Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 483: RADIATION THERAPY MANAGEMENT

Facility

$173.80

Service Code	EAPG 00483
Min. Negotiated Rate	$97.36
Max. Negotiated Rate	$173.80
Rate for Payer: Anthem Medicaid	$167.12
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$97.36
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$167.12
Rate for Payer: Dean Health Medicaid	$167.12
Rate for Payer: Independent Care Health Plan Medicaid	$167.12
Rate for Payer: Managed Health Services Medicaid	$173.80
Rate for Payer: Molina Healthcare Medicaid	$97.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$167.12
Rate for Payer: United Healthcare Medicaid	$167.12
Rate for Payer: WMAP Medicaid	$167.12

EAPG 485: CORNEAL TISSUE PROCESSING

Facility

$1,927.65

Service Code	EAPG 00485
Min. Negotiated Rate	$1,026.31
Max. Negotiated Rate	$1,927.65
Rate for Payer: Anthem Medicaid	$1,026.31
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,927.65
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,026.31
Rate for Payer: Dean Health Medicaid	$1,026.31
Rate for Payer: Independent Care Health Plan Medicaid	$1,026.31
Rate for Payer: Managed Health Services Medicaid	$1,067.36
Rate for Payer: Molina Healthcare Medicaid	$1,927.65
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,026.31
Rate for Payer: United Healthcare Medicaid	$1,026.31
Rate for Payer: WMAP Medicaid	$1,026.31

EAPG 486: LEVEL I BLOOD AND TISSUE TYPING TESTS

Facility

$4.94

Service Code	EAPG 00486
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$4.94
Rate for Payer: Anthem Medicaid	$1.49
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$4.94
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	$4.94
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 488: MINOR DEVICE EVALUATION AND INTERROGATION

Facility

$33.42

Service Code	EAPG 00488
Min. Negotiated Rate	$15.03
Max. Negotiated Rate	$33.42
Rate for Payer: Anthem Medicaid	$15.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$33.42
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$15.03
Rate for Payer: Dean Health Medicaid	$15.03
Rate for Payer: Independent Care Health Plan Medicaid	$15.03
Rate for Payer: Managed Health Services Medicaid	$15.63
Rate for Payer: Molina Healthcare Medicaid	$33.42
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$15.03
Rate for Payer: United Healthcare Medicaid	$15.03
Rate for Payer: WMAP Medicaid	$15.03

EAPG 493: LEVEL I ANCILLARY THERAPEUTIC SERVICES

Facility

$21.82

Service Code	EAPG 00493
Min. Negotiated Rate	$12.58
Max. Negotiated Rate	$21.82
Rate for Payer: Dean Health Medicaid	$12.58
Rate for Payer: Anthem Medicaid	$12.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$21.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$12.58
Rate for Payer: Independent Care Health Plan Medicaid	$12.58
Rate for Payer: Managed Health Services Medicaid	$13.08
Rate for Payer: Molina Healthcare Medicaid	$21.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$12.58
Rate for Payer: United Healthcare Medicaid	$12.58
Rate for Payer: WMAP Medicaid	$12.58

EAPG 494: COMPLEX BLOOD COLLECTION SERVICES

Facility

$32.47

Service Code	EAPG 00494
Min. Negotiated Rate	$31.22
Max. Negotiated Rate	$32.47
Rate for Payer: Anthem Medicaid	$31.22
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$31.22
Rate for Payer: Dean Health Medicaid	$31.22
Rate for Payer: Independent Care Health Plan Medicaid	$31.22
Rate for Payer: Managed Health Services Medicaid	$32.47
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$31.22
Rate for Payer: United Healthcare Medicaid	$31.22
Rate for Payer: WMAP Medicaid	$31.22

EAPG 497: TELEHEALTH FACILITATION

Facility

$11.55

Service Code	EAPG 00497
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$11.55
Rate for Payer: Anthem Medicaid	$5.85
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$11.55
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5.85
Rate for Payer: Dean Health Medicaid	$5.85
Rate for Payer: Independent Care Health Plan Medicaid	$5.85
Rate for Payer: Managed Health Services Medicaid	$6.08
Rate for Payer: Molina Healthcare Medicaid	$11.55
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5.85
Rate for Payer: United Healthcare Medicaid	$5.85
Rate for Payer: WMAP Medicaid	$5.85

EAPG 499: BLOOD PROCESSING, STORAGE AND RELATED SERVICES

Facility

$36.60

Service Code	EAPG 00499
Min. Negotiated Rate	$35.19
Max. Negotiated Rate	$36.60
Rate for Payer: Anthem Medicaid	$35.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$35.19
Rate for Payer: Dean Health Medicaid	$35.19
Rate for Payer: Independent Care Health Plan Medicaid	$35.19
Rate for Payer: Managed Health Services Medicaid	$36.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$35.19
Rate for Payer: United Healthcare Medicaid	$35.19
Rate for Payer: WMAP Medicaid	$35.19

EAPG 49: LEVEL I JOINT, TENDON, OR LIGAMENT INJECTION PROCEDURES

Facility

$255.82

Service Code	EAPG 00049
Min. Negotiated Rate	$102.28
Max. Negotiated Rate	$255.82
Rate for Payer: Anthem Medicaid	$102.28
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$255.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$102.28
Rate for Payer: Dean Health Medicaid	$102.28
Rate for Payer: Independent Care Health Plan Medicaid	$102.28
Rate for Payer: Managed Health Services Medicaid	$106.37
Rate for Payer: Molina Healthcare Medicaid	$255.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$102.28
Rate for Payer: United Healthcare Medicaid	$102.28
Rate for Payer: WMAP Medicaid	$102.28

EAPG 4: LEVEL II SKIN INCISION AND DRAINAGE, DEBRIDEMENT, DESTRUCTION, OTHER RELATED PX

Facility

$828.28

Service Code	EAPG 00004
Min. Negotiated Rate	$445.72
Max. Negotiated Rate	$828.28
Rate for Payer: Anthem Medicaid	$445.72
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$828.28
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$445.72
Rate for Payer: Dean Health Medicaid	$445.72
Rate for Payer: Independent Care Health Plan Medicaid	$445.72
Rate for Payer: Managed Health Services Medicaid	$463.55
Rate for Payer: Molina Healthcare Medicaid	$828.28
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$445.72
Rate for Payer: United Healthcare Medicaid	$445.72
Rate for Payer: WMAP Medicaid	$445.72

EAPG 50: LEVEL II JOINT, TENDON, OR LIGAMENT INJECTION PROCEDURES

Facility

$198.28

Service Code	EAPG 00050
Min. Negotiated Rate	$190.65
Max. Negotiated Rate	$198.28
Rate for Payer: Anthem Medicaid	$190.65
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$190.65
Rate for Payer: Dean Health Medicaid	$190.65
Rate for Payer: Independent Care Health Plan Medicaid	$190.65
Rate for Payer: Managed Health Services Medicaid	$198.28
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$190.65
Rate for Payer: United Healthcare Medicaid	$190.65
Rate for Payer: WMAP Medicaid	$190.65

EAPG 518: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$79.65

Service Code	EAPG 00518
Min. Negotiated Rate	$76.59
Max. Negotiated Rate	$79.65
Rate for Payer: Anthem Medicaid	$76.59
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$76.59
Rate for Payer: Dean Health Medicaid	$76.59
Rate for Payer: Independent Care Health Plan Medicaid	$76.59
Rate for Payer: Managed Health Services Medicaid	$79.65
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$76.59
Rate for Payer: United Healthcare Medicaid	$76.59
Rate for Payer: WMAP Medicaid	$76.59

EAPG 519: NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM

Facility

$56.60

Service Code	EAPG 00519
Min. Negotiated Rate	$54.42
Max. Negotiated Rate	$56.60
Rate for Payer: Anthem Medicaid	$54.42
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.42
Rate for Payer: Dean Health Medicaid	$54.42
Rate for Payer: Independent Care Health Plan Medicaid	$54.42
Rate for Payer: Managed Health Services Medicaid	$56.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.42
Rate for Payer: United Healthcare Medicaid	$54.42
Rate for Payer: WMAP Medicaid	$54.42

EAPG 51: MUSCULOSKELETAL EXCISIONS, BIOPSIES, AND DRAINAGE PROCEDURES

Facility

$773.29

Service Code	EAPG 00051
Min. Negotiated Rate	$743.55
Max. Negotiated Rate	$773.29
Rate for Payer: Anthem Medicaid	$743.55
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$743.55
Rate for Payer: Dean Health Medicaid	$743.55
Rate for Payer: Independent Care Health Plan Medicaid	$743.55
Rate for Payer: Managed Health Services Medicaid	$773.29
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$743.55
Rate for Payer: United Healthcare Medicaid	$743.55
Rate for Payer: WMAP Medicaid	$743.55

EAPG 520: SPINAL DIAGNOSES AND INJURIES

Facility

$110.86

Service Code	EAPG 00520
Min. Negotiated Rate	$66.55
Max. Negotiated Rate	$110.86
Rate for Payer: Anthem Medicaid	$66.55
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$110.86
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$66.55
Rate for Payer: Dean Health Medicaid	$66.55
Rate for Payer: Independent Care Health Plan Medicaid	$66.55
Rate for Payer: Managed Health Services Medicaid	$69.21
Rate for Payer: Molina Healthcare Medicaid	$110.86
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$66.55
Rate for Payer: United Healthcare Medicaid	$66.55
Rate for Payer: WMAP Medicaid	$66.55

EAPG 521: NERVOUS SYSTEM MALIGNANCY

Facility

$121.18

Service Code	EAPG 00521
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$121.18
Rate for Payer: Anthem Medicaid	$59.50
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$121.18
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$59.50
Rate for Payer: Dean Health Medicaid	$59.50
Rate for Payer: Independent Care Health Plan Medicaid	$59.50
Rate for Payer: Managed Health Services Medicaid	$61.88
Rate for Payer: Molina Healthcare Medicaid	$121.18
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$59.50
Rate for Payer: United Healthcare Medicaid	$59.50
Rate for Payer: WMAP Medicaid	$59.50

EAPG 522: DEGENERATIVE NERVOUS SYSTEM DIAGNOSES EXC MULT SCLEROSIS

Facility

$88.75

Service Code	EAPG 00522
Min. Negotiated Rate	$55.07
Max. Negotiated Rate	$88.75
Rate for Payer: Anthem Medicaid	$55.07
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$88.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$55.07
Rate for Payer: Dean Health Medicaid	$55.07
Rate for Payer: Independent Care Health Plan Medicaid	$55.07
Rate for Payer: Managed Health Services Medicaid	$57.27
Rate for Payer: Molina Healthcare Medicaid	$88.75
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$55.07
Rate for Payer: United Healthcare Medicaid	$55.07
Rate for Payer: WMAP Medicaid	$55.07

EAPG 523: MULTIPLE SCLEROSIS AND OTHER DEMYELINATING DISEASES

Facility

$103.96

Service Code	EAPG 00523
Min. Negotiated Rate	$49.32
Max. Negotiated Rate	$103.96
Rate for Payer: Anthem Medicaid	$49.32
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$103.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$49.32
Rate for Payer: Dean Health Medicaid	$49.32
Rate for Payer: Independent Care Health Plan Medicaid	$49.32
Rate for Payer: Managed Health Services Medicaid	$51.29
Rate for Payer: Molina Healthcare Medicaid	$103.96
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$49.32
Rate for Payer: United Healthcare Medicaid	$49.32
Rate for Payer: WMAP Medicaid	$49.32

EAPG 524: OTHER CENTRAL NERVOUS SYSTEM DIAGNOSES

Facility

$92.37

Service Code	EAPG 00524
Min. Negotiated Rate	$66.10
Max. Negotiated Rate	$92.37
Rate for Payer: Anthem Medicaid	$66.10
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$92.37
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$66.10
Rate for Payer: Dean Health Medicaid	$66.10
Rate for Payer: Independent Care Health Plan Medicaid	$66.10
Rate for Payer: Managed Health Services Medicaid	$68.74
Rate for Payer: Molina Healthcare Medicaid	$92.37
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$66.10
Rate for Payer: United Healthcare Medicaid	$66.10
Rate for Payer: WMAP Medicaid	$66.10

EAPG 526: TRANSIENT ISCHEMIA

Facility

$118.40

Service Code	EAPG 00526
Min. Negotiated Rate	$102.93
Max. Negotiated Rate	$118.40
Rate for Payer: Anthem Medicaid	$102.93
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$118.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$102.93
Rate for Payer: Dean Health Medicaid	$102.93
Rate for Payer: Independent Care Health Plan Medicaid	$102.93
Rate for Payer: Managed Health Services Medicaid	$107.05
Rate for Payer: Molina Healthcare Medicaid	$118.40
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$102.93
Rate for Payer: United Healthcare Medicaid	$102.93
Rate for Payer: WMAP Medicaid	$102.93

EAPG 527: PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DIAGNOSES

Facility

$106.02

Service Code	EAPG 00527
Min. Negotiated Rate	$56.15
Max. Negotiated Rate	$106.02
Rate for Payer: Anthem Medicaid	$56.15
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$106.02
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$56.15
Rate for Payer: Dean Health Medicaid	$56.15
Rate for Payer: Independent Care Health Plan Medicaid	$56.15
Rate for Payer: Managed Health Services Medicaid	$58.40
Rate for Payer: Molina Healthcare Medicaid	$106.02
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$56.15
Rate for Payer: United Healthcare Medicaid	$56.15
Rate for Payer: WMAP Medicaid	$56.15

EAPG 528: ANOXIC AND OTHER SEVERE BRAIN DAMAGE OR COMA

Facility

$158.95

Service Code	EAPG 00528
Min. Negotiated Rate	$86.45
Max. Negotiated Rate	$158.95
Rate for Payer: Dean Health Medicaid	$86.45
Rate for Payer: Anthem Medicaid	$86.45
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$158.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$86.45
Rate for Payer: Independent Care Health Plan Medicaid	$86.45
Rate for Payer: Managed Health Services Medicaid	$89.91
Rate for Payer: Molina Healthcare Medicaid	$158.95
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$86.45
Rate for Payer: United Healthcare Medicaid	$86.45
Rate for Payer: WMAP Medicaid	$86.45

EAPG 529: SEIZURE

Facility

$118.30

Service Code	EAPG 00529
Min. Negotiated Rate	$80.65
Max. Negotiated Rate	$118.30
Rate for Payer: Anthem Medicaid	$80.65
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$118.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$80.65
Rate for Payer: Dean Health Medicaid	$80.65
Rate for Payer: Independent Care Health Plan Medicaid	$80.65
Rate for Payer: Managed Health Services Medicaid	$83.88
Rate for Payer: Molina Healthcare Medicaid	$118.30
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$80.65
Rate for Payer: United Healthcare Medicaid	$80.65
Rate for Payer: WMAP Medicaid	$80.65

EAPG 52: LEVEL II KNEE AND LOWER LEG PROCEDURES

Facility

$3,167.77

Service Code	EAPG 00052
Min. Negotiated Rate	$3,045.93
Max. Negotiated Rate	$3,167.77
Rate for Payer: Anthem Medicaid	$3,045.93
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$3,045.93
Rate for Payer: Dean Health Medicaid	$3,045.93
Rate for Payer: Independent Care Health Plan Medicaid	$3,045.93
Rate for Payer: Managed Health Services Medicaid	$3,167.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$3,045.93
Rate for Payer: United Healthcare Medicaid	$3,045.93
Rate for Payer: WMAP Medicaid	$3,045.93

EAPG 530: HEADACHES OTHER THAN MIGRAINE

Facility

$117.32

Service Code	EAPG 00530
Min. Negotiated Rate	$72.97
Max. Negotiated Rate	$117.32
Rate for Payer: Anthem Medicaid	$72.97
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$117.32
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$72.97
Rate for Payer: Dean Health Medicaid	$72.97
Rate for Payer: Independent Care Health Plan Medicaid	$72.97
Rate for Payer: Managed Health Services Medicaid	$75.89
Rate for Payer: Molina Healthcare Medicaid	$117.32
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$72.97
Rate for Payer: United Healthcare Medicaid	$72.97
Rate for Payer: WMAP Medicaid	$72.97

Know your out-of-pocket cost for care.

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