Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 392: PAP SMEARS

Facility

$18.44

Service Code	EAPG 00392
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$18.44
Rate for Payer: Anthem Medicaid	$6.89
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$18.44
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$6.89
Rate for Payer: Dean Health Medicaid	$6.89
Rate for Payer: Independent Care Health Plan Medicaid	$6.89
Rate for Payer: Managed Health Services Medicaid	$7.17
Rate for Payer: Molina Healthcare Medicaid	$18.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$6.89
Rate for Payer: United Healthcare Medicaid	$6.89
Rate for Payer: WMAP Medicaid	$6.89

EAPG 393: LEVEL II BLOOD AND TISSUE TYPING TESTS

Facility

$32.19

Service Code	EAPG 00393
Min. Negotiated Rate	$21.04
Max. Negotiated Rate	$32.19
Rate for Payer: Anthem Medicaid	$21.04
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$32.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$21.04
Rate for Payer: Dean Health Medicaid	$21.04
Rate for Payer: Independent Care Health Plan Medicaid	$21.04
Rate for Payer: Managed Health Services Medicaid	$21.88
Rate for Payer: Molina Healthcare Medicaid	$32.19
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$21.04
Rate for Payer: United Healthcare Medicaid	$21.04
Rate for Payer: WMAP Medicaid	$21.04

EAPG 394: LEVEL I IMMUNOLOGY TESTS

Facility

$7.97

Service Code	EAPG 00394
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$7.97
Rate for Payer: Anthem Medicaid	$3.89
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$7.97
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$3.89
Rate for Payer: Dean Health Medicaid	$3.89
Rate for Payer: Independent Care Health Plan Medicaid	$3.89
Rate for Payer: Managed Health Services Medicaid	$4.05
Rate for Payer: Molina Healthcare Medicaid	$7.97
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$3.89
Rate for Payer: United Healthcare Medicaid	$3.89
Rate for Payer: WMAP Medicaid	$3.89

EAPG 395: LEVEL II IMMUNOLOGY TESTS

Facility

$14.30

Service Code	EAPG 00395
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$14.30
Rate for Payer: Anthem Medicaid	$13.75
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$13.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$13.75
Rate for Payer: Dean Health Medicaid	$13.75
Rate for Payer: Independent Care Health Plan Medicaid	$13.75
Rate for Payer: Managed Health Services Medicaid	$14.30
Rate for Payer: Molina Healthcare Medicaid	$13.75
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$13.75
Rate for Payer: United Healthcare Medicaid	$13.75
Rate for Payer: WMAP Medicaid	$13.75

EAPG 396: LEVEL I MICROBIOLOGY TESTS

Facility

$6.36

Service Code	EAPG 00396
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$6.36
Rate for Payer: Anthem Medicaid	$3.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$6.36
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$3.56
Rate for Payer: Dean Health Medicaid	$3.56
Rate for Payer: Independent Care Health Plan Medicaid	$3.56
Rate for Payer: Managed Health Services Medicaid	$3.70
Rate for Payer: Molina Healthcare Medicaid	$6.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$3.56
Rate for Payer: United Healthcare Medicaid	$3.56
Rate for Payer: WMAP Medicaid	$3.56

EAPG 397: LEVEL II MICROBIOLOGY TESTS

Facility

$21.14

Service Code	EAPG 00397
Min. Negotiated Rate	$14.44
Max. Negotiated Rate	$21.14
Rate for Payer: Anthem Medicaid	$14.44
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$21.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$14.44
Rate for Payer: Dean Health Medicaid	$14.44
Rate for Payer: Independent Care Health Plan Medicaid	$14.44
Rate for Payer: Managed Health Services Medicaid	$15.02
Rate for Payer: Molina Healthcare Medicaid	$21.14
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$14.44
Rate for Payer: United Healthcare Medicaid	$14.44
Rate for Payer: WMAP Medicaid	$14.44

EAPG 398: LEVEL I ENDOCRINOLOGY TESTS

Facility

$11.99

Service Code	EAPG 00398
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$11.99
Rate for Payer: Anthem Medicaid	$4.47
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$11.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4.47
Rate for Payer: Dean Health Medicaid	$4.47
Rate for Payer: Independent Care Health Plan Medicaid	$4.47
Rate for Payer: Managed Health Services Medicaid	$4.65
Rate for Payer: Molina Healthcare Medicaid	$11.99
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4.47
Rate for Payer: United Healthcare Medicaid	$4.47
Rate for Payer: WMAP Medicaid	$4.47

EAPG 399: LEVEL II ENDOCRINOLOGY TESTS

Facility

$20.84

Service Code	EAPG 00399
Min. Negotiated Rate	$11.78
Max. Negotiated Rate	$20.84
Rate for Payer: Anthem Medicaid	$11.78
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$20.84
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$11.78
Rate for Payer: Dean Health Medicaid	$11.78
Rate for Payer: Independent Care Health Plan Medicaid	$11.78
Rate for Payer: Managed Health Services Medicaid	$12.25
Rate for Payer: Molina Healthcare Medicaid	$20.84
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$11.78
Rate for Payer: United Healthcare Medicaid	$11.78
Rate for Payer: WMAP Medicaid	$11.78

EAPG 39: CAST APPLICATION OR REPLACEMENT

Facility

$256.95

Service Code	EAPG 00039
Min. Negotiated Rate	$74.71
Max. Negotiated Rate	$256.95
Rate for Payer: Anthem Medicaid	$74.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$256.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$74.71
Rate for Payer: Dean Health Medicaid	$74.71
Rate for Payer: Independent Care Health Plan Medicaid	$74.71
Rate for Payer: Managed Health Services Medicaid	$77.70
Rate for Payer: Molina Healthcare Medicaid	$256.95
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$74.71
Rate for Payer: United Healthcare Medicaid	$74.71
Rate for Payer: WMAP Medicaid	$74.71

EAPG 3: LEVEL I SKIN INCISION AND DRAINAGE, DEBRIDEMENT, DESTRUCTION, OTHER RELATED PX

Facility

$237.48

Service Code	EAPG 00003
Min. Negotiated Rate	$68.59
Max. Negotiated Rate	$237.48
Rate for Payer: Anthem Medicaid	$68.59
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$237.48
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$68.59
Rate for Payer: Dean Health Medicaid	$68.59
Rate for Payer: Independent Care Health Plan Medicaid	$68.59
Rate for Payer: Managed Health Services Medicaid	$71.33
Rate for Payer: Molina Healthcare Medicaid	$237.48
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$68.59
Rate for Payer: United Healthcare Medicaid	$68.59
Rate for Payer: WMAP Medicaid	$68.59

EAPG 4001: EMERGING TECHNOLOGY PROCEDURES

Facility

$295.94

Service Code	EAPG 04001
Min. Negotiated Rate	$284.56
Max. Negotiated Rate	$295.94
Rate for Payer: Anthem Medicaid	$284.56
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$284.56
Rate for Payer: Dean Health Medicaid	$284.56
Rate for Payer: Independent Care Health Plan Medicaid	$284.56
Rate for Payer: Managed Health Services Medicaid	$295.94
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$284.56
Rate for Payer: United Healthcare Medicaid	$284.56
Rate for Payer: WMAP Medicaid	$284.56

EAPG 400: LEVEL I CHEMISTRY TESTS

Facility

$8.90

Service Code	EAPG 00400
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$8.90
Rate for Payer: Anthem Medicaid	$4.04
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$8.90
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4.04
Rate for Payer: Dean Health Medicaid	$4.04
Rate for Payer: Independent Care Health Plan Medicaid	$4.04
Rate for Payer: Managed Health Services Medicaid	$4.20
Rate for Payer: Molina Healthcare Medicaid	$8.90
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4.04
Rate for Payer: United Healthcare Medicaid	$4.04
Rate for Payer: WMAP Medicaid	$4.04

EAPG 4010: LEVEL I OPIOID TREATMENT PROGRAM SERVICES

Facility

$72.78

Service Code	EAPG 04010
Min. Negotiated Rate	$69.98
Max. Negotiated Rate	$72.78
Rate for Payer: Anthem Medicaid	$69.98
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$69.98
Rate for Payer: Dean Health Medicaid	$69.98
Rate for Payer: Independent Care Health Plan Medicaid	$69.98
Rate for Payer: Managed Health Services Medicaid	$72.78
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$69.98
Rate for Payer: United Healthcare Medicaid	$69.98
Rate for Payer: WMAP Medicaid	$69.98

EAPG 4011: LEVEL II OPIOID TREATMENT PROGRAM SERVICES

Facility

$161.23

Service Code	EAPG 04011
Min. Negotiated Rate	$155.03
Max. Negotiated Rate	$161.23
Rate for Payer: Anthem Medicaid	$155.03
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$155.03
Rate for Payer: Dean Health Medicaid	$155.03
Rate for Payer: Independent Care Health Plan Medicaid	$155.03
Rate for Payer: Managed Health Services Medicaid	$161.23
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$155.03
Rate for Payer: United Healthcare Medicaid	$155.03
Rate for Payer: WMAP Medicaid	$155.03

EAPG 401: LEVEL II CHEMISTRY TESTS

Facility

$23.97

Service Code	EAPG 00401
Min. Negotiated Rate	$9.48
Max. Negotiated Rate	$23.97
Rate for Payer: Anthem Medicaid	$9.48
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$23.97
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$9.48
Rate for Payer: Dean Health Medicaid	$9.48
Rate for Payer: Independent Care Health Plan Medicaid	$9.48
Rate for Payer: Managed Health Services Medicaid	$9.86
Rate for Payer: Molina Healthcare Medicaid	$23.97
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$9.48
Rate for Payer: United Healthcare Medicaid	$9.48
Rate for Payer: WMAP Medicaid	$9.48

EAPG 402: BASIC CHEMISTRY TESTS

Facility

$3.96

Service Code	EAPG 00402
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$3.96
Rate for Payer: Anthem Medicaid	$1.83
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1.83
Rate for Payer: Dean Health Medicaid	$1.83
Rate for Payer: Independent Care Health Plan Medicaid	$1.83
Rate for Payer: Managed Health Services Medicaid	$1.90
Rate for Payer: Molina Healthcare Medicaid	$3.96
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1.83
Rate for Payer: United Healthcare Medicaid	$1.83
Rate for Payer: WMAP Medicaid	$1.83

EAPG 403: ORGAN OR DISEASE ORIENTED PANELS

Facility

$8.12

Service Code	EAPG 00403
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$8.12
Rate for Payer: Anthem Medicaid	$3.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$8.12
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$3.05
Rate for Payer: Dean Health Medicaid	$3.05
Rate for Payer: Independent Care Health Plan Medicaid	$3.05
Rate for Payer: Managed Health Services Medicaid	$3.17
Rate for Payer: Molina Healthcare Medicaid	$8.12
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$3.05
Rate for Payer: United Healthcare Medicaid	$3.05
Rate for Payer: WMAP Medicaid	$3.05

EAPG 404: TOXICOLOGY TESTS

Facility

$10.86

Service Code	EAPG 00404
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$10.86
Rate for Payer: Anthem Medicaid	$4.14
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$10.86
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4.14
Rate for Payer: Dean Health Medicaid	$4.14
Rate for Payer: Independent Care Health Plan Medicaid	$4.14
Rate for Payer: Managed Health Services Medicaid	$4.31
Rate for Payer: Molina Healthcare Medicaid	$10.86
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4.14
Rate for Payer: United Healthcare Medicaid	$4.14
Rate for Payer: WMAP Medicaid	$4.14

EAPG 405: THERAPEUTIC DRUG MONITORING

Facility

$10.23

Service Code	EAPG 00405
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$10.23
Rate for Payer: Anthem Medicaid	$4.08
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$10.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4.08
Rate for Payer: Dean Health Medicaid	$4.08
Rate for Payer: Independent Care Health Plan Medicaid	$4.08
Rate for Payer: Managed Health Services Medicaid	$4.24
Rate for Payer: Molina Healthcare Medicaid	$10.23
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4.08
Rate for Payer: United Healthcare Medicaid	$4.08
Rate for Payer: WMAP Medicaid	$4.08

EAPG 406: LEVEL I CLOTTING TESTS

Facility

$3.23

Service Code	EAPG 00406
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$3.23
Rate for Payer: Anthem Medicaid	$1.49
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1.49
Rate for Payer: Dean Health Medicaid	$1.49
Rate for Payer: Independent Care Health Plan Medicaid	$1.49
Rate for Payer: Managed Health Services Medicaid	$1.55
Rate for Payer: Molina Healthcare Medicaid	$3.23
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1.49
Rate for Payer: United Healthcare Medicaid	$1.49
Rate for Payer: WMAP Medicaid	$1.49

EAPG 407: LEVEL II CLOTTING TESTS

Facility

$9.59

Service Code	EAPG 00407
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$9.59
Rate for Payer: Anthem Medicaid	$8.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$9.59
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$8.56
Rate for Payer: Dean Health Medicaid	$8.56
Rate for Payer: Independent Care Health Plan Medicaid	$8.56
Rate for Payer: Managed Health Services Medicaid	$8.90
Rate for Payer: Molina Healthcare Medicaid	$9.59
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$8.56
Rate for Payer: United Healthcare Medicaid	$8.56
Rate for Payer: WMAP Medicaid	$8.56

EAPG 408: LEVEL I HEMATOLOGY TESTS

Facility

$5.53

Service Code	EAPG 00408
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$5.53
Rate for Payer: Anthem Medicaid	$2.00
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$5.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2.00
Rate for Payer: Dean Health Medicaid	$2.00
Rate for Payer: Independent Care Health Plan Medicaid	$2.00
Rate for Payer: Managed Health Services Medicaid	$2.08
Rate for Payer: Molina Healthcare Medicaid	$5.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2.00
Rate for Payer: United Healthcare Medicaid	$2.00
Rate for Payer: WMAP Medicaid	$2.00

EAPG 409: LEVEL II HEMATOLOGY TESTS

Facility

$8.41

Service Code	EAPG 00409
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$8.41
Rate for Payer: Anthem Medicaid	$5.00
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$8.41
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5.00
Rate for Payer: Dean Health Medicaid	$5.00
Rate for Payer: Independent Care Health Plan Medicaid	$5.00
Rate for Payer: Managed Health Services Medicaid	$5.20
Rate for Payer: Molina Healthcare Medicaid	$8.41
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5.00
Rate for Payer: United Healthcare Medicaid	$5.00
Rate for Payer: WMAP Medicaid	$5.00

EAPG 40: MINOR SPLINT AND STRAPPING APPLICATION

Facility

$199.17

Service Code	EAPG 00040
Min. Negotiated Rate	$31.46
Max. Negotiated Rate	$199.17
Rate for Payer: Anthem Medicaid	$31.46
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$199.17
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$31.46
Rate for Payer: Dean Health Medicaid	$31.46
Rate for Payer: Independent Care Health Plan Medicaid	$31.46
Rate for Payer: Managed Health Services Medicaid	$32.72
Rate for Payer: Molina Healthcare Medicaid	$199.17
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$31.46
Rate for Payer: United Healthcare Medicaid	$31.46
Rate for Payer: WMAP Medicaid	$31.46

EAPG 410: URINALYSIS

Facility

$3.18

Service Code	EAPG 00410
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$3.18
Rate for Payer: Anthem Medicaid	$1.00
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3.18
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1.00
Rate for Payer: Dean Health Medicaid	$1.00
Rate for Payer: Independent Care Health Plan Medicaid	$1.00
Rate for Payer: Managed Health Services Medicaid	$1.04
Rate for Payer: Molina Healthcare Medicaid	$3.18
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1.00
Rate for Payer: United Healthcare Medicaid	$1.00
Rate for Payer: WMAP Medicaid	$1.00

Know your out-of-pocket cost for care.

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