Beloit Memorial Hospital

All Charges

Charge

Type

Price

EAPG 853: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES

Facility OP

$134.93

Service Code	EAPG 00853
Min. Negotiated Rate	$70.56
Max. Negotiated Rate	$134.93
Rate for Payer: Anthem Medicaid	$70.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$134.93
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.56
Rate for Payer: Dean Health Medicaid	$70.56
Rate for Payer: Independent Care Health Plan Medicaid	$70.56
Rate for Payer: Managed Health Services Medicaid	$73.38
Rate for Payer: Molina Healthcare Medicaid	$134.93
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.56
Rate for Payer: United Healthcare Medicaid	$70.56
Rate for Payer: WMAP Medicaid	$70.56

EAPG 854: TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES

Facility OP

$136.60

Service Code	EAPG 00854
Min. Negotiated Rate	$83.69
Max. Negotiated Rate	$136.60
Rate for Payer: Anthem Medicaid	$83.69
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$136.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$83.69
Rate for Payer: Dean Health Medicaid	$83.69
Rate for Payer: Independent Care Health Plan Medicaid	$83.69
Rate for Payer: Managed Health Services Medicaid	$87.04
Rate for Payer: Molina Healthcare Medicaid	$136.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$83.69
Rate for Payer: United Healthcare Medicaid	$83.69
Rate for Payer: WMAP Medicaid	$83.69

EAPG 85: LEVEL III PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility OP

$4,622.36

Service Code	EAPG 00085
Min. Negotiated Rate	$3,910.79
Max. Negotiated Rate	$4,622.36
Rate for Payer: Anthem Medicaid	$4,444.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3,910.79
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4,444.58
Rate for Payer: Dean Health Medicaid	$4,444.58
Rate for Payer: Independent Care Health Plan Medicaid	$4,444.58
Rate for Payer: Managed Health Services Medicaid	$4,622.36
Rate for Payer: Molina Healthcare Medicaid	$3,910.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4,444.58
Rate for Payer: United Healthcare Medicaid	$4,444.58
Rate for Payer: WMAP Medicaid	$4,444.58

EAPG 860: EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS

Facility OP

$162.43

Service Code	EAPG 00860
Min. Negotiated Rate	$82.53
Max. Negotiated Rate	$162.43
Rate for Payer: Anthem Medicaid	$82.53
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$162.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$82.53
Rate for Payer: Dean Health Medicaid	$82.53
Rate for Payer: Independent Care Health Plan Medicaid	$82.53
Rate for Payer: Managed Health Services Medicaid	$85.83
Rate for Payer: Molina Healthcare Medicaid	$162.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$82.53
Rate for Payer: United Healthcare Medicaid	$82.53
Rate for Payer: WMAP Medicaid	$82.53

EAPG 861: PARTIAL THICKNESS BURNS

Facility OP

$146.33

Service Code	EAPG 00861
Min. Negotiated Rate	$70.97
Max. Negotiated Rate	$146.33
Rate for Payer: Anthem Medicaid	$70.97
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$146.33
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.97
Rate for Payer: Dean Health Medicaid	$70.97
Rate for Payer: Independent Care Health Plan Medicaid	$70.97
Rate for Payer: Managed Health Services Medicaid	$73.81
Rate for Payer: Molina Healthcare Medicaid	$146.33
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.97
Rate for Payer: United Healthcare Medicaid	$70.97
Rate for Payer: WMAP Medicaid	$70.97

EAPG 867: ENCOUNTERS FOR CONTACT WITH HEALTH SERVICES

Facility OP

$54.32

Service Code	EAPG 00867
Min. Negotiated Rate	$52.23
Max. Negotiated Rate	$54.32
Rate for Payer: Anthem Medicaid	$52.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$52.23
Rate for Payer: Dean Health Medicaid	$52.23
Rate for Payer: Independent Care Health Plan Medicaid	$52.23
Rate for Payer: Managed Health Services Medicaid	$54.32
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$52.23
Rate for Payer: United Healthcare Medicaid	$52.23
Rate for Payer: WMAP Medicaid	$52.23

EAPG 869: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE INJURIES

Facility OP

$56.85

Service Code	EAPG 00869
Min. Negotiated Rate	$54.66
Max. Negotiated Rate	$56.85
Rate for Payer: Anthem Medicaid	$54.66
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.66
Rate for Payer: Dean Health Medicaid	$54.66
Rate for Payer: Independent Care Health Plan Medicaid	$54.66
Rate for Payer: Managed Health Services Medicaid	$56.85
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.66
Rate for Payer: United Healthcare Medicaid	$54.66
Rate for Payer: WMAP Medicaid	$54.66

EAPG 86: PACEMAKER AND OTHER CARDIOVASCULAR DEVICE INSERTION AND REPLACEMENT

Facility OP

$6,357.58

Service Code	EAPG 00086
Min. Negotiated Rate	$3,269.41
Max. Negotiated Rate	$6,357.58
Rate for Payer: Anthem Medicaid	$3,269.41
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$6,357.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$3,269.41
Rate for Payer: Dean Health Medicaid	$3,269.41
Rate for Payer: Independent Care Health Plan Medicaid	$3,269.41
Rate for Payer: Managed Health Services Medicaid	$3,400.19
Rate for Payer: Molina Healthcare Medicaid	$6,357.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$3,269.41
Rate for Payer: United Healthcare Medicaid	$3,269.41
Rate for Payer: WMAP Medicaid	$3,269.41

EAPG 870: REHABILITATION

Facility OP

$76.86

Service Code	EAPG 00870
Min. Negotiated Rate	$57.19
Max. Negotiated Rate	$76.86
Rate for Payer: Anthem Medicaid	$57.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$76.86
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$57.19
Rate for Payer: Dean Health Medicaid	$57.19
Rate for Payer: Independent Care Health Plan Medicaid	$57.19
Rate for Payer: Managed Health Services Medicaid	$59.48
Rate for Payer: Molina Healthcare Medicaid	$76.86
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$57.19
Rate for Payer: United Healthcare Medicaid	$57.19
Rate for Payer: WMAP Medicaid	$57.19

EAPG 871: SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS

Facility OP

$111.11

Service Code	EAPG 00871
Min. Negotiated Rate	$71.32
Max. Negotiated Rate	$111.11
Rate for Payer: Anthem Medicaid	$71.32
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$111.11
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$71.32
Rate for Payer: Dean Health Medicaid	$71.32
Rate for Payer: Independent Care Health Plan Medicaid	$71.32
Rate for Payer: Managed Health Services Medicaid	$74.17
Rate for Payer: Molina Healthcare Medicaid	$111.11
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$71.32
Rate for Payer: United Healthcare Medicaid	$71.32
Rate for Payer: WMAP Medicaid	$71.32

EAPG 872: OTHER AFTERCARE AND CONVALESCENCE

Facility OP

$87.43

Service Code	EAPG 00872
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$87.43
Rate for Payer: Anthem Medicaid	$68.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$87.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$68.25
Rate for Payer: Dean Health Medicaid	$68.25
Rate for Payer: Independent Care Health Plan Medicaid	$68.25
Rate for Payer: Managed Health Services Medicaid	$70.98
Rate for Payer: Molina Healthcare Medicaid	$87.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$68.25
Rate for Payer: United Healthcare Medicaid	$68.25
Rate for Payer: WMAP Medicaid	$68.25

EAPG 873: NEONATAL AFTERCARE

Facility OP

$88.50

Service Code	EAPG 00873
Min. Negotiated Rate	$45.97
Max. Negotiated Rate	$88.50
Rate for Payer: Anthem Medicaid	$45.97
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$88.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$45.97
Rate for Payer: Dean Health Medicaid	$45.97
Rate for Payer: Independent Care Health Plan Medicaid	$45.97
Rate for Payer: Managed Health Services Medicaid	$47.81
Rate for Payer: Molina Healthcare Medicaid	$88.50
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$45.97
Rate for Payer: United Healthcare Medicaid	$45.97
Rate for Payer: WMAP Medicaid	$45.97

EAPG 874: AFTERCARE FOR JOINT REPLACEMENT

Facility OP

$96.53

Service Code	EAPG 00874
Min. Negotiated Rate	$51.14
Max. Negotiated Rate	$96.53
Rate for Payer: Anthem Medicaid	$51.14
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$96.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$51.14
Rate for Payer: Dean Health Medicaid	$51.14
Rate for Payer: Independent Care Health Plan Medicaid	$51.14
Rate for Payer: Managed Health Services Medicaid	$53.19
Rate for Payer: Molina Healthcare Medicaid	$96.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$51.14
Rate for Payer: United Healthcare Medicaid	$51.14
Rate for Payer: WMAP Medicaid	$51.14

EAPG 875: CONTRACEPTIVE MANAGEMENT

Facility OP

$118.40

Service Code	EAPG 00875
Min. Negotiated Rate	$68.98
Max. Negotiated Rate	$118.40
Rate for Payer: Anthem Medicaid	$68.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$118.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$68.98
Rate for Payer: Dean Health Medicaid	$68.98
Rate for Payer: Independent Care Health Plan Medicaid	$68.98
Rate for Payer: Managed Health Services Medicaid	$71.74
Rate for Payer: Molina Healthcare Medicaid	$118.40
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$68.98
Rate for Payer: United Healthcare Medicaid	$68.98
Rate for Payer: WMAP Medicaid	$68.98

EAPG 876: ADULT PREVENTIVE MEDICINE

Facility OP

$120.50

Service Code	EAPG 00876
Min. Negotiated Rate	$62.47
Max. Negotiated Rate	$120.50
Rate for Payer: Anthem Medicaid	$62.47
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$120.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$62.47
Rate for Payer: Dean Health Medicaid	$62.47
Rate for Payer: Independent Care Health Plan Medicaid	$62.47
Rate for Payer: Managed Health Services Medicaid	$64.97
Rate for Payer: Molina Healthcare Medicaid	$120.50
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$62.47
Rate for Payer: United Healthcare Medicaid	$62.47
Rate for Payer: WMAP Medicaid	$62.47

EAPG 877: CHILD PREVENTIVE MEDICINE

Facility OP

$96.28

Service Code	EAPG 00877
Min. Negotiated Rate	$54.27
Max. Negotiated Rate	$96.28
Rate for Payer: Anthem Medicaid	$54.27
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$96.28
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.27
Rate for Payer: Dean Health Medicaid	$54.27
Rate for Payer: Independent Care Health Plan Medicaid	$54.27
Rate for Payer: Managed Health Services Medicaid	$56.44
Rate for Payer: Molina Healthcare Medicaid	$96.28
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.27
Rate for Payer: United Healthcare Medicaid	$54.27
Rate for Payer: WMAP Medicaid	$54.27

EAPG 878: GYNECOLOGIC PREVENTIVE MEDICINE

Facility OP

$100.73

Service Code	EAPG 00878
Min. Negotiated Rate	$46.30
Max. Negotiated Rate	$100.73
Rate for Payer: Anthem Medicaid	$46.30
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$100.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$46.30
Rate for Payer: Dean Health Medicaid	$46.30
Rate for Payer: Independent Care Health Plan Medicaid	$46.30
Rate for Payer: Managed Health Services Medicaid	$48.15
Rate for Payer: Molina Healthcare Medicaid	$100.73
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$46.30
Rate for Payer: United Healthcare Medicaid	$46.30
Rate for Payer: WMAP Medicaid	$46.30

EAPG 879: PREVENTIVE OR SCREENING ENCOUNTER

Facility OP

$111.69

Service Code	EAPG 00879
Min. Negotiated Rate	$63.56
Max. Negotiated Rate	$111.69
Rate for Payer: Anthem Medicaid	$63.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$111.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$63.56
Rate for Payer: Dean Health Medicaid	$63.56
Rate for Payer: Independent Care Health Plan Medicaid	$63.56
Rate for Payer: Managed Health Services Medicaid	$66.10
Rate for Payer: Molina Healthcare Medicaid	$111.69
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$63.56
Rate for Payer: United Healthcare Medicaid	$63.56
Rate for Payer: WMAP Medicaid	$63.56

EAPG 87: REMOVAL OR REVISION OF PACEMAKERS AND OTHER CARDIOVASCULAR DEVICES

Facility OP

$4,601.50

Service Code	EAPG 00087
Min. Negotiated Rate	$3,002.17
Max. Negotiated Rate	$4,601.50
Rate for Payer: Anthem Medicaid	$3,002.17
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$4,601.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$3,002.17
Rate for Payer: Dean Health Medicaid	$3,002.17
Rate for Payer: Independent Care Health Plan Medicaid	$3,002.17
Rate for Payer: Managed Health Services Medicaid	$3,122.26
Rate for Payer: Molina Healthcare Medicaid	$4,601.50
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$3,002.17
Rate for Payer: United Healthcare Medicaid	$3,002.17
Rate for Payer: WMAP Medicaid	$3,002.17

EAPG 880: HIV INFECTION

Facility OP

$123.53

Service Code	EAPG 00880
Min. Negotiated Rate	$98.51
Max. Negotiated Rate	$123.53
Rate for Payer: Anthem Medicaid	$98.51
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$123.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$98.51
Rate for Payer: Dean Health Medicaid	$98.51
Rate for Payer: Independent Care Health Plan Medicaid	$98.51
Rate for Payer: Managed Health Services Medicaid	$102.45
Rate for Payer: Molina Healthcare Medicaid	$123.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$98.51
Rate for Payer: United Healthcare Medicaid	$98.51
Rate for Payer: WMAP Medicaid	$98.51

EAPG 881: AIDS

Facility OP

$136.30

Service Code	EAPG 00881
Min. Negotiated Rate	$100.96
Max. Negotiated Rate	$136.30
Rate for Payer: Anthem Medicaid	$100.96
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$136.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$100.96
Rate for Payer: Dean Health Medicaid	$100.96
Rate for Payer: Independent Care Health Plan Medicaid	$100.96
Rate for Payer: Managed Health Services Medicaid	$105.00
Rate for Payer: Molina Healthcare Medicaid	$136.30
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$100.96
Rate for Payer: United Healthcare Medicaid	$100.96
Rate for Payer: WMAP Medicaid	$100.96

EAPG 882: GENETIC COUNSELING

Facility OP

$150.49

Service Code	EAPG 00882
Min. Negotiated Rate	$65.69
Max. Negotiated Rate	$150.49
Rate for Payer: Anthem Medicaid	$65.69
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$150.49
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$65.69
Rate for Payer: Dean Health Medicaid	$65.69
Rate for Payer: Independent Care Health Plan Medicaid	$65.69
Rate for Payer: Managed Health Services Medicaid	$68.32
Rate for Payer: Molina Healthcare Medicaid	$150.49
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$65.69
Rate for Payer: United Healthcare Medicaid	$65.69
Rate for Payer: WMAP Medicaid	$65.69

EAPG 883: ALTERATION IN CONSCIOUSNESS

Facility OP

$137.81

Service Code	EAPG 00883
Min. Negotiated Rate	$132.51
Max. Negotiated Rate	$137.81
Rate for Payer: Anthem Medicaid	$132.51
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$132.51
Rate for Payer: Dean Health Medicaid	$132.51
Rate for Payer: Independent Care Health Plan Medicaid	$132.51
Rate for Payer: Managed Health Services Medicaid	$137.81
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$132.51
Rate for Payer: United Healthcare Medicaid	$132.51
Rate for Payer: WMAP Medicaid	$132.51

EAPG 900: AUTOPSY AND POST-MORTEM EXAMINATION SERVICES

Facility OP

$50.55

Service Code	EAPG 00900
Min. Negotiated Rate	$48.61
Max. Negotiated Rate	$50.55
Rate for Payer: Anthem Medicaid	$48.61
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$48.61
Rate for Payer: Dean Health Medicaid	$48.61
Rate for Payer: Independent Care Health Plan Medicaid	$48.61
Rate for Payer: Managed Health Services Medicaid	$50.55
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$48.61
Rate for Payer: United Healthcare Medicaid	$48.61
Rate for Payer: WMAP Medicaid	$48.61

EAPG 90: LEVEL I VARICOSE VEIN AND RELATED PROCEDURES

Facility OP

$693.60

Service Code	EAPG 00090
Min. Negotiated Rate	$263.87
Max. Negotiated Rate	$693.60
Rate for Payer: Anthem Medicaid	$263.87
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$693.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$263.87
Rate for Payer: Dean Health Medicaid	$263.87
Rate for Payer: Independent Care Health Plan Medicaid	$263.87
Rate for Payer: Managed Health Services Medicaid	$274.42
Rate for Payer: Molina Healthcare Medicaid	$693.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$263.87
Rate for Payer: United Healthcare Medicaid	$263.87
Rate for Payer: WMAP Medicaid	$263.87

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