Anthem Medicaid	$446.31
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$446.31
Rate for Payer: Dean Health Medicaid	$446.31
Rate for Payer: Independent Care Health Plan Medicaid	$446.31
Rate for Payer: Managed Health Services Medicaid	$464.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$446.31
Rate for Payer: United Healthcare Medicaid	$446.31
Rate for Payer: WMAP Medicaid	$446.31

EAPG 278: INJECTION(S) FOR RADIOLOGICAL IMAGING

Facility

$141.54

Service Code	EAPG 00278
Min. Negotiated Rate	$136.10
Max. Negotiated Rate	$141.54
Rate for Payer: Anthem Medicaid	$136.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$136.10
Rate for Payer: Dean Health Medicaid	$136.10
Rate for Payer: Independent Care Health Plan Medicaid	$136.10
Rate for Payer: Managed Health Services Medicaid	$141.54
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$136.10
Rate for Payer: United Healthcare Medicaid	$136.10
Rate for Payer: WMAP Medicaid	$136.10

EAPG 279: LEVEL II VASCULAR RADIOLOGICAL PROCEDURES

Facility

$731.47

Service Code	EAPG 00279
Min. Negotiated Rate	$703.34
Max. Negotiated Rate	$731.47
Rate for Payer: Anthem Medicaid	$703.34
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$703.34
Rate for Payer: Dean Health Medicaid	$703.34
Rate for Payer: Independent Care Health Plan Medicaid	$703.34
Rate for Payer: Managed Health Services Medicaid	$731.47
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$703.34
Rate for Payer: United Healthcare Medicaid	$703.34
Rate for Payer: WMAP Medicaid	$703.34

EAPG 27: LEVEL I HIP AND FEMUR PROCEDURES

Facility

$1,796.38

Service Code	EAPG 00027
Min. Negotiated Rate	$1,727.29
Max. Negotiated Rate	$1,796.38
Rate for Payer: Anthem Medicaid	$1,727.29
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,727.29
Rate for Payer: Dean Health Medicaid	$1,727.29
Rate for Payer: Independent Care Health Plan Medicaid	$1,727.29
Rate for Payer: Managed Health Services Medicaid	$1,796.38
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,727.29
Rate for Payer: United Healthcare Medicaid	$1,727.29
Rate for Payer: WMAP Medicaid	$1,727.29

EAPG 280: LEVEL III VASCULAR RADIOLOGICAL PROCEDURES

Facility

$2,114.74

Service Code	EAPG 00280
Min. Negotiated Rate	$1,836.55
Max. Negotiated Rate	$2,114.74
Rate for Payer: Anthem Medicaid	$1,836.55
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,114.74
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,836.55
Rate for Payer: Dean Health Medicaid	$1,836.55
Rate for Payer: Independent Care Health Plan Medicaid	$1,836.55
Rate for Payer: Managed Health Services Medicaid	$1,910.01
Rate for Payer: Molina Healthcare Medicaid	$2,114.74
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,836.55
Rate for Payer: United Healthcare Medicaid	$1,836.55
Rate for Payer: WMAP Medicaid	$1,836.55

EAPG 282: MAGNETIC RESONANCE ANGIOGRAPHY

Facility

$311.40

Service Code	EAPG 00282
Min. Negotiated Rate	$204.30
Max. Negotiated Rate	$311.40
Rate for Payer: Anthem Medicaid	$204.30
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$311.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$204.30
Rate for Payer: Dean Health Medicaid	$204.30
Rate for Payer: Independent Care Health Plan Medicaid	$204.30
Rate for Payer: Managed Health Services Medicaid	$212.47
Rate for Payer: Molina Healthcare Medicaid	$311.40
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$204.30
Rate for Payer: United Healthcare Medicaid	$204.30
Rate for Payer: WMAP Medicaid	$204.30

EAPG 284: MYELOGRAPHY AND DISCOGRAPHY IMAGING PROCEDURES

Facility

$478.62

Service Code	EAPG 00284
Min. Negotiated Rate	$232.33
Max. Negotiated Rate	$478.62
Rate for Payer: Anthem Medicaid	$232.33
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$478.62
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$232.33
Rate for Payer: Dean Health Medicaid	$232.33
Rate for Payer: Independent Care Health Plan Medicaid	$232.33
Rate for Payer: Managed Health Services Medicaid	$241.62
Rate for Payer: Molina Healthcare Medicaid	$478.62
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$232.33
Rate for Payer: United Healthcare Medicaid	$232.33
Rate for Payer: WMAP Medicaid	$232.33

EAPG 286: MAMMOGRAPHY AND OTHER RELATED PROCEDURES

Facility

$54.60

Service Code	EAPG 00286
Min. Negotiated Rate	$19.82
Max. Negotiated Rate	$54.60
Rate for Payer: Anthem Medicaid	$19.82
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$54.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$19.82
Rate for Payer: Dean Health Medicaid	$19.82
Rate for Payer: Independent Care Health Plan Medicaid	$19.82
Rate for Payer: Managed Health Services Medicaid	$20.61
Rate for Payer: Molina Healthcare Medicaid	$54.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$19.82
Rate for Payer: United Healthcare Medicaid	$19.82
Rate for Payer: WMAP Medicaid	$19.82

EAPG 288: LEVEL I DIAGNOSTIC ULTRASOUND

Facility

$120.21

Service Code	EAPG 00288
Min. Negotiated Rate	$45.41
Max. Negotiated Rate	$120.21
Rate for Payer: Anthem Medicaid	$45.41
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$120.21
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$45.41
Rate for Payer: Dean Health Medicaid	$45.41
Rate for Payer: Independent Care Health Plan Medicaid	$45.41
Rate for Payer: Managed Health Services Medicaid	$47.23
Rate for Payer: Molina Healthcare Medicaid	$120.21
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$45.41
Rate for Payer: United Healthcare Medicaid	$45.41
Rate for Payer: WMAP Medicaid	$45.41

Know your out-of-pocket cost for care.

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