Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 563: DENTAL AND ORAL DIAGNOSES AND INJURIES

Facility

$96.58

Service Code	EAPG 00563
Min. Negotiated Rate	$53.43
Max. Negotiated Rate	$96.58
Rate for Payer: Anthem Medicaid	$53.43
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$96.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$53.43
Rate for Payer: Dean Health Medicaid	$53.43
Rate for Payer: Independent Care Health Plan Medicaid	$53.43
Rate for Payer: Managed Health Services Medicaid	$55.57
Rate for Payer: Molina Healthcare Medicaid	$96.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$53.43
Rate for Payer: United Healthcare Medicaid	$53.43
Rate for Payer: WMAP Medicaid	$53.43

EAPG 564: OTHER EAR, NOSE, MOUTH, THROAT AND CRANIOFACIAL DIAGNOSES

Facility

$100.15

Service Code	EAPG 00564
Min. Negotiated Rate	$64.72
Max. Negotiated Rate	$100.15
Rate for Payer: Anthem Medicaid	$64.72
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$100.15
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$64.72
Rate for Payer: Dean Health Medicaid	$64.72
Rate for Payer: Independent Care Health Plan Medicaid	$64.72
Rate for Payer: Managed Health Services Medicaid	$67.31
Rate for Payer: Molina Healthcare Medicaid	$100.15
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$64.72
Rate for Payer: United Healthcare Medicaid	$64.72
Rate for Payer: WMAP Medicaid	$64.72

EAPG 566: MALFUNCTION, REACTION, OR COMPLICATION OF OTOLARYNGOLOGIC DEVICE OR PROCEDURE

Facility

$62.51

Service Code	EAPG 00566
Min. Negotiated Rate	$60.11
Max. Negotiated Rate	$62.51
Rate for Payer: Anthem Medicaid	$60.11
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$60.11
Rate for Payer: Dean Health Medicaid	$60.11
Rate for Payer: Independent Care Health Plan Medicaid	$60.11
Rate for Payer: Managed Health Services Medicaid	$62.51
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$60.11
Rate for Payer: United Healthcare Medicaid	$60.11
Rate for Payer: WMAP Medicaid	$60.11

EAPG 56: SKIN AND CONNECTIVE TISSUE GRAFTING AND FLAP PROCEDURES

Facility

$839.03

Service Code	EAPG 00056
Min. Negotiated Rate	$806.76
Max. Negotiated Rate	$839.03
Rate for Payer: Anthem Medicaid	$806.76
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$806.76
Rate for Payer: Dean Health Medicaid	$806.76
Rate for Payer: Independent Care Health Plan Medicaid	$806.76
Rate for Payer: Managed Health Services Medicaid	$839.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$806.76
Rate for Payer: United Healthcare Medicaid	$806.76
Rate for Payer: WMAP Medicaid	$806.76

EAPG 570: CYSTIC FIBROSIS - PULMONARY DISEASE

Facility

$204.01

Service Code	EAPG 00570
Min. Negotiated Rate	$122.31
Max. Negotiated Rate	$204.01
Rate for Payer: Anthem Medicaid	$122.31
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$204.01
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$122.31
Rate for Payer: Dean Health Medicaid	$122.31
Rate for Payer: Independent Care Health Plan Medicaid	$122.31
Rate for Payer: Managed Health Services Medicaid	$127.20
Rate for Payer: Molina Healthcare Medicaid	$204.01
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$122.31
Rate for Payer: United Healthcare Medicaid	$122.31
Rate for Payer: WMAP Medicaid	$122.31

EAPG 571: RESPIRATORY MALIGNANCY

Facility

$121.97

Service Code	EAPG 00571
Min. Negotiated Rate	$63.31
Max. Negotiated Rate	$121.97
Rate for Payer: Anthem Medicaid	$63.31
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$121.97
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$63.31
Rate for Payer: Dean Health Medicaid	$63.31
Rate for Payer: Independent Care Health Plan Medicaid	$63.31
Rate for Payer: Managed Health Services Medicaid	$65.84
Rate for Payer: Molina Healthcare Medicaid	$121.97
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$63.31
Rate for Payer: United Healthcare Medicaid	$63.31
Rate for Payer: WMAP Medicaid	$63.31

EAPG 572: BRONCHIOLITIS AND RSV PNEUMONIA

Facility

$142.42

Service Code	EAPG 00572
Min. Negotiated Rate	$136.94
Max. Negotiated Rate	$142.42
Rate for Payer: Anthem Medicaid	$136.94
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$140.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$136.94
Rate for Payer: Dean Health Medicaid	$136.94
Rate for Payer: Independent Care Health Plan Medicaid	$136.94
Rate for Payer: Managed Health Services Medicaid	$142.42
Rate for Payer: Molina Healthcare Medicaid	$140.75
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$136.94
Rate for Payer: United Healthcare Medicaid	$136.94
Rate for Payer: WMAP Medicaid	$136.94

EAPG 574: CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$126.03

Service Code	EAPG 00574
Min. Negotiated Rate	$102.19
Max. Negotiated Rate	$126.03
Rate for Payer: Anthem Medicaid	$102.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$126.03
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$102.19
Rate for Payer: Dean Health Medicaid	$102.19
Rate for Payer: Independent Care Health Plan Medicaid	$102.19
Rate for Payer: Managed Health Services Medicaid	$106.28
Rate for Payer: Molina Healthcare Medicaid	$126.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$102.19
Rate for Payer: United Healthcare Medicaid	$102.19
Rate for Payer: WMAP Medicaid	$102.19

EAPG 575: ASTHMA

Facility

$117.03

Service Code	EAPG 00575
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$117.03
Rate for Payer: Anthem Medicaid	$86.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$117.03
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$86.25
Rate for Payer: Dean Health Medicaid	$86.25
Rate for Payer: Independent Care Health Plan Medicaid	$86.25
Rate for Payer: Managed Health Services Medicaid	$89.70
Rate for Payer: Molina Healthcare Medicaid	$117.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$86.25
Rate for Payer: United Healthcare Medicaid	$86.25
Rate for Payer: WMAP Medicaid	$86.25

EAPG 576: OTHER RESPIRATORY SYSTEM DIAGNOSES

Facility

$136.64

Service Code	EAPG 00576
Min. Negotiated Rate	$83.67
Max. Negotiated Rate	$136.64
Rate for Payer: Anthem Medicaid	$83.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$136.64
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$83.67
Rate for Payer: Dean Health Medicaid	$83.67
Rate for Payer: Independent Care Health Plan Medicaid	$83.67
Rate for Payer: Managed Health Services Medicaid	$87.02
Rate for Payer: Molina Healthcare Medicaid	$136.64
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$83.67
Rate for Payer: United Healthcare Medicaid	$83.67
Rate for Payer: WMAP Medicaid	$83.67

EAPG 579: STATUS ASTHMATICUS

Facility

$135.00

Service Code	EAPG 00579
Min. Negotiated Rate	$119.13
Max. Negotiated Rate	$135.00
Rate for Payer: Anthem Medicaid	$129.81
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$119.13
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$129.81
Rate for Payer: Dean Health Medicaid	$129.81
Rate for Payer: Independent Care Health Plan Medicaid	$129.81
Rate for Payer: Managed Health Services Medicaid	$135.00
Rate for Payer: Molina Healthcare Medicaid	$119.13
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$129.81
Rate for Payer: United Healthcare Medicaid	$129.81
Rate for Payer: WMAP Medicaid	$129.81

EAPG 57: LEVEL III SPINE PROCEDURES

Facility

$7,192.79

Service Code	EAPG 00057
Min. Negotiated Rate	$6,916.14
Max. Negotiated Rate	$7,192.79
Rate for Payer: Anthem Medicaid	$6,916.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$6,916.14
Rate for Payer: Dean Health Medicaid	$6,916.14
Rate for Payer: Independent Care Health Plan Medicaid	$6,916.14
Rate for Payer: Managed Health Services Medicaid	$7,192.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$6,916.14
Rate for Payer: United Healthcare Medicaid	$6,916.14
Rate for Payer: WMAP Medicaid	$6,916.14

EAPG 580: MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$167.08

Service Code	EAPG 00580
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$167.08
Rate for Payer: Anthem Medicaid	$160.65
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$160.65
Rate for Payer: Dean Health Medicaid	$160.65
Rate for Payer: Independent Care Health Plan Medicaid	$160.65
Rate for Payer: Managed Health Services Medicaid	$167.08
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$160.65
Rate for Payer: United Healthcare Medicaid	$160.65
Rate for Payer: WMAP Medicaid	$160.65

EAPG 581: PULMONARY INFECTION DIAGNOSES INCLUDING PNEUMONIA

Facility

$131.84

Service Code	EAPG 00581
Min. Negotiated Rate	$126.77
Max. Negotiated Rate	$131.84
Rate for Payer: Anthem Medicaid	$126.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$126.77
Rate for Payer: Dean Health Medicaid	$126.77
Rate for Payer: Independent Care Health Plan Medicaid	$126.77
Rate for Payer: Managed Health Services Medicaid	$131.84
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$126.77
Rate for Payer: United Healthcare Medicaid	$126.77
Rate for Payer: WMAP Medicaid	$126.77

EAPG 582: INTERSTITIAL AND ALVEOLAR LUNG DIAGNOSES

Facility

$85.70

Service Code	EAPG 00582
Min. Negotiated Rate	$82.40
Max. Negotiated Rate	$85.70
Rate for Payer: Anthem Medicaid	$82.40
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$82.40
Rate for Payer: Dean Health Medicaid	$82.40
Rate for Payer: Independent Care Health Plan Medicaid	$82.40
Rate for Payer: Managed Health Services Medicaid	$85.70
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$82.40
Rate for Payer: United Healthcare Medicaid	$82.40
Rate for Payer: WMAP Medicaid	$82.40

EAPG 583: MALFUNCTION, REACTION, OR COMPLICATION OF PULMONARY DEVICE OR PROCEDURE

Facility

$128.70

Service Code	EAPG 00583
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$128.70
Rate for Payer: Anthem Medicaid	$123.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$123.75
Rate for Payer: Dean Health Medicaid	$123.75
Rate for Payer: Independent Care Health Plan Medicaid	$123.75
Rate for Payer: Managed Health Services Medicaid	$128.70
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$123.75
Rate for Payer: United Healthcare Medicaid	$123.75
Rate for Payer: WMAP Medicaid	$123.75

EAPG 584: ACUTE BRONCHITIS

Facility

$114.33

Service Code	EAPG 00584
Min. Negotiated Rate	$109.93
Max. Negotiated Rate	$114.33
Rate for Payer: Anthem Medicaid	$109.93
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$109.93
Rate for Payer: Dean Health Medicaid	$109.93
Rate for Payer: Independent Care Health Plan Medicaid	$109.93
Rate for Payer: Managed Health Services Medicaid	$114.33
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$109.93
Rate for Payer: United Healthcare Medicaid	$109.93
Rate for Payer: WMAP Medicaid	$109.93

EAPG 585: AFTERCARE, OPEN WOUNDS AND OTHER TRAUMATIC INJURIES

Facility

$51.99

Service Code	EAPG 00585
Min. Negotiated Rate	$49.99
Max. Negotiated Rate	$51.99
Rate for Payer: Anthem Medicaid	$49.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$49.99
Rate for Payer: Dean Health Medicaid	$49.99
Rate for Payer: Independent Care Health Plan Medicaid	$49.99
Rate for Payer: Managed Health Services Medicaid	$51.99
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$49.99
Rate for Payer: United Healthcare Medicaid	$49.99
Rate for Payer: WMAP Medicaid	$49.99

EAPG 586: PULMONARY EMBOLISM

Facility

$79.16

Service Code	EAPG 00586
Min. Negotiated Rate	$76.12
Max. Negotiated Rate	$79.16
Rate for Payer: Anthem Medicaid	$76.12
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$76.12
Rate for Payer: Dean Health Medicaid	$76.12
Rate for Payer: Independent Care Health Plan Medicaid	$76.12
Rate for Payer: Managed Health Services Medicaid	$79.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$76.12
Rate for Payer: United Healthcare Medicaid	$76.12
Rate for Payer: WMAP Medicaid	$76.12

EAPG 587: RESPIRATORY FAILURE

Facility

$175.22

Service Code	EAPG 00587
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$175.22
Rate for Payer: Anthem Medicaid	$168.48
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$168.48
Rate for Payer: Dean Health Medicaid	$168.48
Rate for Payer: Independent Care Health Plan Medicaid	$168.48
Rate for Payer: Managed Health Services Medicaid	$175.22
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$168.48
Rate for Payer: United Healthcare Medicaid	$168.48
Rate for Payer: WMAP Medicaid	$168.48

EAPG 589: MALFUNCTION, REACTION, OR COMPLICATION OF CARDIOVASCULAR DEVICE OR PROC

Facility

$107.03

Service Code	EAPG 00589
Min. Negotiated Rate	$102.91
Max. Negotiated Rate	$107.03
Rate for Payer: Anthem Medicaid	$102.91
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$102.91
Rate for Payer: Dean Health Medicaid	$102.91
Rate for Payer: Independent Care Health Plan Medicaid	$102.91
Rate for Payer: Managed Health Services Medicaid	$107.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$102.91
Rate for Payer: United Healthcare Medicaid	$102.91
Rate for Payer: WMAP Medicaid	$102.91

EAPG 58: LEVEL II SHOULDER AND UPPER ARM PROCEDURES

Facility

$3,862.36

Service Code	EAPG 00058
Min. Negotiated Rate	$3,713.81
Max. Negotiated Rate	$3,862.36
Rate for Payer: Anthem Medicaid	$3,713.81
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$3,713.81
Rate for Payer: Dean Health Medicaid	$3,713.81
Rate for Payer: Independent Care Health Plan Medicaid	$3,713.81
Rate for Payer: Managed Health Services Medicaid	$3,862.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$3,713.81
Rate for Payer: United Healthcare Medicaid	$3,713.81
Rate for Payer: WMAP Medicaid	$3,713.81

EAPG 591: ACUTE MYOCARDIAL INFARCTION

Facility

$278.92

Service Code	EAPG 00591
Min. Negotiated Rate	$179.93
Max. Negotiated Rate	$278.92
Rate for Payer: Anthem Medicaid	$179.93
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$278.92
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$179.93
Rate for Payer: Dean Health Medicaid	$179.93
Rate for Payer: Independent Care Health Plan Medicaid	$179.93
Rate for Payer: Managed Health Services Medicaid	$187.13
Rate for Payer: Molina Healthcare Medicaid	$278.92
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$179.93
Rate for Payer: United Healthcare Medicaid	$179.93
Rate for Payer: WMAP Medicaid	$179.93

EAPG 592: OTHER CARDIOVASCULAR SYSTEM DIAGNOSES

Facility

$126.52

Service Code	EAPG 00592
Min. Negotiated Rate	$79.07
Max. Negotiated Rate	$126.52
Rate for Payer: Anthem Medicaid	$79.07
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$126.52
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$79.07
Rate for Payer: Dean Health Medicaid	$79.07
Rate for Payer: Independent Care Health Plan Medicaid	$79.07
Rate for Payer: Managed Health Services Medicaid	$82.23
Rate for Payer: Molina Healthcare Medicaid	$126.52
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$79.07
Rate for Payer: United Healthcare Medicaid	$79.07
Rate for Payer: WMAP Medicaid	$79.07

EAPG 594: HEART FAILURE

Facility

$146.09

Service Code	EAPG 00594
Min. Negotiated Rate	$85.97
Max. Negotiated Rate	$146.09
Rate for Payer: Anthem Medicaid	$85.97
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$146.09
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$85.97
Rate for Payer: Dean Health Medicaid	$85.97
Rate for Payer: Independent Care Health Plan Medicaid	$85.97
Rate for Payer: Managed Health Services Medicaid	$89.41
Rate for Payer: Molina Healthcare Medicaid	$146.09
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$85.97
Rate for Payer: United Healthcare Medicaid	$85.97
Rate for Payer: WMAP Medicaid	$85.97

Know your out-of-pocket cost for care.

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