Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 531: MIGRAINE

Facility

$125.98

Service Code	EAPG 00531
Min. Negotiated Rate	$53.74
Max. Negotiated Rate	$125.98
Rate for Payer: Anthem Medicaid	$53.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$125.98
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	$125.98
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 532: HEAD TRAUMA WITH OR WITHOUT LOC/COMA LESS THAN 1 HR

Facility

$163.36

Service Code	EAPG 00532
Min. Negotiated Rate	$97.09
Max. Negotiated Rate	$163.36
Rate for Payer: Anthem Medicaid	$97.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$163.36
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$97.09
Rate for Payer: Dean Health Medicaid	$97.09
Rate for Payer: Independent Care Health Plan Medicaid	$97.09
Rate for Payer: Managed Health Services Medicaid	$100.97
Rate for Payer: Molina Healthcare Medicaid	$163.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$97.09
Rate for Payer: United Healthcare Medicaid	$97.09
Rate for Payer: WMAP Medicaid	$97.09

EAPG 533: AFTEREFFECTS OF CEREBROVASCULAR ACCIDENT

Facility

$99.46

Service Code	EAPG 00533
Min. Negotiated Rate	$66.34
Max. Negotiated Rate	$99.46
Rate for Payer: Anthem Medicaid	$66.34
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$99.46
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$66.34
Rate for Payer: Dean Health Medicaid	$66.34
Rate for Payer: Independent Care Health Plan Medicaid	$66.34
Rate for Payer: Managed Health Services Medicaid	$68.99
Rate for Payer: Molina Healthcare Medicaid	$99.46
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$66.34
Rate for Payer: United Healthcare Medicaid	$66.34
Rate for Payer: WMAP Medicaid	$66.34

EAPG 534: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION W/O INFARC

Facility

$92.86

Service Code	EAPG 00534
Min. Negotiated Rate	$51.65
Max. Negotiated Rate	$92.86
Rate for Payer: Anthem Medicaid	$51.65
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$92.86
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$51.65
Rate for Payer: Dean Health Medicaid	$51.65
Rate for Payer: Independent Care Health Plan Medicaid	$51.65
Rate for Payer: Managed Health Services Medicaid	$53.72
Rate for Payer: Molina Healthcare Medicaid	$92.86
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$51.65
Rate for Payer: United Healthcare Medicaid	$51.65
Rate for Payer: WMAP Medicaid	$51.65

EAPG 535: CVA AND PRECEREBRAL OCCLUSION W INFARCT

Facility

$109.25

Service Code	EAPG 00535
Min. Negotiated Rate	$97.01
Max. Negotiated Rate	$109.25
Rate for Payer: Anthem Medicaid	$97.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$109.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$97.01
Rate for Payer: Dean Health Medicaid	$97.01
Rate for Payer: Independent Care Health Plan Medicaid	$97.01
Rate for Payer: Managed Health Services Medicaid	$100.89
Rate for Payer: Molina Healthcare Medicaid	$109.25
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$97.01
Rate for Payer: United Healthcare Medicaid	$97.01
Rate for Payer: WMAP Medicaid	$97.01

EAPG 536: CEREBRAL PALSY

Facility

$114.34

Service Code	EAPG 00536
Min. Negotiated Rate	$66.99
Max. Negotiated Rate	$114.34
Rate for Payer: Anthem Medicaid	$66.99
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$114.34
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$66.99
Rate for Payer: Dean Health Medicaid	$66.99
Rate for Payer: Independent Care Health Plan Medicaid	$66.99
Rate for Payer: Managed Health Services Medicaid	$69.67
Rate for Payer: Molina Healthcare Medicaid	$114.34
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$66.99
Rate for Payer: United Healthcare Medicaid	$66.99
Rate for Payer: WMAP Medicaid	$66.99

EAPG 537: MALFUNCTION, REACTION, COMPLICATION OF NEUROLOGICAL DEVICE OR PROC

Facility

$87.30

Service Code	EAPG 00537
Min. Negotiated Rate	$83.94
Max. Negotiated Rate	$87.30
Rate for Payer: Anthem Medicaid	$83.94
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$83.94
Rate for Payer: Dean Health Medicaid	$83.94
Rate for Payer: Independent Care Health Plan Medicaid	$83.94
Rate for Payer: Managed Health Services Medicaid	$87.30
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$83.94
Rate for Payer: United Healthcare Medicaid	$83.94
Rate for Payer: WMAP Medicaid	$83.94

EAPG 538: HEAD TRAUMA WITH LOC/COMA MORE THAN 1 HR

Facility

$235.90

Service Code	EAPG 00538
Min. Negotiated Rate	$226.83
Max. Negotiated Rate	$235.90
Rate for Payer: Anthem Medicaid	$226.83
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$226.83
Rate for Payer: Dean Health Medicaid	$226.83
Rate for Payer: Independent Care Health Plan Medicaid	$226.83
Rate for Payer: Managed Health Services Medicaid	$235.90
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$226.83
Rate for Payer: United Healthcare Medicaid	$226.83
Rate for Payer: WMAP Medicaid	$226.83

EAPG 539: INTRACRANIAL HEMORRHAGE

Facility

$130.25

Service Code	EAPG 00539
Min. Negotiated Rate	$125.24
Max. Negotiated Rate	$130.25
Rate for Payer: Anthem Medicaid	$125.24
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$125.24
Rate for Payer: Dean Health Medicaid	$125.24
Rate for Payer: Independent Care Health Plan Medicaid	$125.24
Rate for Payer: Managed Health Services Medicaid	$130.25
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$125.24
Rate for Payer: United Healthcare Medicaid	$125.24
Rate for Payer: WMAP Medicaid	$125.24

EAPG 53: SPINE INJECTIONS AND OTHER RELATED PROCEDURES

Facility

$330.11

Service Code	EAPG 00053
Min. Negotiated Rate	$317.41
Max. Negotiated Rate	$330.11
Rate for Payer: Anthem Medicaid	$317.41
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$317.41
Rate for Payer: Dean Health Medicaid	$317.41
Rate for Payer: Independent Care Health Plan Medicaid	$317.41
Rate for Payer: Managed Health Services Medicaid	$330.11
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$317.41
Rate for Payer: United Healthcare Medicaid	$317.41
Rate for Payer: WMAP Medicaid	$317.41

EAPG 545: PERIPHERAL, CRANIAL, AND AUTONOMIC NERVE INJURIES

Facility

$78.10

Service Code	EAPG 00545
Min. Negotiated Rate	$75.10
Max. Negotiated Rate	$78.10
Rate for Payer: Anthem Medicaid	$75.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$75.10
Rate for Payer: Dean Health Medicaid	$75.10
Rate for Payer: Independent Care Health Plan Medicaid	$75.10
Rate for Payer: Managed Health Services Medicaid	$78.10
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$75.10
Rate for Payer: United Healthcare Medicaid	$75.10
Rate for Payer: WMAP Medicaid	$75.10

EAPG 548: PERIPHERAL AND OTHER VASCULAR RELATED INJURIES

Facility

$93.17

Service Code	EAPG 00548
Min. Negotiated Rate	$89.59
Max. Negotiated Rate	$93.17
Rate for Payer: Anthem Medicaid	$89.59
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$89.59
Rate for Payer: Dean Health Medicaid	$89.59
Rate for Payer: Independent Care Health Plan Medicaid	$89.59
Rate for Payer: Managed Health Services Medicaid	$93.17
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$89.59
Rate for Payer: United Healthcare Medicaid	$89.59
Rate for Payer: WMAP Medicaid	$89.59

EAPG 54: FIXATION DEVICE INSERTION OR REPLACEMENT PROCEDURES

Facility

$1,000.39

Service Code	EAPG 00054
Min. Negotiated Rate	$961.91
Max. Negotiated Rate	$1,000.39
Rate for Payer: Anthem Medicaid	$961.91
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$961.91
Rate for Payer: Dean Health Medicaid	$961.91
Rate for Payer: Independent Care Health Plan Medicaid	$961.91
Rate for Payer: Managed Health Services Medicaid	$1,000.39
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$961.91
Rate for Payer: United Healthcare Medicaid	$961.91
Rate for Payer: WMAP Medicaid	$961.91

EAPG 550: ACUTE MAJOR EYE INFECTIONS

Facility

$89.68

Service Code	EAPG 00550
Min. Negotiated Rate	$57.92
Max. Negotiated Rate	$89.68
Rate for Payer: Anthem Medicaid	$57.92
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$89.68
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$57.92
Rate for Payer: Dean Health Medicaid	$57.92
Rate for Payer: Independent Care Health Plan Medicaid	$57.92
Rate for Payer: Managed Health Services Medicaid	$60.24
Rate for Payer: Molina Healthcare Medicaid	$89.68
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$57.92
Rate for Payer: United Healthcare Medicaid	$57.92
Rate for Payer: WMAP Medicaid	$57.92

EAPG 551: CATARACTS

Facility

$77.06

Service Code	EAPG 00551
Min. Negotiated Rate	$46.69
Max. Negotiated Rate	$77.06
Rate for Payer: Anthem Medicaid	$46.69
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$77.06
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$46.69
Rate for Payer: Dean Health Medicaid	$46.69
Rate for Payer: Independent Care Health Plan Medicaid	$46.69
Rate for Payer: Managed Health Services Medicaid	$48.56
Rate for Payer: Molina Healthcare Medicaid	$77.06
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$46.69
Rate for Payer: United Healthcare Medicaid	$46.69
Rate for Payer: WMAP Medicaid	$46.69

EAPG 552: GLAUCOMA

Facility

$96.28

Service Code	EAPG 00552
Min. Negotiated Rate	$55.85
Max. Negotiated Rate	$96.28
Rate for Payer: Anthem Medicaid	$55.85
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$96.28
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$55.85
Rate for Payer: Dean Health Medicaid	$55.85
Rate for Payer: Independent Care Health Plan Medicaid	$55.85
Rate for Payer: Managed Health Services Medicaid	$58.08
Rate for Payer: Molina Healthcare Medicaid	$96.28
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$55.85
Rate for Payer: United Healthcare Medicaid	$55.85
Rate for Payer: WMAP Medicaid	$55.85

EAPG 553: OTHER OPHTHALMIC SYSTEM DIAGNOSES

Facility

$89.58

Service Code	EAPG 00553
Min. Negotiated Rate	$63.28
Max. Negotiated Rate	$89.58
Rate for Payer: Anthem Medicaid	$63.28
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$89.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$63.28
Rate for Payer: Dean Health Medicaid	$63.28
Rate for Payer: Independent Care Health Plan Medicaid	$63.28
Rate for Payer: Managed Health Services Medicaid	$65.81
Rate for Payer: Molina Healthcare Medicaid	$89.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$63.28
Rate for Payer: United Healthcare Medicaid	$63.28
Rate for Payer: WMAP Medicaid	$63.28

EAPG 555: CONJUNCTIVITIS

Facility

$91.88

Service Code	EAPG 00555
Min. Negotiated Rate	$49.39
Max. Negotiated Rate	$91.88
Rate for Payer: Anthem Medicaid	$49.39
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$91.88
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$49.39
Rate for Payer: Dean Health Medicaid	$49.39
Rate for Payer: Independent Care Health Plan Medicaid	$49.39
Rate for Payer: Managed Health Services Medicaid	$51.37
Rate for Payer: Molina Healthcare Medicaid	$91.88
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$49.39
Rate for Payer: United Healthcare Medicaid	$49.39
Rate for Payer: WMAP Medicaid	$49.39

EAPG 556: OCULAR AND PERIOCULAR MALIGNANCY

Facility

$70.47

Service Code	EAPG 00556
Min. Negotiated Rate	$67.76
Max. Negotiated Rate	$70.47
Rate for Payer: Anthem Medicaid	$67.76
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$67.76
Rate for Payer: Dean Health Medicaid	$67.76
Rate for Payer: Independent Care Health Plan Medicaid	$67.76
Rate for Payer: Managed Health Services Medicaid	$70.47
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$67.76
Rate for Payer: United Healthcare Medicaid	$67.76
Rate for Payer: WMAP Medicaid	$67.76

EAPG 557: OTHER EYE INFECTION DIAGNOSES

Facility

$44.70

Service Code	EAPG 00557
Min. Negotiated Rate	$42.98
Max. Negotiated Rate	$44.70
Rate for Payer: Anthem Medicaid	$42.98
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$42.98
Rate for Payer: Dean Health Medicaid	$42.98
Rate for Payer: Independent Care Health Plan Medicaid	$42.98
Rate for Payer: Managed Health Services Medicaid	$44.70
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$42.98
Rate for Payer: United Healthcare Medicaid	$42.98
Rate for Payer: WMAP Medicaid	$42.98

EAPG 558: MALFUNCTION, REACTION, OR COMPLICATION OF OCULAR DEVICE OR PROCEDURE

Facility

$58.10

Service Code	EAPG 00558
Min. Negotiated Rate	$55.87
Max. Negotiated Rate	$58.10
Rate for Payer: Anthem Medicaid	$55.87
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$55.87
Rate for Payer: Dean Health Medicaid	$55.87
Rate for Payer: Independent Care Health Plan Medicaid	$55.87
Rate for Payer: Managed Health Services Medicaid	$58.10
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$55.87
Rate for Payer: United Healthcare Medicaid	$55.87
Rate for Payer: WMAP Medicaid	$55.87

EAPG 55: LEVEL II HIP AND FEMUR PROCEDURES

Facility

$5,057.74

Service Code	EAPG 00055
Min. Negotiated Rate	$4,863.21
Max. Negotiated Rate	$5,057.74
Rate for Payer: Anthem Medicaid	$4,863.21
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4,863.21
Rate for Payer: Dean Health Medicaid	$4,863.21
Rate for Payer: Independent Care Health Plan Medicaid	$4,863.21
Rate for Payer: Managed Health Services Medicaid	$5,057.74
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4,863.21
Rate for Payer: United Healthcare Medicaid	$4,863.21
Rate for Payer: WMAP Medicaid	$4,863.21

EAPG 560: EAR, NOSE, MOUTH, THROAT, CRANIAL AND FACIAL MALIGNANCIES

Facility

$110.03

Service Code	EAPG 00560
Min. Negotiated Rate	$69.84
Max. Negotiated Rate	$110.03
Rate for Payer: Anthem Medicaid	$69.84
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$110.03
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$69.84
Rate for Payer: Dean Health Medicaid	$69.84
Rate for Payer: Independent Care Health Plan Medicaid	$69.84
Rate for Payer: Managed Health Services Medicaid	$72.63
Rate for Payer: Molina Healthcare Medicaid	$110.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$69.84
Rate for Payer: United Healthcare Medicaid	$69.84
Rate for Payer: WMAP Medicaid	$69.84

EAPG 561: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$139.78

Service Code	EAPG 00561
Min. Negotiated Rate	$94.86
Max. Negotiated Rate	$139.78
Rate for Payer: Anthem Medicaid	$94.86
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$139.78
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$94.86
Rate for Payer: Dean Health Medicaid	$94.86
Rate for Payer: Independent Care Health Plan Medicaid	$94.86
Rate for Payer: Managed Health Services Medicaid	$98.65
Rate for Payer: Molina Healthcare Medicaid	$139.78
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$94.86
Rate for Payer: United Healthcare Medicaid	$94.86
Rate for Payer: WMAP Medicaid	$94.86

EAPG 562: INFECTIONS OF UPPER RESPIRATORY TRACT AND OTITIS MEDIA

Facility

$94.91

Service Code	EAPG 00562
Min. Negotiated Rate	$65.71
Max. Negotiated Rate	$94.91
Rate for Payer: Anthem Medicaid	$65.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$94.91
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$65.71
Rate for Payer: Dean Health Medicaid	$65.71
Rate for Payer: Independent Care Health Plan Medicaid	$65.71
Rate for Payer: Managed Health Services Medicaid	$68.34
Rate for Payer: Molina Healthcare Medicaid	$94.91
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$65.71
Rate for Payer: United Healthcare Medicaid	$65.71
Rate for Payer: WMAP Medicaid	$65.71

Know your out-of-pocket cost for care.

All Charges