Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 412: ANCILLARY RESPIRATORY THERAPY AND OTHER PULMONARY TESTS AND SERVICES

Facility

$59.10

Service Code	EAPG 00412
Min. Negotiated Rate	$23.95
Max. Negotiated Rate	$59.10
Rate for Payer: Anthem Medicaid	$23.95
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$59.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$23.95
Rate for Payer: Dean Health Medicaid	$23.95
Rate for Payer: Independent Care Health Plan Medicaid	$23.95
Rate for Payer: Managed Health Services Medicaid	$24.91
Rate for Payer: Molina Healthcare Medicaid	$59.10
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$23.95
Rate for Payer: United Healthcare Medicaid	$23.95
Rate for Payer: WMAP Medicaid	$23.95

EAPG 413: CARDIOGRAM

Facility

$20.35

Service Code	EAPG 00413
Min. Negotiated Rate	$10.68
Max. Negotiated Rate	$20.35
Rate for Payer: Anthem Medicaid	$10.68
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$20.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$10.68
Rate for Payer: Dean Health Medicaid	$10.68
Rate for Payer: Independent Care Health Plan Medicaid	$10.68
Rate for Payer: Managed Health Services Medicaid	$11.11
Rate for Payer: Molina Healthcare Medicaid	$20.35
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$10.68
Rate for Payer: United Healthcare Medicaid	$10.68
Rate for Payer: WMAP Medicaid	$10.68

EAPG 414: LEVEL I IMMUNIZATION

Facility

$17.37

Service Code	EAPG 00414
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$17.37
Rate for Payer: Anthem Medicaid	$8.85
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$17.37
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$8.85
Rate for Payer: Dean Health Medicaid	$8.85
Rate for Payer: Independent Care Health Plan Medicaid	$8.85
Rate for Payer: Managed Health Services Medicaid	$9.20
Rate for Payer: Molina Healthcare Medicaid	$17.37
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$8.85
Rate for Payer: United Healthcare Medicaid	$8.85
Rate for Payer: WMAP Medicaid	$8.85

EAPG 415: LEVEL II IMMUNIZATION

Facility

$73.14

Service Code	EAPG 00415
Min. Negotiated Rate	$46.77
Max. Negotiated Rate	$73.14
Rate for Payer: Anthem Medicaid	$46.77
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$73.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$46.77
Rate for Payer: Dean Health Medicaid	$46.77
Rate for Payer: Independent Care Health Plan Medicaid	$46.77
Rate for Payer: Managed Health Services Medicaid	$48.64
Rate for Payer: Molina Healthcare Medicaid	$73.14
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$46.77
Rate for Payer: United Healthcare Medicaid	$46.77
Rate for Payer: WMAP Medicaid	$46.77

EAPG 417: MINOR FEMALE REPRODUCTIVE PROCEDURES

Facility

$141.83

Service Code	EAPG 00417
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$141.83
Rate for Payer: Anthem Medicaid	$87.78
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$141.83
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$87.78
Rate for Payer: Dean Health Medicaid	$87.78
Rate for Payer: Independent Care Health Plan Medicaid	$87.78
Rate for Payer: Managed Health Services Medicaid	$91.29
Rate for Payer: Molina Healthcare Medicaid	$141.83
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$87.78
Rate for Payer: United Healthcare Medicaid	$87.78
Rate for Payer: WMAP Medicaid	$87.78

EAPG 418: AMBULATORY PATIENT MONITORING AND RELATED ASSESSMENTS

Facility

$112.08

Service Code	EAPG 00418
Min. Negotiated Rate	$25.66
Max. Negotiated Rate	$112.08
Rate for Payer: Anthem Medicaid	$25.66
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$112.08
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$25.66
Rate for Payer: Dean Health Medicaid	$25.66
Rate for Payer: Independent Care Health Plan Medicaid	$25.66
Rate for Payer: Managed Health Services Medicaid	$26.69
Rate for Payer: Molina Healthcare Medicaid	$112.08
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$25.66
Rate for Payer: United Healthcare Medicaid	$25.66
Rate for Payer: WMAP Medicaid	$25.66

EAPG 419: ANCILLARY OPHTHALMOLOGY OR OPTOMETRY SERVICES

Facility

$37.92

Service Code	EAPG 00419
Min. Negotiated Rate	$31.30
Max. Negotiated Rate	$37.92
Rate for Payer: Anthem Medicaid	$31.30
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$37.92
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$31.30
Rate for Payer: Dean Health Medicaid	$31.30
Rate for Payer: Independent Care Health Plan Medicaid	$31.30
Rate for Payer: Managed Health Services Medicaid	$32.55
Rate for Payer: Molina Healthcare Medicaid	$37.92
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$31.30
Rate for Payer: United Healthcare Medicaid	$31.30
Rate for Payer: WMAP Medicaid	$31.30

EAPG 41: CLOSED TREATMENT FX AND DISLOCATION

Facility

$448.73

Service Code	EAPG 00041
Min. Negotiated Rate	$191.13
Max. Negotiated Rate	$448.73
Rate for Payer: Anthem Medicaid	$191.13
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$448.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$191.13
Rate for Payer: Dean Health Medicaid	$191.13
Rate for Payer: Independent Care Health Plan Medicaid	$191.13
Rate for Payer: Managed Health Services Medicaid	$198.78
Rate for Payer: Molina Healthcare Medicaid	$448.73
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$191.13
Rate for Payer: United Healthcare Medicaid	$191.13
Rate for Payer: WMAP Medicaid	$191.13

EAPG 420: ELECTRONIC ANALYSIS FOR CARDIAC, NEUROLOGICAL AND OTHER DEVICES

Facility

$200.20

Service Code	EAPG 00420
Min. Negotiated Rate	$59.18
Max. Negotiated Rate	$200.20
Rate for Payer: Anthem Medicaid	$59.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$200.20
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$59.18
Rate for Payer: Dean Health Medicaid	$59.18
Rate for Payer: Independent Care Health Plan Medicaid	$59.18
Rate for Payer: Managed Health Services Medicaid	$61.55
Rate for Payer: Molina Healthcare Medicaid	$200.20
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$59.18
Rate for Payer: United Healthcare Medicaid	$59.18
Rate for Payer: WMAP Medicaid	$59.18

EAPG 423: VASCULAR ACCESS BY NEEDLE OR CATHETER

Facility

$295.52

Service Code	EAPG 00423
Min. Negotiated Rate	$220.45
Max. Negotiated Rate	$295.52
Rate for Payer: Anthem Medicaid	$284.15
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$220.45
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$284.15
Rate for Payer: Dean Health Medicaid	$284.15
Rate for Payer: Independent Care Health Plan Medicaid	$284.15
Rate for Payer: Managed Health Services Medicaid	$295.52
Rate for Payer: Molina Healthcare Medicaid	$220.45
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$284.15
Rate for Payer: United Healthcare Medicaid	$284.15
Rate for Payer: WMAP Medicaid	$284.15

EAPG 427: BIOFEEDBACK AND OTHER TRAINING

Facility

$171.19

Service Code	EAPG 00427
Min. Negotiated Rate	$36.61
Max. Negotiated Rate	$171.19
Rate for Payer: Anthem Medicaid	$36.61
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$171.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$36.61
Rate for Payer: Dean Health Medicaid	$36.61
Rate for Payer: Independent Care Health Plan Medicaid	$36.61
Rate for Payer: Managed Health Services Medicaid	$38.07
Rate for Payer: Molina Healthcare Medicaid	$171.19
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$36.61
Rate for Payer: United Healthcare Medicaid	$36.61
Rate for Payer: WMAP Medicaid	$36.61

EAPG 428: PATIENT EDUCATION, INDIVIDUAL

Facility

$31.04

Service Code	EAPG 00428
Min. Negotiated Rate	$28.52
Max. Negotiated Rate	$31.04
Rate for Payer: Anthem Medicaid	$29.85
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$28.52
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$29.85
Rate for Payer: Dean Health Medicaid	$29.85
Rate for Payer: Independent Care Health Plan Medicaid	$29.85
Rate for Payer: Managed Health Services Medicaid	$31.04
Rate for Payer: Molina Healthcare Medicaid	$28.52
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$29.85
Rate for Payer: United Healthcare Medicaid	$29.85
Rate for Payer: WMAP Medicaid	$29.85

EAPG 429: PATIENT EDUCATION, GROUP

Facility

$36.35

Service Code	EAPG 00429
Min. Negotiated Rate	$15.65
Max. Negotiated Rate	$36.35
Rate for Payer: Anthem Medicaid	$15.65
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$36.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$15.65
Rate for Payer: Dean Health Medicaid	$15.65
Rate for Payer: Independent Care Health Plan Medicaid	$15.65
Rate for Payer: Managed Health Services Medicaid	$16.28
Rate for Payer: Molina Healthcare Medicaid	$36.35
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$15.65
Rate for Payer: United Healthcare Medicaid	$15.65
Rate for Payer: WMAP Medicaid	$15.65

EAPG 431: CLASS II CHEMOTHERAPY DRUGS

Facility

$107.88

Service Code	EAPG 00431
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$107.88
Rate for Payer: Anthem Medicaid	$14.91
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$107.88
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$14.91
Rate for Payer: Dean Health Medicaid	$14.91
Rate for Payer: Independent Care Health Plan Medicaid	$14.91
Rate for Payer: Managed Health Services Medicaid	$15.51
Rate for Payer: Molina Healthcare Medicaid	$107.88
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$14.91
Rate for Payer: United Healthcare Medicaid	$14.91
Rate for Payer: WMAP Medicaid	$14.91

EAPG 432: CLASS III CHEMOTHERAPY DRUGS

Facility

$139.58

Service Code	EAPG 00432
Min. Negotiated Rate	$51.63
Max. Negotiated Rate	$139.58
Rate for Payer: Anthem Medicaid	$51.63
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$139.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$51.63
Rate for Payer: Dean Health Medicaid	$51.63
Rate for Payer: Independent Care Health Plan Medicaid	$51.63
Rate for Payer: Managed Health Services Medicaid	$53.70
Rate for Payer: Molina Healthcare Medicaid	$139.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$51.63
Rate for Payer: United Healthcare Medicaid	$51.63
Rate for Payer: WMAP Medicaid	$51.63

EAPG 433: CLASS IV CHEMOTHERAPY DRUGS

Facility

$262.87

Service Code	EAPG 00433
Min. Negotiated Rate	$121.74
Max. Negotiated Rate	$262.87
Rate for Payer: Anthem Medicaid	$121.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$262.87
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$121.74
Rate for Payer: Dean Health Medicaid	$121.74
Rate for Payer: Independent Care Health Plan Medicaid	$121.74
Rate for Payer: Managed Health Services Medicaid	$126.61
Rate for Payer: Molina Healthcare Medicaid	$262.87
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$121.74
Rate for Payer: United Healthcare Medicaid	$121.74
Rate for Payer: WMAP Medicaid	$121.74

EAPG 434: CLASS V CHEMOTHERAPY DRUGS

Facility

$323.29

Service Code	EAPG 00434
Min. Negotiated Rate	$132.44
Max. Negotiated Rate	$323.29
Rate for Payer: Anthem Medicaid	$132.44
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$323.29
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$132.44
Rate for Payer: Dean Health Medicaid	$132.44
Rate for Payer: Independent Care Health Plan Medicaid	$132.44
Rate for Payer: Managed Health Services Medicaid	$137.74
Rate for Payer: Molina Healthcare Medicaid	$323.29
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$132.44
Rate for Payer: United Healthcare Medicaid	$132.44
Rate for Payer: WMAP Medicaid	$132.44

EAPG 436: CLASS II PHARMACOTHERAPY

Facility

$63.36

Service Code	EAPG 00436
Min. Negotiated Rate	$40.29
Max. Negotiated Rate	$63.36
Rate for Payer: Anthem Medicaid	$40.29
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$63.36
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$40.29
Rate for Payer: Dean Health Medicaid	$40.29
Rate for Payer: Independent Care Health Plan Medicaid	$40.29
Rate for Payer: Managed Health Services Medicaid	$41.90
Rate for Payer: Molina Healthcare Medicaid	$63.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$40.29
Rate for Payer: United Healthcare Medicaid	$40.29
Rate for Payer: WMAP Medicaid	$40.29

EAPG 437: CLASS III PHARMACOTHERAPY

Facility

$137.82

Service Code	EAPG 00437
Min. Negotiated Rate	$48.14
Max. Negotiated Rate	$137.82
Rate for Payer: Anthem Medicaid	$48.14
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$137.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$48.14
Rate for Payer: Dean Health Medicaid	$48.14
Rate for Payer: Independent Care Health Plan Medicaid	$48.14
Rate for Payer: Managed Health Services Medicaid	$50.07
Rate for Payer: Molina Healthcare Medicaid	$137.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$48.14
Rate for Payer: United Healthcare Medicaid	$48.14
Rate for Payer: WMAP Medicaid	$48.14

EAPG 438: CLASS IV PHARMACOTHERAPY

Facility

$252.40

Service Code	EAPG 00438
Min. Negotiated Rate	$78.21
Max. Negotiated Rate	$252.40
Rate for Payer: Anthem Medicaid	$78.21
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$252.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$78.21
Rate for Payer: Dean Health Medicaid	$78.21
Rate for Payer: Independent Care Health Plan Medicaid	$78.21
Rate for Payer: Managed Health Services Medicaid	$81.34
Rate for Payer: Molina Healthcare Medicaid	$252.40
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$78.21
Rate for Payer: United Healthcare Medicaid	$78.21
Rate for Payer: WMAP Medicaid	$78.21

EAPG 439: CLASS V PHARMACOTHERAPY

Facility

$265.07

Service Code	EAPG 00439
Min. Negotiated Rate	$188.76
Max. Negotiated Rate	$265.07
Rate for Payer: Anthem Medicaid	$188.76
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$265.07
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$188.76
Rate for Payer: Dean Health Medicaid	$188.76
Rate for Payer: Independent Care Health Plan Medicaid	$188.76
Rate for Payer: Managed Health Services Medicaid	$196.31
Rate for Payer: Molina Healthcare Medicaid	$265.07
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$188.76
Rate for Payer: United Healthcare Medicaid	$188.76
Rate for Payer: WMAP Medicaid	$188.76

EAPG 43: OPEN OR PERCUTANEOUS TREATMENT OF FRACTURES

Facility

$3,542.29

Service Code	EAPG 00043
Min. Negotiated Rate	$2,191.85
Max. Negotiated Rate	$3,542.29
Rate for Payer: Anthem Medicaid	$2,191.85
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3,542.29
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,191.85
Rate for Payer: Dean Health Medicaid	$2,191.85
Rate for Payer: Independent Care Health Plan Medicaid	$2,191.85
Rate for Payer: Managed Health Services Medicaid	$2,279.52
Rate for Payer: Molina Healthcare Medicaid	$3,542.29
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,191.85
Rate for Payer: United Healthcare Medicaid	$2,191.85
Rate for Payer: WMAP Medicaid	$2,191.85

EAPG 440: CLASS VI PHARMACOTHERAPY

Facility

$532.34

Service Code	EAPG 00440
Min. Negotiated Rate	$230.00
Max. Negotiated Rate	$532.34
Rate for Payer: Anthem Medicaid	$230.00
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$532.34
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$230.00
Rate for Payer: Dean Health Medicaid	$230.00
Rate for Payer: Independent Care Health Plan Medicaid	$230.00
Rate for Payer: Managed Health Services Medicaid	$239.20
Rate for Payer: Molina Healthcare Medicaid	$532.34
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$230.00
Rate for Payer: United Healthcare Medicaid	$230.00
Rate for Payer: WMAP Medicaid	$230.00

EAPG 441: CLASS VI CHEMOTHERAPY DRUGS

Facility

$339.39

Service Code	EAPG 00441
Min. Negotiated Rate	$241.46
Max. Negotiated Rate	$339.39
Rate for Payer: Anthem Medicaid	$241.46
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$339.39
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$241.46
Rate for Payer: Dean Health Medicaid	$241.46
Rate for Payer: Independent Care Health Plan Medicaid	$241.46
Rate for Payer: Managed Health Services Medicaid	$251.12
Rate for Payer: Molina Healthcare Medicaid	$339.39
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$241.46
Rate for Payer: United Healthcare Medicaid	$241.46
Rate for Payer: WMAP Medicaid	$241.46

EAPG 443: CLASS VII CHEMOTHERAPY DRUGS

Facility

$719.23

Service Code	EAPG 00443
Min. Negotiated Rate	$383.74
Max. Negotiated Rate	$719.23
Rate for Payer: Anthem Medicaid	$383.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$719.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$383.74
Rate for Payer: Dean Health Medicaid	$383.74
Rate for Payer: Independent Care Health Plan Medicaid	$383.74
Rate for Payer: Managed Health Services Medicaid	$399.09
Rate for Payer: Molina Healthcare Medicaid	$719.23
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$383.74
Rate for Payer: United Healthcare Medicaid	$383.74
Rate for Payer: WMAP Medicaid	$383.74

Know your out-of-pocket cost for care.

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