Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 595: CARDIAC ARREST OR OTHER CAUSES OF MORTALITY

Facility

$238.70

Service Code	EAPG 00595
Min. Negotiated Rate	$87.06
Max. Negotiated Rate	$238.70
Rate for Payer: Anthem Medicaid	$87.06
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$238.70
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$87.06
Rate for Payer: Dean Health Medicaid	$87.06
Rate for Payer: Independent Care Health Plan Medicaid	$87.06
Rate for Payer: Managed Health Services Medicaid	$90.54
Rate for Payer: Molina Healthcare Medicaid	$238.70
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$87.06
Rate for Payer: United Healthcare Medicaid	$87.06
Rate for Payer: WMAP Medicaid	$87.06

EAPG 596: PERIPHERAL AND OTHER VASCULAR DIAGNOSES

Facility

$109.25

Service Code	EAPG 00596
Min. Negotiated Rate	$63.03
Max. Negotiated Rate	$109.25
Rate for Payer: Anthem Medicaid	$63.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$109.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$63.03
Rate for Payer: Dean Health Medicaid	$63.03
Rate for Payer: Independent Care Health Plan Medicaid	$63.03
Rate for Payer: Managed Health Services Medicaid	$65.55
Rate for Payer: Molina Healthcare Medicaid	$109.25
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$63.03
Rate for Payer: United Healthcare Medicaid	$63.03
Rate for Payer: WMAP Medicaid	$63.03

EAPG 597: PHLEBITIS

Facility

$92.61

Service Code	EAPG 00597
Min. Negotiated Rate	$89.05
Max. Negotiated Rate	$92.61
Rate for Payer: Anthem Medicaid	$89.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$92.32
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$89.05
Rate for Payer: Dean Health Medicaid	$89.05
Rate for Payer: Independent Care Health Plan Medicaid	$89.05
Rate for Payer: Managed Health Services Medicaid	$92.61
Rate for Payer: Molina Healthcare Medicaid	$92.32
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$89.05
Rate for Payer: United Healthcare Medicaid	$89.05
Rate for Payer: WMAP Medicaid	$89.05

EAPG 598: ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility

$90.02

Service Code	EAPG 00598
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$90.02
Rate for Payer: Anthem Medicaid	$55.00
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$90.02
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$55.00
Rate for Payer: Dean Health Medicaid	$55.00
Rate for Payer: Independent Care Health Plan Medicaid	$55.00
Rate for Payer: Managed Health Services Medicaid	$57.20
Rate for Payer: Molina Healthcare Medicaid	$90.02
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$55.00
Rate for Payer: United Healthcare Medicaid	$55.00
Rate for Payer: WMAP Medicaid	$55.00

EAPG 599: HYPERTENSION

Facility

$98.19

Service Code	EAPG 00599
Min. Negotiated Rate	$57.45
Max. Negotiated Rate	$98.19
Rate for Payer: Anthem Medicaid	$57.45
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$98.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$57.45
Rate for Payer: Dean Health Medicaid	$57.45
Rate for Payer: Independent Care Health Plan Medicaid	$57.45
Rate for Payer: Managed Health Services Medicaid	$59.75
Rate for Payer: Molina Healthcare Medicaid	$98.19
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$57.45
Rate for Payer: United Healthcare Medicaid	$57.45
Rate for Payer: WMAP Medicaid	$57.45

EAPG 59: ARTERIOVENOUS FISTULA CREATION OR REVISION FOR HEMODIALYSIS

Facility

$1,520.46

Service Code	EAPG 00059
Min. Negotiated Rate	$1,461.98
Max. Negotiated Rate	$1,520.46
Rate for Payer: Anthem Medicaid	$1,461.98
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,461.98
Rate for Payer: Dean Health Medicaid	$1,461.98
Rate for Payer: Independent Care Health Plan Medicaid	$1,461.98
Rate for Payer: Managed Health Services Medicaid	$1,520.46
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,461.98
Rate for Payer: United Healthcare Medicaid	$1,461.98
Rate for Payer: WMAP Medicaid	$1,461.98

EAPG 5: NAIL PROCEDURES

Facility

$64.82

Service Code	EAPG 00005
Min. Negotiated Rate	$27.63
Max. Negotiated Rate	$64.82
Rate for Payer: Anthem Medicaid	$27.63
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$64.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$27.63
Rate for Payer: Dean Health Medicaid	$27.63
Rate for Payer: Independent Care Health Plan Medicaid	$27.63
Rate for Payer: Managed Health Services Medicaid	$28.74
Rate for Payer: Molina Healthcare Medicaid	$64.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$27.63
Rate for Payer: United Healthcare Medicaid	$27.63
Rate for Payer: WMAP Medicaid	$27.63

EAPG 600: CARDIAC STRUCTURAL AND VALVULAR DIAGNOSES

Facility

$89.53

Service Code	EAPG 00600
Min. Negotiated Rate	$55.67
Max. Negotiated Rate	$89.53
Rate for Payer: Anthem Medicaid	$55.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$89.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$55.67
Rate for Payer: Dean Health Medicaid	$55.67
Rate for Payer: Independent Care Health Plan Medicaid	$55.67
Rate for Payer: Managed Health Services Medicaid	$57.90
Rate for Payer: Molina Healthcare Medicaid	$89.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$55.67
Rate for Payer: United Healthcare Medicaid	$55.67
Rate for Payer: WMAP Medicaid	$55.67

EAPG 601: CARDIAC ARRHYTHMIA AND CONDUCTION DIAGNOSES

Facility

$110.03

Service Code	EAPG 00601
Min. Negotiated Rate	$79.82
Max. Negotiated Rate	$110.03
Rate for Payer: Anthem Medicaid	$79.82
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$110.03
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$79.82
Rate for Payer: Dean Health Medicaid	$79.82
Rate for Payer: Independent Care Health Plan Medicaid	$79.82
Rate for Payer: Managed Health Services Medicaid	$83.01
Rate for Payer: Molina Healthcare Medicaid	$110.03
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$79.82
Rate for Payer: United Healthcare Medicaid	$79.82
Rate for Payer: WMAP Medicaid	$79.82

EAPG 602: ATRIAL FIBRILLATION

Facility

$91.93

Service Code	EAPG 00602
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$91.93
Rate for Payer: Anthem Medicaid	$60.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$91.93
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$60.25
Rate for Payer: Dean Health Medicaid	$60.25
Rate for Payer: Independent Care Health Plan Medicaid	$60.25
Rate for Payer: Managed Health Services Medicaid	$62.66
Rate for Payer: Molina Healthcare Medicaid	$91.93
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$60.25
Rate for Payer: United Healthcare Medicaid	$60.25
Rate for Payer: WMAP Medicaid	$60.25

EAPG 604: CHEST PAIN

Facility

$241.78

Service Code	EAPG 00604
Min. Negotiated Rate	$157.84
Max. Negotiated Rate	$241.78
Rate for Payer: Anthem Medicaid	$157.84
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$241.78
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$157.84
Rate for Payer: Dean Health Medicaid	$157.84
Rate for Payer: Independent Care Health Plan Medicaid	$157.84
Rate for Payer: Managed Health Services Medicaid	$164.15
Rate for Payer: Molina Healthcare Medicaid	$241.78
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$157.84
Rate for Payer: United Healthcare Medicaid	$157.84
Rate for Payer: WMAP Medicaid	$157.84

EAPG 605: SYNCOPE AND COLLAPSE

Facility

$179.11

Service Code	EAPG 00605
Min. Negotiated Rate	$119.16
Max. Negotiated Rate	$179.11
Rate for Payer: Anthem Medicaid	$119.16
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$179.11
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$119.16
Rate for Payer: Dean Health Medicaid	$119.16
Rate for Payer: Independent Care Health Plan Medicaid	$119.16
Rate for Payer: Managed Health Services Medicaid	$123.93
Rate for Payer: Molina Healthcare Medicaid	$179.11
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$119.16
Rate for Payer: United Healthcare Medicaid	$119.16
Rate for Payer: WMAP Medicaid	$119.16

EAPG 607: CARDIOMYOPATHY DIAGNOSES

Facility

$56.82

Service Code	EAPG 00607
Min. Negotiated Rate	$54.63
Max. Negotiated Rate	$56.82
Rate for Payer: Anthem Medicaid	$54.63
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.63
Rate for Payer: Dean Health Medicaid	$54.63
Rate for Payer: Independent Care Health Plan Medicaid	$54.63
Rate for Payer: Managed Health Services Medicaid	$56.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.63
Rate for Payer: United Healthcare Medicaid	$54.63
Rate for Payer: WMAP Medicaid	$54.63

EAPG 608: ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$54.49

Service Code	EAPG 00608
Min. Negotiated Rate	$52.39
Max. Negotiated Rate	$54.49
Rate for Payer: Anthem Medicaid	$52.39
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$52.39
Rate for Payer: Dean Health Medicaid	$52.39
Rate for Payer: Independent Care Health Plan Medicaid	$52.39
Rate for Payer: Managed Health Services Medicaid	$54.49
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$52.39
Rate for Payer: United Healthcare Medicaid	$52.39
Rate for Payer: WMAP Medicaid	$52.39

EAPG 60: PULMONARY FUNCTION TESTS

Facility

$180.58

Service Code	EAPG 00060
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$180.58
Rate for Payer: Anthem Medicaid	$42.88
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$180.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$42.88
Rate for Payer: Dean Health Medicaid	$42.88
Rate for Payer: Independent Care Health Plan Medicaid	$42.88
Rate for Payer: Managed Health Services Medicaid	$44.60
Rate for Payer: Molina Healthcare Medicaid	$180.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$42.88
Rate for Payer: United Healthcare Medicaid	$42.88
Rate for Payer: WMAP Medicaid	$42.88

EAPG 610: CONTUSIONS TO EXTERNAL ORGANS OTHER THAN HEAD TRAUMA

Facility

$111.77

Service Code	EAPG 00610
Min. Negotiated Rate	$107.47
Max. Negotiated Rate	$111.77
Rate for Payer: Anthem Medicaid	$107.47
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$107.47
Rate for Payer: Dean Health Medicaid	$107.47
Rate for Payer: Independent Care Health Plan Medicaid	$107.47
Rate for Payer: Managed Health Services Medicaid	$111.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$107.47
Rate for Payer: United Healthcare Medicaid	$107.47
Rate for Payer: WMAP Medicaid	$107.47

EAPG 616: DIVERTICULITIS AND DIVERTICULOSIS

Facility

$93.46

Service Code	EAPG 00616
Min. Negotiated Rate	$89.87
Max. Negotiated Rate	$93.46
Rate for Payer: Anthem Medicaid	$89.87
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$89.87
Rate for Payer: Dean Health Medicaid	$89.87
Rate for Payer: Independent Care Health Plan Medicaid	$89.87
Rate for Payer: Managed Health Services Medicaid	$93.46
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$89.87
Rate for Payer: United Healthcare Medicaid	$89.87
Rate for Payer: WMAP Medicaid	$89.87

EAPG 617: GASTROINTESTINAL HEMORRHAGE AND RELATED POSTPROCEDURAL HEMORRHAGE DIAGNOSES

Facility

$122.26

Service Code	EAPG 00617
Min. Negotiated Rate	$117.56
Max. Negotiated Rate	$122.26
Rate for Payer: Anthem Medicaid	$117.56
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$117.56
Rate for Payer: Dean Health Medicaid	$117.56
Rate for Payer: Independent Care Health Plan Medicaid	$117.56
Rate for Payer: Managed Health Services Medicaid	$122.26
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$117.56
Rate for Payer: United Healthcare Medicaid	$117.56
Rate for Payer: WMAP Medicaid	$117.56

EAPG 618: INTESTINAL OBSTRUCTION DIAGNOSES

Facility

$121.99

Service Code	EAPG 00618
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$121.99
Rate for Payer: Anthem Medicaid	$117.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$117.30
Rate for Payer: Dean Health Medicaid	$117.30
Rate for Payer: Independent Care Health Plan Medicaid	$117.30
Rate for Payer: Managed Health Services Medicaid	$121.99
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$117.30
Rate for Payer: United Healthcare Medicaid	$117.30
Rate for Payer: WMAP Medicaid	$117.30

EAPG 619: GASTROINTESTINAL AND PERITONEAL INFECTION DIAGNOSES

Facility

$91.87

Service Code	EAPG 00619
Min. Negotiated Rate	$88.34
Max. Negotiated Rate	$91.87
Rate for Payer: Anthem Medicaid	$88.34
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$88.34
Rate for Payer: Dean Health Medicaid	$88.34
Rate for Payer: Independent Care Health Plan Medicaid	$88.34
Rate for Payer: Managed Health Services Medicaid	$91.87
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$88.34
Rate for Payer: United Healthcare Medicaid	$88.34
Rate for Payer: WMAP Medicaid	$88.34

EAPG 620: DIGESTIVE MALIGNANCY

Facility

$122.99

Service Code	EAPG 00620
Min. Negotiated Rate	$74.83
Max. Negotiated Rate	$122.99
Rate for Payer: Anthem Medicaid	$74.83
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$122.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$74.83
Rate for Payer: Dean Health Medicaid	$74.83
Rate for Payer: Independent Care Health Plan Medicaid	$74.83
Rate for Payer: Managed Health Services Medicaid	$77.82
Rate for Payer: Molina Healthcare Medicaid	$122.99
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$74.83
Rate for Payer: United Healthcare Medicaid	$74.83
Rate for Payer: WMAP Medicaid	$74.83

EAPG 621: PEPTIC ULCER AND GASTRITIS

Facility

$175.88

Service Code	EAPG 00621
Min. Negotiated Rate	$115.58
Max. Negotiated Rate	$175.88
Rate for Payer: Anthem Medicaid	$115.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$175.88
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$115.58
Rate for Payer: Dean Health Medicaid	$115.58
Rate for Payer: Independent Care Health Plan Medicaid	$115.58
Rate for Payer: Managed Health Services Medicaid	$120.20
Rate for Payer: Molina Healthcare Medicaid	$175.88
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$115.58
Rate for Payer: United Healthcare Medicaid	$115.58
Rate for Payer: WMAP Medicaid	$115.58

EAPG 623: ESOPHAGITIS AND OTHER ESOPHAGEAL DIAGNOSES

Facility

$117.96

Service Code	EAPG 00623
Min. Negotiated Rate	$65.76
Max. Negotiated Rate	$117.96
Rate for Payer: Anthem Medicaid	$65.76
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$117.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$65.76
Rate for Payer: Dean Health Medicaid	$65.76
Rate for Payer: Independent Care Health Plan Medicaid	$65.76
Rate for Payer: Managed Health Services Medicaid	$68.39
Rate for Payer: Molina Healthcare Medicaid	$117.96
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$65.76
Rate for Payer: United Healthcare Medicaid	$65.76
Rate for Payer: WMAP Medicaid	$65.76

EAPG 624: OTHER GASTROINTESTINAL SYSTEM DIAGNOSES

Facility

$114.24

Service Code	EAPG 00624
Min. Negotiated Rate	$75.13
Max. Negotiated Rate	$114.24
Rate for Payer: Anthem Medicaid	$75.13
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$114.24
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$75.13
Rate for Payer: Dean Health Medicaid	$75.13
Rate for Payer: Independent Care Health Plan Medicaid	$75.13
Rate for Payer: Managed Health Services Medicaid	$78.14
Rate for Payer: Molina Healthcare Medicaid	$114.24
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$75.13
Rate for Payer: United Healthcare Medicaid	$75.13
Rate for Payer: WMAP Medicaid	$75.13

EAPG 626: INFLAMMATORY BOWEL DISEASE

Facility

$100.15

Service Code	EAPG 00626
Min. Negotiated Rate	$54.92
Max. Negotiated Rate	$100.15
Rate for Payer: Anthem Medicaid	$54.92
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$100.15
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.92
Rate for Payer: Dean Health Medicaid	$54.92
Rate for Payer: Independent Care Health Plan Medicaid	$54.92
Rate for Payer: Managed Health Services Medicaid	$57.12
Rate for Payer: Molina Healthcare Medicaid	$100.15
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.92
Rate for Payer: United Healthcare Medicaid	$54.92
Rate for Payer: WMAP Medicaid	$54.92

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