Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 307: INSERTION OR REMOVAL OF DRUG DELIVERY DEVICE

Facility

$138.35

Service Code	EAPG 00307
Min. Negotiated Rate	$133.03
Max. Negotiated Rate	$138.35
Rate for Payer: Anthem Medicaid	$133.03
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$133.03
Rate for Payer: Dean Health Medicaid	$133.03
Rate for Payer: Independent Care Health Plan Medicaid	$133.03
Rate for Payer: Managed Health Services Medicaid	$138.35
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$133.03
Rate for Payer: United Healthcare Medicaid	$133.03
Rate for Payer: WMAP Medicaid	$133.03

EAPG 308: LEVEL III PATHOLOGY TESTS

Facility

$63.87

Service Code	EAPG 00308
Min. Negotiated Rate	$61.41
Max. Negotiated Rate	$63.87
Rate for Payer: Anthem Medicaid	$61.41
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$61.41
Rate for Payer: Dean Health Medicaid	$61.41
Rate for Payer: Independent Care Health Plan Medicaid	$61.41
Rate for Payer: Managed Health Services Medicaid	$63.87
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$61.41
Rate for Payer: United Healthcare Medicaid	$61.41
Rate for Payer: WMAP Medicaid	$61.41

EAPG 309: ADAPTIVE BEHAVIORAL HEALTH TREATMENT SERVICES

Facility

$18.78

Service Code	EAPG 00309
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$18.78
Rate for Payer: Anthem Medicaid	$18.06
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$18.06
Rate for Payer: Dean Health Medicaid	$18.06
Rate for Payer: Independent Care Health Plan Medicaid	$18.06
Rate for Payer: Managed Health Services Medicaid	$18.78
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$18.06
Rate for Payer: United Healthcare Medicaid	$18.06
Rate for Payer: WMAP Medicaid	$18.06

EAPG 310: DEVELOPMENTAL AND NEUROPSYCHOLOGICAL TESTING

Facility

$635.03

Service Code	EAPG 00310
Min. Negotiated Rate	$242.61
Max. Negotiated Rate	$635.03
Rate for Payer: Anthem Medicaid	$242.61
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$635.03
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$242.61
Rate for Payer: Dean Health Medicaid	$242.61
Rate for Payer: Independent Care Health Plan Medicaid	$242.61
Rate for Payer: Managed Health Services Medicaid	$252.31
Rate for Payer: Molina Healthcare Medicaid	$635.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$242.61
Rate for Payer: United Healthcare Medicaid	$242.61
Rate for Payer: WMAP Medicaid	$242.61

EAPG 312: BEHAVIORAL AND SUBSTANCE ABUSE PARTIAL HOSPITALIZATION PROGRAM

Facility

$305.73

Service Code	EAPG 00312
Min. Negotiated Rate	$147.73
Max. Negotiated Rate	$305.73
Rate for Payer: Anthem Medicaid	$147.73
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$305.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$147.73
Rate for Payer: Dean Health Medicaid	$147.73
Rate for Payer: Independent Care Health Plan Medicaid	$147.73
Rate for Payer: Managed Health Services Medicaid	$153.64
Rate for Payer: Molina Healthcare Medicaid	$305.73
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$147.73
Rate for Payer: United Healthcare Medicaid	$147.73
Rate for Payer: WMAP Medicaid	$147.73

EAPG 315: COUNSELING OR INDIVIDUAL BRIEF PSYCHOTHERAPY

Facility

$116.98

Service Code	EAPG 00315
Min. Negotiated Rate	$53.74
Max. Negotiated Rate	$116.98
Rate for Payer: Anthem Medicaid	$53.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$116.98
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$53.74
Rate for Payer: Dean Health Medicaid	$53.74
Rate for Payer: Independent Care Health Plan Medicaid	$53.74
Rate for Payer: Managed Health Services Medicaid	$55.89
Rate for Payer: Molina Healthcare Medicaid	$116.98
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$53.74
Rate for Payer: United Healthcare Medicaid	$53.74
Rate for Payer: WMAP Medicaid	$53.74

EAPG 316: INDIVIDUAL COMPREHENSIVE PSYCHOTHERAPY

Facility

$117.17

Service Code	EAPG 00316
Min. Negotiated Rate	$64.21
Max. Negotiated Rate	$117.17
Rate for Payer: Anthem Medicaid	$64.21
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$117.17
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$64.21
Rate for Payer: Dean Health Medicaid	$64.21
Rate for Payer: Independent Care Health Plan Medicaid	$64.21
Rate for Payer: Managed Health Services Medicaid	$66.78
Rate for Payer: Molina Healthcare Medicaid	$117.17
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$64.21
Rate for Payer: United Healthcare Medicaid	$64.21
Rate for Payer: WMAP Medicaid	$64.21

EAPG 317: FAMILY PSYCHOTHERAPY

Facility

$123.53

Service Code	EAPG 00317
Min. Negotiated Rate	$70.03
Max. Negotiated Rate	$123.53
Rate for Payer: Anthem Medicaid	$70.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$123.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.03
Rate for Payer: Dean Health Medicaid	$70.03
Rate for Payer: Independent Care Health Plan Medicaid	$70.03
Rate for Payer: Managed Health Services Medicaid	$72.83
Rate for Payer: Molina Healthcare Medicaid	$123.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.03
Rate for Payer: United Healthcare Medicaid	$70.03
Rate for Payer: WMAP Medicaid	$70.03

EAPG 318: GROUP PSYCHOTHERAPY

Facility

$166.15

Service Code	EAPG 00318
Min. Negotiated Rate	$97.88
Max. Negotiated Rate	$166.15
Rate for Payer: Anthem Medicaid	$97.88
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$166.15
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$97.88
Rate for Payer: Dean Health Medicaid	$97.88
Rate for Payer: Independent Care Health Plan Medicaid	$97.88
Rate for Payer: Managed Health Services Medicaid	$101.80
Rate for Payer: Molina Healthcare Medicaid	$166.15
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$97.88
Rate for Payer: United Healthcare Medicaid	$97.88
Rate for Payer: WMAP Medicaid	$97.88

EAPG 319: ACTIVITY THERAPY

Facility

$66.73

Service Code	EAPG 00319
Min. Negotiated Rate	$64.03
Max. Negotiated Rate	$66.73
Rate for Payer: Anthem Medicaid	$64.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$66.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$64.03
Rate for Payer: Dean Health Medicaid	$64.03
Rate for Payer: Independent Care Health Plan Medicaid	$64.03
Rate for Payer: Managed Health Services Medicaid	$66.59
Rate for Payer: Molina Healthcare Medicaid	$66.73
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$64.03
Rate for Payer: United Healthcare Medicaid	$64.03
Rate for Payer: WMAP Medicaid	$64.03

EAPG 320: BEHAVIORAL HEALTH - CASE MANAGEMENT AND TREATMENT PLAN DEVELOPMENT

Facility

$130.92

Service Code	EAPG 00320
Min. Negotiated Rate	$41.15
Max. Negotiated Rate	$130.92
Rate for Payer: Anthem Medicaid	$41.15
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$130.92
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$41.15
Rate for Payer: Dean Health Medicaid	$41.15
Rate for Payer: Independent Care Health Plan Medicaid	$41.15
Rate for Payer: Managed Health Services Medicaid	$42.80
Rate for Payer: Molina Healthcare Medicaid	$130.92
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$41.15
Rate for Payer: United Healthcare Medicaid	$41.15
Rate for Payer: WMAP Medicaid	$41.15

EAPG 321: CRISIS INTERVENTION

Facility

$188.06

Service Code	EAPG 00321
Min. Negotiated Rate	$76.58
Max. Negotiated Rate	$188.06
Rate for Payer: Anthem Medicaid	$76.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$188.06
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$76.58
Rate for Payer: Dean Health Medicaid	$76.58
Rate for Payer: Independent Care Health Plan Medicaid	$76.58
Rate for Payer: Managed Health Services Medicaid	$79.64
Rate for Payer: Molina Healthcare Medicaid	$188.06
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$76.58
Rate for Payer: United Healthcare Medicaid	$76.58
Rate for Payer: WMAP Medicaid	$76.58

EAPG 322: MEDICATION ADMINISTRATION AND OBSERVATION

Facility

$111.06

Service Code	EAPG 00322
Min. Negotiated Rate	$18.03
Max. Negotiated Rate	$111.06
Rate for Payer: Anthem Medicaid	$18.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$111.06
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$18.03
Rate for Payer: Dean Health Medicaid	$18.03
Rate for Payer: Independent Care Health Plan Medicaid	$18.03
Rate for Payer: Managed Health Services Medicaid	$18.75
Rate for Payer: Molina Healthcare Medicaid	$111.06
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$18.03
Rate for Payer: United Healthcare Medicaid	$18.03
Rate for Payer: WMAP Medicaid	$18.03

EAPG 323: BEHAVIORAL HEALTH ASSESSMENT

Facility

$217.42

Service Code	EAPG 00323
Min. Negotiated Rate	$103.19
Max. Negotiated Rate	$217.42
Rate for Payer: Anthem Medicaid	$103.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$217.42
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$103.19
Rate for Payer: Dean Health Medicaid	$103.19
Rate for Payer: Independent Care Health Plan Medicaid	$103.19
Rate for Payer: Managed Health Services Medicaid	$107.32
Rate for Payer: Molina Healthcare Medicaid	$217.42
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$103.19
Rate for Payer: United Healthcare Medicaid	$103.19
Rate for Payer: WMAP Medicaid	$103.19

EAPG 324: SCREENING FOR BEHAVIORAL CHANGE OR RISK ASSESSMENT

Facility

$97.26

Service Code	EAPG 00324
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$97.26
Rate for Payer: Anthem Medicaid	$9.59
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$97.26
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$9.59
Rate for Payer: Dean Health Medicaid	$9.59
Rate for Payer: Independent Care Health Plan Medicaid	$9.59
Rate for Payer: Managed Health Services Medicaid	$9.97
Rate for Payer: Molina Healthcare Medicaid	$97.26
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$9.59
Rate for Payer: United Healthcare Medicaid	$9.59
Rate for Payer: WMAP Medicaid	$9.59

EAPG 325: PREVENTION COUNSELING

Facility

$31.21

Service Code	EAPG 00325
Min. Negotiated Rate	$30.01
Max. Negotiated Rate	$31.21
Rate for Payer: Anthem Medicaid	$30.01
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$30.01
Rate for Payer: Dean Health Medicaid	$30.01
Rate for Payer: Independent Care Health Plan Medicaid	$30.01
Rate for Payer: Managed Health Services Medicaid	$31.21
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$30.01
Rate for Payer: United Healthcare Medicaid	$30.01
Rate for Payer: WMAP Medicaid	$30.01

EAPG 327: INTENSIVE OUTPATIENT PSYCHIATRIC TREATMENT

Facility

$471.04

Service Code	EAPG 00327
Min. Negotiated Rate	$144.09
Max. Negotiated Rate	$471.04
Rate for Payer: Anthem Medicaid	$144.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$471.04
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$144.09
Rate for Payer: Dean Health Medicaid	$144.09
Rate for Payer: Independent Care Health Plan Medicaid	$144.09
Rate for Payer: Managed Health Services Medicaid	$149.85
Rate for Payer: Molina Healthcare Medicaid	$471.04
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$144.09
Rate for Payer: United Healthcare Medicaid	$144.09
Rate for Payer: WMAP Medicaid	$144.09

EAPG 328: DAY REHABILITATION, HALF DAY

Facility

$231.36

Service Code	EAPG 00328
Min. Negotiated Rate	$130.39
Max. Negotiated Rate	$231.36
Rate for Payer: Anthem Medicaid	$130.39
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$231.36
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$130.39
Rate for Payer: Dean Health Medicaid	$130.39
Rate for Payer: Independent Care Health Plan Medicaid	$130.39
Rate for Payer: Managed Health Services Medicaid	$135.61
Rate for Payer: Molina Healthcare Medicaid	$231.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$130.39
Rate for Payer: United Healthcare Medicaid	$130.39
Rate for Payer: WMAP Medicaid	$130.39

EAPG 329: DAY REHABILITATION, FULL DAY

Facility

$382.98

Service Code	EAPG 00329
Min. Negotiated Rate	$194.27
Max. Negotiated Rate	$382.98
Rate for Payer: Anthem Medicaid	$194.27
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$382.98
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$194.27
Rate for Payer: Dean Health Medicaid	$194.27
Rate for Payer: Independent Care Health Plan Medicaid	$194.27
Rate for Payer: Managed Health Services Medicaid	$202.04
Rate for Payer: Molina Healthcare Medicaid	$382.98
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$194.27
Rate for Payer: United Healthcare Medicaid	$194.27
Rate for Payer: WMAP Medicaid	$194.27

EAPG 331: LEVEL I DIAGNOSTIC NUCLEAR MEDICINE

Facility

$332.59

Service Code	EAPG 00331
Min. Negotiated Rate	$152.70
Max. Negotiated Rate	$332.59
Rate for Payer: Anthem Medicaid	$152.70
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$332.59
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$152.70
Rate for Payer: Dean Health Medicaid	$152.70
Rate for Payer: Independent Care Health Plan Medicaid	$152.70
Rate for Payer: Managed Health Services Medicaid	$158.81
Rate for Payer: Molina Healthcare Medicaid	$332.59
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$152.70
Rate for Payer: United Healthcare Medicaid	$152.70
Rate for Payer: WMAP Medicaid	$152.70

EAPG 332: LEVEL II DIAGNOSTIC NUCLEAR MEDICINE

Facility

$728.18

Service Code	EAPG 00332
Min. Negotiated Rate	$365.71
Max. Negotiated Rate	$728.18
Rate for Payer: Anthem Medicaid	$365.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$728.18
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$365.71
Rate for Payer: Dean Health Medicaid	$365.71
Rate for Payer: Independent Care Health Plan Medicaid	$365.71
Rate for Payer: Managed Health Services Medicaid	$380.34
Rate for Payer: Molina Healthcare Medicaid	$728.18
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$365.71
Rate for Payer: United Healthcare Medicaid	$365.71
Rate for Payer: WMAP Medicaid	$365.71

EAPG 333: BEHAVIORAL HEALTH RESIDENTIAL TREATMENT

Facility

$224.48

Service Code	EAPG 00333
Min. Negotiated Rate	$215.85
Max. Negotiated Rate	$224.48
Rate for Payer: Anthem Medicaid	$215.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$215.85
Rate for Payer: Dean Health Medicaid	$215.85
Rate for Payer: Independent Care Health Plan Medicaid	$215.85
Rate for Payer: Managed Health Services Medicaid	$224.48
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$215.85
Rate for Payer: United Healthcare Medicaid	$215.85
Rate for Payer: WMAP Medicaid	$215.85

EAPG 335: CLASS I BRACHYTHERAPY SOURCES

Facility

$110.52

Service Code	EAPG 00335
Min. Negotiated Rate	$106.27
Max. Negotiated Rate	$110.52
Rate for Payer: Anthem Medicaid	$106.27
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$106.27
Rate for Payer: Dean Health Medicaid	$106.27
Rate for Payer: Independent Care Health Plan Medicaid	$106.27
Rate for Payer: Managed Health Services Medicaid	$110.52
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$106.27
Rate for Payer: United Healthcare Medicaid	$106.27
Rate for Payer: WMAP Medicaid	$106.27

EAPG 336: CLASS II BRACHYTHERAPY SOURCES

Facility

$1,458.40

Service Code	EAPG 00336
Min. Negotiated Rate	$1,402.31
Max. Negotiated Rate	$1,458.40
Rate for Payer: Anthem Medicaid	$1,402.31
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,402.31
Rate for Payer: Dean Health Medicaid	$1,402.31
Rate for Payer: Independent Care Health Plan Medicaid	$1,402.31
Rate for Payer: Managed Health Services Medicaid	$1,458.40
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,402.31
Rate for Payer: United Healthcare Medicaid	$1,402.31
Rate for Payer: WMAP Medicaid	$1,402.31

EAPG 337: CLASS III BRACHYTHERAPY SOURCES

Facility

$4,841.37

Service Code	EAPG 00337
Min. Negotiated Rate	$4,655.16
Max. Negotiated Rate	$4,841.37
Rate for Payer: Anthem Medicaid	$4,655.16
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4,655.16
Rate for Payer: Dean Health Medicaid	$4,655.16
Rate for Payer: Independent Care Health Plan Medicaid	$4,655.16
Rate for Payer: Managed Health Services Medicaid	$4,841.37
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4,655.16
Rate for Payer: United Healthcare Medicaid	$4,655.16
Rate for Payer: WMAP Medicaid	$4,655.16

Know your out-of-pocket cost for care.

All Charges