Beloit Memorial Hospital

All Charges

Charge

Type

Price

EAPG 810: H. PYLORI INFECTION

Facility OP

$88.16

Service Code	EAPG 00810
Min. Negotiated Rate	$50.65
Max. Negotiated Rate	$88.16
Rate for Payer: Anthem Medicaid	$50.65
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$88.16
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$50.65
Rate for Payer: Dean Health Medicaid	$50.65
Rate for Payer: Independent Care Health Plan Medicaid	$50.65
Rate for Payer: Managed Health Services Medicaid	$52.68
Rate for Payer: Molina Healthcare Medicaid	$88.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$50.65
Rate for Payer: United Healthcare Medicaid	$50.65
Rate for Payer: WMAP Medicaid	$50.65

EAPG 812: VIRAL MENINGITIS

Facility OP

$87.46

Service Code	EAPG 00812
Min. Negotiated Rate	$84.10
Max. Negotiated Rate	$87.46
Rate for Payer: Anthem Medicaid	$84.10
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: Quartz Badgercare/Employee Trust Funds/QHP	$84.10
Rate for Payer: United Healthcare Medicaid	$84.10
Rate for Payer: WMAP Medicaid	$84.10

EAPG 81: ECHOCARDIOGRAPHY

Facility OP

$383.42

Service Code	EAPG 00081
Min. Negotiated Rate	$179.94
Max. Negotiated Rate	$383.42
Rate for Payer: Anthem Medicaid	$179.94
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$383.42
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$179.94
Rate for Payer: Dean Health Medicaid	$179.94
Rate for Payer: Independent Care Health Plan Medicaid	$179.94
Rate for Payer: Managed Health Services Medicaid	$187.14
Rate for Payer: Molina Healthcare Medicaid	$383.42
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$179.94
Rate for Payer: United Healthcare Medicaid	$179.94
Rate for Payer: WMAP Medicaid	$179.94

EAPG 820: SCHIZOPHRENIA

Facility OP

$120.99

Service Code	EAPG 00820
Min. Negotiated Rate	$90.32
Max. Negotiated Rate	$120.99
Rate for Payer: Anthem Medicaid	$90.32
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$120.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$90.32
Rate for Payer: Dean Health Medicaid	$90.32
Rate for Payer: Independent Care Health Plan Medicaid	$90.32
Rate for Payer: Managed Health Services Medicaid	$93.93
Rate for Payer: Molina Healthcare Medicaid	$120.99
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$90.32
Rate for Payer: United Healthcare Medicaid	$90.32
Rate for Payer: WMAP Medicaid	$90.32

EAPG 822: PERSONALITY AND IMPULSE CONTROL DIAGNOSES

Facility OP

$134.05

Service Code	EAPG 00822
Min. Negotiated Rate	$90.61
Max. Negotiated Rate	$134.05
Rate for Payer: Anthem Medicaid	$90.61
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$134.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$90.61
Rate for Payer: Dean Health Medicaid	$90.61
Rate for Payer: Independent Care Health Plan Medicaid	$90.61
Rate for Payer: Managed Health Services Medicaid	$94.23
Rate for Payer: Molina Healthcare Medicaid	$134.05
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$90.61
Rate for Payer: United Healthcare Medicaid	$90.61
Rate for Payer: WMAP Medicaid	$90.61

EAPG 823: BIPOLAR DISORDERS

Facility OP

$107.19

Service Code	EAPG 00823
Min. Negotiated Rate	$69.88
Max. Negotiated Rate	$107.19
Rate for Payer: Anthem Medicaid	$69.88
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$107.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$69.88
Rate for Payer: Dean Health Medicaid	$69.88
Rate for Payer: Independent Care Health Plan Medicaid	$69.88
Rate for Payer: Managed Health Services Medicaid	$72.68
Rate for Payer: Molina Healthcare Medicaid	$107.19
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$69.88
Rate for Payer: United Healthcare Medicaid	$69.88
Rate for Payer: WMAP Medicaid	$69.88

EAPG 824: DEPRESSION EXCEPT MAJOR DEPRESSIVE DIAGNOSES

Facility OP

$96.82

Service Code	EAPG 00824
Min. Negotiated Rate	$65.75
Max. Negotiated Rate	$96.82
Rate for Payer: Anthem Medicaid	$65.75
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$96.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$65.75
Rate for Payer: Dean Health Medicaid	$65.75
Rate for Payer: Independent Care Health Plan Medicaid	$65.75
Rate for Payer: Managed Health Services Medicaid	$68.38
Rate for Payer: Molina Healthcare Medicaid	$96.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$65.75
Rate for Payer: United Healthcare Medicaid	$65.75
Rate for Payer: WMAP Medicaid	$65.75

EAPG 825: ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES

Facility OP

$107.53

Service Code	EAPG 00825
Min. Negotiated Rate	$65.81
Max. Negotiated Rate	$107.53
Rate for Payer: Anthem Medicaid	$65.81
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$107.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$65.81
Rate for Payer: Dean Health Medicaid	$65.81
Rate for Payer: Independent Care Health Plan Medicaid	$65.81
Rate for Payer: Managed Health Services Medicaid	$68.44
Rate for Payer: Molina Healthcare Medicaid	$107.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$65.81
Rate for Payer: United Healthcare Medicaid	$65.81
Rate for Payer: WMAP Medicaid	$65.81

EAPG 826: ACUTE ANXIETY AND DELIRIUM STATES

Facility OP

$131.80

Service Code	EAPG 00826
Min. Negotiated Rate	$86.97
Max. Negotiated Rate	$131.80
Rate for Payer: Anthem Medicaid	$86.97
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$131.80
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$86.97
Rate for Payer: Dean Health Medicaid	$86.97
Rate for Payer: Independent Care Health Plan Medicaid	$86.97
Rate for Payer: Managed Health Services Medicaid	$90.45
Rate for Payer: Molina Healthcare Medicaid	$131.80
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$86.97
Rate for Payer: United Healthcare Medicaid	$86.97
Rate for Payer: WMAP Medicaid	$86.97

EAPG 827: ORGANIC BEHAVIORAL HEALTH DISTURBANCES

Facility OP

$114.68

Service Code	EAPG 00827
Min. Negotiated Rate	$59.98
Max. Negotiated Rate	$114.68
Rate for Payer: Anthem Medicaid	$59.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$114.68
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$59.98
Rate for Payer: Dean Health Medicaid	$59.98
Rate for Payer: Independent Care Health Plan Medicaid	$59.98
Rate for Payer: Managed Health Services Medicaid	$62.38
Rate for Payer: Molina Healthcare Medicaid	$114.68
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$59.98
Rate for Payer: United Healthcare Medicaid	$59.98
Rate for Payer: WMAP Medicaid	$59.98

EAPG 828: INTELLECTUAL DISABILITY

Facility OP

$93.35

Service Code	EAPG 00828
Min. Negotiated Rate	$60.98
Max. Negotiated Rate	$93.35
Rate for Payer: Anthem Medicaid	$60.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$93.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$60.98
Rate for Payer: Dean Health Medicaid	$60.98
Rate for Payer: Independent Care Health Plan Medicaid	$60.98
Rate for Payer: Managed Health Services Medicaid	$63.42
Rate for Payer: Molina Healthcare Medicaid	$93.35
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$60.98
Rate for Payer: United Healthcare Medicaid	$60.98
Rate for Payer: WMAP Medicaid	$60.98

EAPG 829: CHILDHOOD BEHAVIORAL DIAGNOSES

Facility OP

$99.61

Service Code	EAPG 00829
Min. Negotiated Rate	$64.68
Max. Negotiated Rate	$99.61
Rate for Payer: Anthem Medicaid	$64.68
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$99.61
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$64.68
Rate for Payer: Dean Health Medicaid	$64.68
Rate for Payer: Independent Care Health Plan Medicaid	$64.68
Rate for Payer: Managed Health Services Medicaid	$67.27
Rate for Payer: Molina Healthcare Medicaid	$99.61
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$64.68
Rate for Payer: United Healthcare Medicaid	$64.68
Rate for Payer: WMAP Medicaid	$64.68

EAPG 82: COMPREHENSIVE CARDIAC ELECTROPHYSIOLOGIC PROCEDURES WITH ABLATION

Facility OP

$9,468.16

Service Code	EAPG 00082
Min. Negotiated Rate	$7,261.98
Max. Negotiated Rate	$9,468.16
Rate for Payer: Anthem Medicaid	$7,261.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$9,468.16
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$7,261.98
Rate for Payer: Dean Health Medicaid	$7,261.98
Rate for Payer: Independent Care Health Plan Medicaid	$7,261.98
Rate for Payer: Managed Health Services Medicaid	$7,552.46
Rate for Payer: Molina Healthcare Medicaid	$9,468.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$7,261.98
Rate for Payer: United Healthcare Medicaid	$7,261.98
Rate for Payer: WMAP Medicaid	$7,261.98

EAPG 830: EATING DISORDERS

Facility OP

$142.61

Service Code	EAPG 00830
Min. Negotiated Rate	$75.68
Max. Negotiated Rate	$142.61
Rate for Payer: Anthem Medicaid	$75.68
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$142.61
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$75.68
Rate for Payer: Dean Health Medicaid	$75.68
Rate for Payer: Independent Care Health Plan Medicaid	$75.68
Rate for Payer: Managed Health Services Medicaid	$78.71
Rate for Payer: Molina Healthcare Medicaid	$142.61
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$75.68
Rate for Payer: United Healthcare Medicaid	$75.68
Rate for Payer: WMAP Medicaid	$75.68

EAPG 831: OTHER BEHAVIORAL HEALTH DIAGNOSES

Facility OP

$120.84

Service Code	EAPG 00831
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$120.84
Rate for Payer: Anthem Medicaid	$84.90
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$120.84
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$84.90
Rate for Payer: Dean Health Medicaid	$84.90
Rate for Payer: Independent Care Health Plan Medicaid	$84.90
Rate for Payer: Managed Health Services Medicaid	$88.30
Rate for Payer: Molina Healthcare Medicaid	$120.84
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$84.90
Rate for Payer: United Healthcare Medicaid	$84.90
Rate for Payer: WMAP Medicaid	$84.90

EAPG 832: INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility OP

$192.72

Service Code	EAPG 00832
Min. Negotiated Rate	$185.31
Max. Negotiated Rate	$192.72
Rate for Payer: Anthem Medicaid	$185.31
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$185.31
Rate for Payer: Dean Health Medicaid	$185.31
Rate for Payer: Independent Care Health Plan Medicaid	$185.31
Rate for Payer: Managed Health Services Medicaid	$192.72
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$185.31
Rate for Payer: United Healthcare Medicaid	$185.31
Rate for Payer: WMAP Medicaid	$185.31

EAPG 83: LEVEL II CENTRAL VENOUS ACCESS PROCEDURES

Facility OP

$1,345.21

Service Code	EAPG 00083
Min. Negotiated Rate	$880.46
Max. Negotiated Rate	$1,345.21
Rate for Payer: Anthem Medicaid	$880.46
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,345.21
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$880.46
Rate for Payer: Dean Health Medicaid	$880.46
Rate for Payer: Independent Care Health Plan Medicaid	$880.46
Rate for Payer: Managed Health Services Medicaid	$915.68
Rate for Payer: Molina Healthcare Medicaid	$1,345.21
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$880.46
Rate for Payer: United Healthcare Medicaid	$880.46
Rate for Payer: WMAP Medicaid	$880.46

EAPG 840: OPIOID ABUSE AND DEPENDENCE

Facility OP

$102.10

Service Code	EAPG 00840
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$102.10
Rate for Payer: Anthem Medicaid	$64.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$102.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$64.35
Rate for Payer: Dean Health Medicaid	$64.35
Rate for Payer: Independent Care Health Plan Medicaid	$64.35
Rate for Payer: Managed Health Services Medicaid	$66.92
Rate for Payer: Molina Healthcare Medicaid	$102.10
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$64.35
Rate for Payer: United Healthcare Medicaid	$64.35
Rate for Payer: WMAP Medicaid	$64.35

EAPG 841: COCAINE ABUSE AND DEPENDENCE

Facility OP

$204.50

Service Code	EAPG 00841
Min. Negotiated Rate	$124.38
Max. Negotiated Rate	$204.50
Rate for Payer: Anthem Medicaid	$124.38
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$204.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$124.38
Rate for Payer: Dean Health Medicaid	$124.38
Rate for Payer: Independent Care Health Plan Medicaid	$124.38
Rate for Payer: Managed Health Services Medicaid	$129.36
Rate for Payer: Molina Healthcare Medicaid	$204.50
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$124.38
Rate for Payer: United Healthcare Medicaid	$124.38
Rate for Payer: WMAP Medicaid	$124.38

EAPG 842: ALCOHOL ABUSE AND DEPENDENCE

Facility OP

$190.46

Service Code	EAPG 00842
Min. Negotiated Rate	$117.03
Max. Negotiated Rate	$190.46
Rate for Payer: Anthem Medicaid	$117.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$190.46
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$117.03
Rate for Payer: Dean Health Medicaid	$117.03
Rate for Payer: Independent Care Health Plan Medicaid	$117.03
Rate for Payer: Managed Health Services Medicaid	$121.71
Rate for Payer: Molina Healthcare Medicaid	$190.46
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$117.03
Rate for Payer: United Healthcare Medicaid	$117.03
Rate for Payer: WMAP Medicaid	$117.03

EAPG 843: OTHER DRUG ABUSE AND DEPENDENCE

Facility OP

$179.55

Service Code	EAPG 00843
Min. Negotiated Rate	$111.55
Max. Negotiated Rate	$179.55
Rate for Payer: Anthem Medicaid	$111.55
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$179.55
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$111.55
Rate for Payer: Dean Health Medicaid	$111.55
Rate for Payer: Independent Care Health Plan Medicaid	$111.55
Rate for Payer: Managed Health Services Medicaid	$116.01
Rate for Payer: Molina Healthcare Medicaid	$179.55
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$111.55
Rate for Payer: United Healthcare Medicaid	$111.55
Rate for Payer: WMAP Medicaid	$111.55

EAPG 84: CARDIAC CATHETERIZATION PROCEDURES

Facility OP

$1,925.45

Service Code	EAPG 00084
Min. Negotiated Rate	$1,002.36
Max. Negotiated Rate	$1,925.45
Rate for Payer: Anthem Medicaid	$1,002.36
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,925.45
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,002.36
Rate for Payer: Dean Health Medicaid	$1,002.36
Rate for Payer: Independent Care Health Plan Medicaid	$1,002.36
Rate for Payer: Managed Health Services Medicaid	$1,042.45
Rate for Payer: Molina Healthcare Medicaid	$1,925.45
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,002.36
Rate for Payer: United Healthcare Medicaid	$1,002.36
Rate for Payer: WMAP Medicaid	$1,002.36

EAPG 850: ALLERGIC REACTIONS

Facility OP

$158.86

Service Code	EAPG 00850
Min. Negotiated Rate	$105.02
Max. Negotiated Rate	$158.86
Rate for Payer: Anthem Medicaid	$105.02
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$158.86
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$105.02
Rate for Payer: Dean Health Medicaid	$105.02
Rate for Payer: Independent Care Health Plan Medicaid	$105.02
Rate for Payer: Managed Health Services Medicaid	$109.22
Rate for Payer: Molina Healthcare Medicaid	$158.86
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$105.02
Rate for Payer: United Healthcare Medicaid	$105.02
Rate for Payer: WMAP Medicaid	$105.02

EAPG 851: POISONING OR TOXIC EFFECTS OF MEDICINAL AGENTS

Facility OP

$189.68

Service Code	EAPG 00851
Min. Negotiated Rate	$113.71
Max. Negotiated Rate	$189.68
Rate for Payer: Anthem Medicaid	$113.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$189.68
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$113.71
Rate for Payer: Dean Health Medicaid	$113.71
Rate for Payer: Independent Care Health Plan Medicaid	$113.71
Rate for Payer: Managed Health Services Medicaid	$118.26
Rate for Payer: Molina Healthcare Medicaid	$189.68
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$113.71
Rate for Payer: United Healthcare Medicaid	$113.71
Rate for Payer: WMAP Medicaid	$113.71

EAPG 852: OTHER COMPLICATIONS OF TREATMENT

Facility OP

$134.98

Service Code	EAPG 00852
Min. Negotiated Rate	$72.66
Max. Negotiated Rate	$134.98
Rate for Payer: Anthem Medicaid	$72.66
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$134.98
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$72.66
Rate for Payer: Dean Health Medicaid	$72.66
Rate for Payer: Independent Care Health Plan Medicaid	$72.66
Rate for Payer: Managed Health Services Medicaid	$75.57
Rate for Payer: Molina Healthcare Medicaid	$134.98
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$72.66
Rate for Payer: United Healthcare Medicaid	$72.66
Rate for Payer: WMAP Medicaid	$72.66

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