Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 654: OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$112.48

Service Code	EAPG 00654
Min. Negotiated Rate	$63.37
Max. Negotiated Rate	$112.48
Rate for Payer: Anthem Medicaid	$63.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$112.48
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$63.37
Rate for Payer: Dean Health Medicaid	$63.37
Rate for Payer: Independent Care Health Plan Medicaid	$63.37
Rate for Payer: Managed Health Services Medicaid	$65.90
Rate for Payer: Molina Healthcare Medicaid	$112.48
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$63.37
Rate for Payer: United Healthcare Medicaid	$63.37
Rate for Payer: WMAP Medicaid	$63.37

EAPG 655: CONNECTIVE TISSUE DIAGNOSES

Facility

$100.44

Service Code	EAPG 00655
Min. Negotiated Rate	$52.54
Max. Negotiated Rate	$100.44
Rate for Payer: Anthem Medicaid	$52.54
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$100.44
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$52.54
Rate for Payer: Dean Health Medicaid	$52.54
Rate for Payer: Independent Care Health Plan Medicaid	$52.54
Rate for Payer: Managed Health Services Medicaid	$54.64
Rate for Payer: Molina Healthcare Medicaid	$100.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$52.54
Rate for Payer: United Healthcare Medicaid	$52.54
Rate for Payer: WMAP Medicaid	$52.54

EAPG 656: FRACTURES, DISLOCATIONS, OTHER INJURIES OF THE NECK, UPPER BACK AND CHEST

Facility

$132.83

Service Code	EAPG 00656
Min. Negotiated Rate	$127.51
Max. Negotiated Rate	$132.83
Rate for Payer: Anthem Medicaid	$127.51
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$132.83
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$127.51
Rate for Payer: Dean Health Medicaid	$127.51
Rate for Payer: Independent Care Health Plan Medicaid	$127.51
Rate for Payer: Managed Health Services Medicaid	$132.61
Rate for Payer: Molina Healthcare Medicaid	$132.83
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$127.51
Rate for Payer: United Healthcare Medicaid	$127.51
Rate for Payer: WMAP Medicaid	$127.51

EAPG 657: FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE LOWER BACK

Facility

$117.76

Service Code	EAPG 00657
Min. Negotiated Rate	$70.89
Max. Negotiated Rate	$117.76
Rate for Payer: Anthem Medicaid	$70.89
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$117.76
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.89
Rate for Payer: Dean Health Medicaid	$70.89
Rate for Payer: Independent Care Health Plan Medicaid	$70.89
Rate for Payer: Managed Health Services Medicaid	$73.73
Rate for Payer: Molina Healthcare Medicaid	$117.76
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.89
Rate for Payer: United Healthcare Medicaid	$70.89
Rate for Payer: WMAP Medicaid	$70.89

EAPG 658: SCIATICA AND LOW BACK PAIN

Facility

$130.58

Service Code	EAPG 00658
Min. Negotiated Rate	$69.04
Max. Negotiated Rate	$130.58
Rate for Payer: Anthem Medicaid	$69.04
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$130.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$69.04
Rate for Payer: Dean Health Medicaid	$69.04
Rate for Payer: Independent Care Health Plan Medicaid	$69.04
Rate for Payer: Managed Health Services Medicaid	$71.80
Rate for Payer: Molina Healthcare Medicaid	$130.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$69.04
Rate for Payer: United Healthcare Medicaid	$69.04
Rate for Payer: WMAP Medicaid	$69.04

EAPG 659: MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$123.78

Service Code	EAPG 00659
Min. Negotiated Rate	$79.75
Max. Negotiated Rate	$123.78
Rate for Payer: Anthem Medicaid	$79.75
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$123.78
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$79.75
Rate for Payer: Dean Health Medicaid	$79.75
Rate for Payer: Independent Care Health Plan Medicaid	$79.75
Rate for Payer: Managed Health Services Medicaid	$82.94
Rate for Payer: Molina Healthcare Medicaid	$123.78
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$79.75
Rate for Payer: United Healthcare Medicaid	$79.75
Rate for Payer: WMAP Medicaid	$79.75

EAPG 660: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES

Facility

$124.02

Service Code	EAPG 00660
Min. Negotiated Rate	$70.92
Max. Negotiated Rate	$124.02
Rate for Payer: WMAP Medicaid	$70.92
Rate for Payer: Anthem Medicaid	$70.92
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$124.02
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.92
Rate for Payer: Dean Health Medicaid	$70.92
Rate for Payer: Independent Care Health Plan Medicaid	$70.92
Rate for Payer: Managed Health Services Medicaid	$73.76
Rate for Payer: Molina Healthcare Medicaid	$124.02
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.92
Rate for Payer: United Healthcare Medicaid	$70.92

EAPG 662: OSTEOPOROSIS

Facility

$89.68

Service Code	EAPG 00662
Min. Negotiated Rate	$56.57
Max. Negotiated Rate	$89.68
Rate for Payer: Anthem Medicaid	$56.57
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$89.68
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$56.57
Rate for Payer: Dean Health Medicaid	$56.57
Rate for Payer: Independent Care Health Plan Medicaid	$56.57
Rate for Payer: Managed Health Services Medicaid	$58.83
Rate for Payer: Molina Healthcare Medicaid	$89.68
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$56.57
Rate for Payer: United Healthcare Medicaid	$56.57
Rate for Payer: WMAP Medicaid	$56.57

EAPG 663: PAIN RELATED DIAGNOSES

Facility

$114.38

Service Code	EAPG 00663
Min. Negotiated Rate	$59.08
Max. Negotiated Rate	$114.38
Rate for Payer: Anthem Medicaid	$59.08
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$114.38
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$59.08
Rate for Payer: Dean Health Medicaid	$59.08
Rate for Payer: Independent Care Health Plan Medicaid	$59.08
Rate for Payer: Managed Health Services Medicaid	$61.44
Rate for Payer: Molina Healthcare Medicaid	$114.38
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$59.08
Rate for Payer: United Healthcare Medicaid	$59.08
Rate for Payer: WMAP Medicaid	$59.08

EAPG 66: PULMONARY REHABILITATIVE SERVICES

Facility

$101.32

Service Code	EAPG 00066
Min. Negotiated Rate	$14.19
Max. Negotiated Rate	$101.32
Rate for Payer: Anthem Medicaid	$14.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$101.32
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$14.19
Rate for Payer: Dean Health Medicaid	$14.19
Rate for Payer: Independent Care Health Plan Medicaid	$14.19
Rate for Payer: Managed Health Services Medicaid	$14.76
Rate for Payer: Molina Healthcare Medicaid	$101.32
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$14.19
Rate for Payer: United Healthcare Medicaid	$14.19
Rate for Payer: WMAP Medicaid	$14.19

EAPG 670: NON-PRESSURE CHRONIC SKIN ULCERS

Facility

$136.30

Service Code	EAPG 00670
Min. Negotiated Rate	$59.90
Max. Negotiated Rate	$136.30
Rate for Payer: Anthem Medicaid	$59.90
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$136.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$59.90
Rate for Payer: Dean Health Medicaid	$59.90
Rate for Payer: Independent Care Health Plan Medicaid	$59.90
Rate for Payer: Managed Health Services Medicaid	$62.30
Rate for Payer: Molina Healthcare Medicaid	$136.30
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$59.90
Rate for Payer: United Healthcare Medicaid	$59.90
Rate for Payer: WMAP Medicaid	$59.90

EAPG 671: MAJOR SKIN DIAGNOSES

Facility

$102.69

Service Code	EAPG 00671
Min. Negotiated Rate	$52.55
Max. Negotiated Rate	$102.69
Rate for Payer: Anthem Medicaid	$52.55
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$102.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$52.55
Rate for Payer: Dean Health Medicaid	$52.55
Rate for Payer: Independent Care Health Plan Medicaid	$52.55
Rate for Payer: Managed Health Services Medicaid	$54.65
Rate for Payer: Molina Healthcare Medicaid	$102.69
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$52.55
Rate for Payer: United Healthcare Medicaid	$52.55
Rate for Payer: WMAP Medicaid	$52.55

EAPG 672: MALIGNANT BREAST DIAGNOSES

Facility

$111.55

Service Code	EAPG 00672
Min. Negotiated Rate	$56.37
Max. Negotiated Rate	$111.55
Rate for Payer: Anthem Medicaid	$56.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$111.55
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$56.37
Rate for Payer: Dean Health Medicaid	$56.37
Rate for Payer: Independent Care Health Plan Medicaid	$56.37
Rate for Payer: Managed Health Services Medicaid	$58.62
Rate for Payer: Molina Healthcare Medicaid	$111.55
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$56.37
Rate for Payer: United Healthcare Medicaid	$56.37
Rate for Payer: WMAP Medicaid	$56.37

EAPG 673: CELLULITIS AND OTHER BACTERIAL SKIN INFECTIONS

Facility

$112.87

Service Code	EAPG 00673
Min. Negotiated Rate	$77.38
Max. Negotiated Rate	$112.87
Rate for Payer: Anthem Medicaid	$77.38
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$112.87
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$77.38
Rate for Payer: Dean Health Medicaid	$77.38
Rate for Payer: Independent Care Health Plan Medicaid	$77.38
Rate for Payer: Managed Health Services Medicaid	$80.48
Rate for Payer: Molina Healthcare Medicaid	$112.87
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$77.38
Rate for Payer: United Healthcare Medicaid	$77.38
Rate for Payer: WMAP Medicaid	$77.38

EAPG 674: OPEN WOUNDS, PUNCTURES AND OTHER OPEN TRAUMATIC INJURIES

Facility

$144.23

Service Code	EAPG 00674
Min. Negotiated Rate	$70.71
Max. Negotiated Rate	$144.23
Rate for Payer: WMAP Medicaid	$70.71
Rate for Payer: Anthem Medicaid	$70.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$144.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.71
Rate for Payer: Dean Health Medicaid	$70.71
Rate for Payer: Independent Care Health Plan Medicaid	$70.71
Rate for Payer: Managed Health Services Medicaid	$73.54
Rate for Payer: Molina Healthcare Medicaid	$144.23
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.71
Rate for Payer: United Healthcare Medicaid	$70.71

EAPG 675: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DIAGNOSES

Facility

$92.27

Service Code	EAPG 00675
Min. Negotiated Rate	$44.69
Max. Negotiated Rate	$92.27
Rate for Payer: Anthem Medicaid	$44.69
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$92.27
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$44.69
Rate for Payer: Dean Health Medicaid	$44.69
Rate for Payer: Independent Care Health Plan Medicaid	$44.69
Rate for Payer: Managed Health Services Medicaid	$46.48
Rate for Payer: Molina Healthcare Medicaid	$92.27
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$44.69
Rate for Payer: United Healthcare Medicaid	$44.69
Rate for Payer: WMAP Medicaid	$44.69

EAPG 676: PRESSURE ULCERS

Facility

$141.39

Service Code	EAPG 00676
Min. Negotiated Rate	$61.42
Max. Negotiated Rate	$141.39
Rate for Payer: Anthem Medicaid	$61.42
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$141.39
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$61.42
Rate for Payer: Dean Health Medicaid	$61.42
Rate for Payer: Independent Care Health Plan Medicaid	$61.42
Rate for Payer: Managed Health Services Medicaid	$63.88
Rate for Payer: Molina Healthcare Medicaid	$141.39
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$61.42
Rate for Payer: United Healthcare Medicaid	$61.42
Rate for Payer: WMAP Medicaid	$61.42

EAPG 67: VENTILATION ASSISTANCE AND MANAGEMENT

Facility

$578.77

Service Code	EAPG 00067
Min. Negotiated Rate	$439.36
Max. Negotiated Rate	$578.77
Rate for Payer: Anthem Medicaid	$439.36
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$578.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$439.36
Rate for Payer: Dean Health Medicaid	$439.36
Rate for Payer: Independent Care Health Plan Medicaid	$439.36
Rate for Payer: Managed Health Services Medicaid	$456.93
Rate for Payer: Molina Healthcare Medicaid	$578.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$439.36
Rate for Payer: United Healthcare Medicaid	$439.36
Rate for Payer: WMAP Medicaid	$439.36

EAPG 68: THORACENTESIS, RELATED BIOPSY AND PLEURAL DRAINAGE PROCEDURES

Facility

$430.51

Service Code	EAPG 00068
Min. Negotiated Rate	$413.95
Max. Negotiated Rate	$430.51
Rate for Payer: Anthem Medicaid	$413.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$413.95
Rate for Payer: Dean Health Medicaid	$413.95
Rate for Payer: Independent Care Health Plan Medicaid	$413.95
Rate for Payer: Managed Health Services Medicaid	$430.51
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$413.95
Rate for Payer: United Healthcare Medicaid	$413.95
Rate for Payer: WMAP Medicaid	$413.95

EAPG 690: MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DIAGNOSES

Facility

$104.80

Service Code	EAPG 00690
Min. Negotiated Rate	$67.42
Max. Negotiated Rate	$104.80
Rate for Payer: Anthem Medicaid	$67.42
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$104.80
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$67.42
Rate for Payer: Dean Health Medicaid	$67.42
Rate for Payer: Independent Care Health Plan Medicaid	$67.42
Rate for Payer: Managed Health Services Medicaid	$70.12
Rate for Payer: Molina Healthcare Medicaid	$104.80
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$67.42
Rate for Payer: United Healthcare Medicaid	$67.42
Rate for Payer: WMAP Medicaid	$67.42

EAPG 691: INBORN ERRORS OF METABOLISM

Facility

$91.34

Service Code	EAPG 00691
Min. Negotiated Rate	$48.68
Max. Negotiated Rate	$91.34
Rate for Payer: Anthem Medicaid	$48.68
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$91.34
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$48.68
Rate for Payer: Dean Health Medicaid	$48.68
Rate for Payer: Independent Care Health Plan Medicaid	$48.68
Rate for Payer: Managed Health Services Medicaid	$50.63
Rate for Payer: Molina Healthcare Medicaid	$91.34
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$48.68
Rate for Payer: United Healthcare Medicaid	$48.68
Rate for Payer: WMAP Medicaid	$48.68

EAPG 692: OTHER ENDOCRINE SYSTEM DIAGNOSES

Facility

$97.16

Service Code	EAPG 00692
Min. Negotiated Rate	$59.32
Max. Negotiated Rate	$97.16
Rate for Payer: Anthem Medicaid	$59.32
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$97.16
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$59.32
Rate for Payer: Dean Health Medicaid	$59.32
Rate for Payer: Independent Care Health Plan Medicaid	$59.32
Rate for Payer: Managed Health Services Medicaid	$61.69
Rate for Payer: Molina Healthcare Medicaid	$97.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$59.32
Rate for Payer: United Healthcare Medicaid	$59.32
Rate for Payer: WMAP Medicaid	$59.32

EAPG 694: ELECTROLYTE DISORDERS

Facility

$170.89

Service Code	EAPG 00694
Min. Negotiated Rate	$100.24
Max. Negotiated Rate	$170.89
Rate for Payer: Anthem Medicaid	$100.24
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$170.89
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$100.24
Rate for Payer: Dean Health Medicaid	$100.24
Rate for Payer: Independent Care Health Plan Medicaid	$100.24
Rate for Payer: Managed Health Services Medicaid	$104.25
Rate for Payer: Molina Healthcare Medicaid	$170.89
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$100.24
Rate for Payer: United Healthcare Medicaid	$100.24
Rate for Payer: WMAP Medicaid	$100.24

EAPG 695: OBESITY

Facility

$97.21

Service Code	EAPG 00695
Min. Negotiated Rate	$47.26
Max. Negotiated Rate	$97.21
Rate for Payer: Anthem Medicaid	$47.26
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$97.21
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$47.26
Rate for Payer: Dean Health Medicaid	$47.26
Rate for Payer: Independent Care Health Plan Medicaid	$47.26
Rate for Payer: Managed Health Services Medicaid	$49.15
Rate for Payer: Molina Healthcare Medicaid	$97.21
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$47.26
Rate for Payer: United Healthcare Medicaid	$47.26
Rate for Payer: WMAP Medicaid	$47.26

EAPG 696: THYROID AND PARATHYROID DIAGNOSES

Facility

$56.74

Service Code	EAPG 00696
Min. Negotiated Rate	$54.56
Max. Negotiated Rate	$56.74
Rate for Payer: Anthem Medicaid	$54.56
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.56
Rate for Payer: Dean Health Medicaid	$54.56
Rate for Payer: Independent Care Health Plan Medicaid	$54.56
Rate for Payer: Managed Health Services Medicaid	$56.74
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.56
Rate for Payer: United Healthcare Medicaid	$54.56
Rate for Payer: WMAP Medicaid	$54.56

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