Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 627: NON-BACTERIAL GASTROENTERITIS, NAUSEA AND VOMITING

Facility

$162.13

Service Code	EAPG 00627
Min. Negotiated Rate	$89.42
Max. Negotiated Rate	$162.13
Rate for Payer: Anthem Medicaid	$89.42
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$162.13
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$89.42
Rate for Payer: Dean Health Medicaid	$89.42
Rate for Payer: Independent Care Health Plan Medicaid	$89.42
Rate for Payer: Managed Health Services Medicaid	$93.00
Rate for Payer: Molina Healthcare Medicaid	$162.13
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$89.42
Rate for Payer: United Healthcare Medicaid	$89.42
Rate for Payer: WMAP Medicaid	$89.42

EAPG 628: ABDOMINAL PAIN

Facility

$166.83

Service Code	EAPG 00628
Min. Negotiated Rate	$104.10
Max. Negotiated Rate	$166.83
Rate for Payer: Anthem Medicaid	$104.10
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$166.83
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$104.10
Rate for Payer: Dean Health Medicaid	$104.10
Rate for Payer: Independent Care Health Plan Medicaid	$104.10
Rate for Payer: Managed Health Services Medicaid	$108.26
Rate for Payer: Molina Healthcare Medicaid	$166.83
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$104.10
Rate for Payer: United Healthcare Medicaid	$104.10
Rate for Payer: WMAP Medicaid	$104.10

EAPG 629: MALFUNCTION, REACTION AND COMPLICATION OF GI DEVICE OR PROCEDURE

Facility

$134.25

Service Code	EAPG 00629
Min. Negotiated Rate	$123.41
Max. Negotiated Rate	$134.25
Rate for Payer: Anthem Medicaid	$123.41
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$134.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$123.41
Rate for Payer: Dean Health Medicaid	$123.41
Rate for Payer: Independent Care Health Plan Medicaid	$123.41
Rate for Payer: Managed Health Services Medicaid	$128.35
Rate for Payer: Molina Healthcare Medicaid	$134.25
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$123.41
Rate for Payer: United Healthcare Medicaid	$123.41
Rate for Payer: WMAP Medicaid	$123.41

EAPG 62: LEVEL I ENDOSCOPY OF THE UPPER AIRWAY

Facility

$319.18

Service Code	EAPG 00062
Min. Negotiated Rate	$250.87
Max. Negotiated Rate	$319.18
Rate for Payer: Anthem Medicaid	$250.87
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$319.18
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$250.87
Rate for Payer: Dean Health Medicaid	$250.87
Rate for Payer: Independent Care Health Plan Medicaid	$250.87
Rate for Payer: Managed Health Services Medicaid	$260.90
Rate for Payer: Molina Healthcare Medicaid	$319.18
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$250.87
Rate for Payer: United Healthcare Medicaid	$250.87
Rate for Payer: WMAP Medicaid	$250.87

EAPG 630: CONSTIPATION

Facility

$146.77

Service Code	EAPG 00630
Min. Negotiated Rate	$85.01
Max. Negotiated Rate	$146.77
Rate for Payer: Anthem Medicaid	$85.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$146.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$85.01
Rate for Payer: Dean Health Medicaid	$85.01
Rate for Payer: Independent Care Health Plan Medicaid	$85.01
Rate for Payer: Managed Health Services Medicaid	$88.41
Rate for Payer: Molina Healthcare Medicaid	$146.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$85.01
Rate for Payer: United Healthcare Medicaid	$85.01
Rate for Payer: WMAP Medicaid	$85.01

EAPG 631: HERNIA

Facility

$104.26

Service Code	EAPG 00631
Min. Negotiated Rate	$65.58
Max. Negotiated Rate	$104.26
Rate for Payer: Anthem Medicaid	$65.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$104.26
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$65.58
Rate for Payer: Dean Health Medicaid	$65.58
Rate for Payer: Independent Care Health Plan Medicaid	$65.58
Rate for Payer: Managed Health Services Medicaid	$68.20
Rate for Payer: Molina Healthcare Medicaid	$104.26
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$65.58
Rate for Payer: United Healthcare Medicaid	$65.58
Rate for Payer: WMAP Medicaid	$65.58

EAPG 632: IRRITABLE BOWEL SYNDROME

Facility

$86.99

Service Code	EAPG 00632
Min. Negotiated Rate	$47.78
Max. Negotiated Rate	$86.99
Rate for Payer: Anthem Medicaid	$47.78
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$86.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$47.78
Rate for Payer: Dean Health Medicaid	$47.78
Rate for Payer: Independent Care Health Plan Medicaid	$47.78
Rate for Payer: Managed Health Services Medicaid	$49.69
Rate for Payer: Molina Healthcare Medicaid	$86.99
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$47.78
Rate for Payer: United Healthcare Medicaid	$47.78
Rate for Payer: WMAP Medicaid	$47.78

EAPG 633: ALCOHOLIC LIVER DISEASE

Facility

$124.81

Service Code	EAPG 00633
Min. Negotiated Rate	$75.49
Max. Negotiated Rate	$124.81
Rate for Payer: Anthem Medicaid	$75.49
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$124.81
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$75.49
Rate for Payer: Dean Health Medicaid	$75.49
Rate for Payer: Independent Care Health Plan Medicaid	$75.49
Rate for Payer: Managed Health Services Medicaid	$78.51
Rate for Payer: Molina Healthcare Medicaid	$124.81
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$75.49
Rate for Payer: United Healthcare Medicaid	$75.49
Rate for Payer: WMAP Medicaid	$75.49

EAPG 634: MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS

Facility

$132.63

Service Code	EAPG 00634
Min. Negotiated Rate	$90.23
Max. Negotiated Rate	$132.63
Rate for Payer: Anthem Medicaid	$90.23
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$132.63
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$90.23
Rate for Payer: Dean Health Medicaid	$90.23
Rate for Payer: Independent Care Health Plan Medicaid	$90.23
Rate for Payer: Managed Health Services Medicaid	$93.84
Rate for Payer: Molina Healthcare Medicaid	$132.63
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$90.23
Rate for Payer: United Healthcare Medicaid	$90.23
Rate for Payer: WMAP Medicaid	$90.23

EAPG 635: PANCREAS DIAGNOSES EXCEPT MALIGNANCY

Facility

$135.08

Service Code	EAPG 00635
Min. Negotiated Rate	$86.13
Max. Negotiated Rate	$135.08
Rate for Payer: Anthem Medicaid	$86.13
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$135.08
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$86.13
Rate for Payer: Dean Health Medicaid	$86.13
Rate for Payer: Independent Care Health Plan Medicaid	$86.13
Rate for Payer: Managed Health Services Medicaid	$89.58
Rate for Payer: Molina Healthcare Medicaid	$135.08
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$86.13
Rate for Payer: United Healthcare Medicaid	$86.13
Rate for Payer: WMAP Medicaid	$86.13

EAPG 636: HEPATITIS WITHOUT COMA

Facility

$113.41

Service Code	EAPG 00636
Min. Negotiated Rate	$71.90
Max. Negotiated Rate	$113.41
Rate for Payer: Anthem Medicaid	$71.90
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$113.41
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$71.90
Rate for Payer: Dean Health Medicaid	$71.90
Rate for Payer: Independent Care Health Plan Medicaid	$71.90
Rate for Payer: Managed Health Services Medicaid	$74.78
Rate for Payer: Molina Healthcare Medicaid	$113.41
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$71.90
Rate for Payer: United Healthcare Medicaid	$71.90
Rate for Payer: WMAP Medicaid	$71.90

EAPG 637: GALLBLADDER AND BILIARY TRACT DIAGNOSES

Facility

$114.92

Service Code	EAPG 00637
Min. Negotiated Rate	$88.10
Max. Negotiated Rate	$114.92
Rate for Payer: Anthem Medicaid	$88.10
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$114.92
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$88.10
Rate for Payer: Dean Health Medicaid	$88.10
Rate for Payer: Independent Care Health Plan Medicaid	$88.10
Rate for Payer: Managed Health Services Medicaid	$91.62
Rate for Payer: Molina Healthcare Medicaid	$114.92
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$88.10
Rate for Payer: United Healthcare Medicaid	$88.10
Rate for Payer: WMAP Medicaid	$88.10

EAPG 638: CHOLECYSTITIS

Facility

$155.43

Service Code	EAPG 00638
Min. Negotiated Rate	$126.12
Max. Negotiated Rate	$155.43
Rate for Payer: Anthem Medicaid	$126.12
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$155.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$126.12
Rate for Payer: Dean Health Medicaid	$126.12
Rate for Payer: Independent Care Health Plan Medicaid	$126.12
Rate for Payer: Managed Health Services Medicaid	$131.16
Rate for Payer: Molina Healthcare Medicaid	$155.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$126.12
Rate for Payer: United Healthcare Medicaid	$126.12
Rate for Payer: WMAP Medicaid	$126.12

EAPG 639: OTHER HEPATOBILIARY SYSTEM DIAGNOSES

Facility

$119.23

Service Code	EAPG 00639
Min. Negotiated Rate	$73.57
Max. Negotiated Rate	$119.23
Rate for Payer: Anthem Medicaid	$73.57
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$119.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$73.57
Rate for Payer: Dean Health Medicaid	$73.57
Rate for Payer: Independent Care Health Plan Medicaid	$73.57
Rate for Payer: Managed Health Services Medicaid	$76.51
Rate for Payer: Molina Healthcare Medicaid	$119.23
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$73.57
Rate for Payer: United Healthcare Medicaid	$73.57
Rate for Payer: WMAP Medicaid	$73.57

EAPG 63: LEVEL II ENDOSCOPY OF THE UPPER AIRWAY

Facility

$2,321.00

Service Code	EAPG 00063
Min. Negotiated Rate	$782.05
Max. Negotiated Rate	$2,321.00
Rate for Payer: Anthem Medicaid	$782.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,321.00
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$782.05
Rate for Payer: Dean Health Medicaid	$782.05
Rate for Payer: Independent Care Health Plan Medicaid	$782.05
Rate for Payer: Managed Health Services Medicaid	$813.33
Rate for Payer: Molina Healthcare Medicaid	$2,321.00
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$782.05
Rate for Payer: United Healthcare Medicaid	$782.05
Rate for Payer: WMAP Medicaid	$782.05

EAPG 641: HEPATIC COMA AND MAJOR ACUTE LIVER DIAGNOSES

Facility

$71.76

Service Code	EAPG 00641
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$71.76
Rate for Payer: Anthem Medicaid	$69.00
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$69.00
Rate for Payer: Dean Health Medicaid	$69.00
Rate for Payer: Independent Care Health Plan Medicaid	$69.00
Rate for Payer: Managed Health Services Medicaid	$71.76
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$69.00
Rate for Payer: United Healthcare Medicaid	$69.00
Rate for Payer: WMAP Medicaid	$69.00

EAPG 642: GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$96.06

Service Code	EAPG 00642
Min. Negotiated Rate	$92.37
Max. Negotiated Rate	$96.06
Rate for Payer: Anthem Medicaid	$92.37
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$92.37
Rate for Payer: Dean Health Medicaid	$92.37
Rate for Payer: Independent Care Health Plan Medicaid	$92.37
Rate for Payer: Managed Health Services Medicaid	$96.06
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$92.37
Rate for Payer: United Healthcare Medicaid	$92.37
Rate for Payer: WMAP Medicaid	$92.37

EAPG 647: FRACTURES, DISLOCATIONS, OTHER INJURIES - UPPER EXTREMITY INCLUDING SHOULDER

Facility

$120.97

Service Code	EAPG 00647
Min. Negotiated Rate	$116.32
Max. Negotiated Rate	$120.97
Rate for Payer: Anthem Medicaid	$116.32
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$116.32
Rate for Payer: Dean Health Medicaid	$116.32
Rate for Payer: Independent Care Health Plan Medicaid	$116.32
Rate for Payer: Managed Health Services Medicaid	$120.97
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$116.32
Rate for Payer: United Healthcare Medicaid	$116.32
Rate for Payer: WMAP Medicaid	$116.32

EAPG 648: FRACTURES, DISLOCATIONS AND SPRAINS OF THE SKULL, CRANIUM AND FACE

Facility

$138.56

Service Code	EAPG 00648
Min. Negotiated Rate	$133.23
Max. Negotiated Rate	$138.56
Rate for Payer: Anthem Medicaid	$133.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$133.23
Rate for Payer: Dean Health Medicaid	$133.23
Rate for Payer: Independent Care Health Plan Medicaid	$133.23
Rate for Payer: Managed Health Services Medicaid	$138.56
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$133.23
Rate for Payer: United Healthcare Medicaid	$133.23
Rate for Payer: WMAP Medicaid	$133.23

EAPG 649: OTHER PATHOLOGICAL FRACTURES W/O MUSCULOSKELETAL MALIGNANCY

Facility

$116.04

Service Code	EAPG 00649
Min. Negotiated Rate	$111.58
Max. Negotiated Rate	$116.04
Rate for Payer: Anthem Medicaid	$111.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$111.58
Rate for Payer: Dean Health Medicaid	$111.58
Rate for Payer: Independent Care Health Plan Medicaid	$111.58
Rate for Payer: Managed Health Services Medicaid	$116.04
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$111.58
Rate for Payer: United Healthcare Medicaid	$111.58
Rate for Payer: WMAP Medicaid	$111.58

EAPG 64: LEVEL I LOWER AIRWAY ENDOSCOPY

Facility

$1,368.21

Service Code	EAPG 00064
Min. Negotiated Rate	$744.66
Max. Negotiated Rate	$1,368.21
Rate for Payer: Anthem Medicaid	$744.66
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,368.21
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$744.66
Rate for Payer: Dean Health Medicaid	$744.66
Rate for Payer: Independent Care Health Plan Medicaid	$744.66
Rate for Payer: Managed Health Services Medicaid	$774.45
Rate for Payer: Molina Healthcare Medicaid	$1,368.21
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$744.66
Rate for Payer: United Healthcare Medicaid	$744.66
Rate for Payer: WMAP Medicaid	$744.66

EAPG 650: FRACTURES, DISLOCATIONS, OTHER INJURIES - LOWER EXTREMITY INCLUDING FEMUR

Facility

$258.61

Service Code	EAPG 00650
Min. Negotiated Rate	$114.79
Max. Negotiated Rate	$258.61
Rate for Payer: Anthem Medicaid	$114.79
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$258.61
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$114.79
Rate for Payer: Dean Health Medicaid	$114.79
Rate for Payer: Independent Care Health Plan Medicaid	$114.79
Rate for Payer: Managed Health Services Medicaid	$119.38
Rate for Payer: Molina Healthcare Medicaid	$258.61
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$114.79
Rate for Payer: United Healthcare Medicaid	$114.79
Rate for Payer: WMAP Medicaid	$114.79

EAPG 651: FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE PELVIS AND HIP

Facility

$201.96

Service Code	EAPG 00651
Min. Negotiated Rate	$145.47
Max. Negotiated Rate	$201.96
Rate for Payer: Anthem Medicaid	$145.47
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$201.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$145.47
Rate for Payer: Dean Health Medicaid	$145.47
Rate for Payer: Independent Care Health Plan Medicaid	$145.47
Rate for Payer: Managed Health Services Medicaid	$151.29
Rate for Payer: Molina Healthcare Medicaid	$201.96
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$145.47
Rate for Payer: United Healthcare Medicaid	$145.47
Rate for Payer: WMAP Medicaid	$145.47

EAPG 652: OTHER INJURIES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE

Facility

$178.52

Service Code	EAPG 00652
Min. Negotiated Rate	$60.11
Max. Negotiated Rate	$178.52
Rate for Payer: Anthem Medicaid	$60.11
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$178.52
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: Molina Healthcare Medicaid	$178.52
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 653: MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FX DUE TO MALIGNANCY

Facility

$142.81

Service Code	EAPG 00653
Min. Negotiated Rate	$81.27
Max. Negotiated Rate	$142.81
Rate for Payer: Anthem Medicaid	$81.27
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$142.81
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$81.27
Rate for Payer: Dean Health Medicaid	$81.27
Rate for Payer: Independent Care Health Plan Medicaid	$81.27
Rate for Payer: Managed Health Services Medicaid	$84.52
Rate for Payer: Molina Healthcare Medicaid	$142.81
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$81.27
Rate for Payer: United Healthcare Medicaid	$81.27
Rate for Payer: WMAP Medicaid	$81.27

Know your out-of-pocket cost for care.

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