Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 69: LEVEL I THORACIC AND CHEST PROCEDURES

Facility

$1,000.55

Service Code	EAPG 00069
Min. Negotiated Rate	$962.07
Max. Negotiated Rate	$1,000.55
Rate for Payer: Anthem Medicaid	$962.07
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$962.07
Rate for Payer: Dean Health Medicaid	$962.07
Rate for Payer: Independent Care Health Plan Medicaid	$962.07
Rate for Payer: Managed Health Services Medicaid	$1,000.55
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$962.07
Rate for Payer: United Healthcare Medicaid	$962.07
Rate for Payer: WMAP Medicaid	$962.07

EAPG 70: LEVEL II THORACIC AND CHEST PROCEDURES

Facility

$2,182.16

Service Code	EAPG 00070
Min. Negotiated Rate	$2,098.23
Max. Negotiated Rate	$2,182.16
Rate for Payer: Anthem Medicaid	$2,098.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,098.23
Rate for Payer: Dean Health Medicaid	$2,098.23
Rate for Payer: Independent Care Health Plan Medicaid	$2,098.23
Rate for Payer: Managed Health Services Medicaid	$2,182.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,098.23
Rate for Payer: United Healthcare Medicaid	$2,098.23
Rate for Payer: WMAP Medicaid	$2,098.23

EAPG 710: DIABETES WITH OPHTHALMIC MANIFESTATIONS

Facility

$97.85

Service Code	EAPG 00710
Min. Negotiated Rate	$77.04
Max. Negotiated Rate	$97.85
Rate for Payer: Anthem Medicaid	$77.04
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$97.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$77.04
Rate for Payer: Dean Health Medicaid	$77.04
Rate for Payer: Independent Care Health Plan Medicaid	$77.04
Rate for Payer: Managed Health Services Medicaid	$80.12
Rate for Payer: Molina Healthcare Medicaid	$97.85
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$77.04
Rate for Payer: United Healthcare Medicaid	$77.04
Rate for Payer: WMAP Medicaid	$77.04

EAPG 711: DIABETES WITH OTHER MANIFESTATIONS AND COMPLICATIONS

Facility

$123.53

Service Code	EAPG 00711
Min. Negotiated Rate	$66.82
Max. Negotiated Rate	$123.53
Rate for Payer: Anthem Medicaid	$66.82
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$123.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$66.82
Rate for Payer: Dean Health Medicaid	$66.82
Rate for Payer: Independent Care Health Plan Medicaid	$66.82
Rate for Payer: Managed Health Services Medicaid	$69.49
Rate for Payer: Molina Healthcare Medicaid	$123.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$66.82
Rate for Payer: United Healthcare Medicaid	$66.82
Rate for Payer: WMAP Medicaid	$66.82

EAPG 712: DIABETES WITH NEUROLOGIC MANIFESTATIONS

Facility

$101.08

Service Code	EAPG 00712
Min. Negotiated Rate	$53.08
Max. Negotiated Rate	$101.08
Rate for Payer: Anthem Medicaid	$53.08
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$101.08
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$53.08
Rate for Payer: Dean Health Medicaid	$53.08
Rate for Payer: Independent Care Health Plan Medicaid	$53.08
Rate for Payer: Managed Health Services Medicaid	$55.20
Rate for Payer: Molina Healthcare Medicaid	$101.08
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$53.08
Rate for Payer: United Healthcare Medicaid	$53.08
Rate for Payer: WMAP Medicaid	$53.08

EAPG 713: DIABETES WITHOUT COMPLICATIONS

Facility

$94.86

Service Code	EAPG 00713
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$94.86
Rate for Payer: Anthem Medicaid	$49.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$94.86
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$49.35
Rate for Payer: Dean Health Medicaid	$49.35
Rate for Payer: Independent Care Health Plan Medicaid	$49.35
Rate for Payer: Managed Health Services Medicaid	$51.32
Rate for Payer: Molina Healthcare Medicaid	$94.86
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$49.35
Rate for Payer: United Healthcare Medicaid	$49.35
Rate for Payer: WMAP Medicaid	$49.35

EAPG 714: DIABETES WITH RENAL MANIFESTATIONS

Facility

$99.46

Service Code	EAPG 00714
Min. Negotiated Rate	$55.68
Max. Negotiated Rate	$99.46
Rate for Payer: Anthem Medicaid	$55.68
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$99.46
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$55.68
Rate for Payer: Dean Health Medicaid	$55.68
Rate for Payer: Independent Care Health Plan Medicaid	$55.68
Rate for Payer: Managed Health Services Medicaid	$57.91
Rate for Payer: Molina Healthcare Medicaid	$99.46
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$55.68
Rate for Payer: United Healthcare Medicaid	$55.68
Rate for Payer: WMAP Medicaid	$55.68

EAPG 715: DIABETES WITH VASCULAR COMPLICATIONS INCLUDING FOOT AND OTHER SKIN ULCERS

Facility

$58.71

Service Code	EAPG 00715
Min. Negotiated Rate	$56.45
Max. Negotiated Rate	$58.71
Rate for Payer: Anthem Medicaid	$56.45
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$56.45
Rate for Payer: Dean Health Medicaid	$56.45
Rate for Payer: Independent Care Health Plan Medicaid	$56.45
Rate for Payer: Managed Health Services Medicaid	$58.71
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$56.45
Rate for Payer: United Healthcare Medicaid	$56.45
Rate for Payer: WMAP Medicaid	$56.45

EAPG 71: LEVEL II LOWER AIRWAY ENDOSCOPY

Facility

$1,577.88

Service Code	EAPG 00071
Min. Negotiated Rate	$1,517.19
Max. Negotiated Rate	$1,577.88
Rate for Payer: Anthem Medicaid	$1,517.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,517.19
Rate for Payer: Dean Health Medicaid	$1,517.19
Rate for Payer: Independent Care Health Plan Medicaid	$1,517.19
Rate for Payer: Managed Health Services Medicaid	$1,577.88
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,517.19
Rate for Payer: United Healthcare Medicaid	$1,517.19
Rate for Payer: WMAP Medicaid	$1,517.19

EAPG 720: CHRONIC KIDNEY DISEASE

Facility

$111.69

Service Code	EAPG 00720
Min. Negotiated Rate	$61.17
Max. Negotiated Rate	$111.69
Rate for Payer: Anthem Medicaid	$61.17
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$111.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$61.17
Rate for Payer: Dean Health Medicaid	$61.17
Rate for Payer: Independent Care Health Plan Medicaid	$61.17
Rate for Payer: Managed Health Services Medicaid	$63.62
Rate for Payer: Molina Healthcare Medicaid	$111.69
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$61.17
Rate for Payer: United Healthcare Medicaid	$61.17
Rate for Payer: WMAP Medicaid	$61.17

EAPG 721: KIDNEY AND URINARY TRACT MALIGNANCY

Facility

$119.91

Service Code	EAPG 00721
Min. Negotiated Rate	$57.28
Max. Negotiated Rate	$119.91
Rate for Payer: Anthem Medicaid	$57.28
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$119.91
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$57.28
Rate for Payer: Dean Health Medicaid	$57.28
Rate for Payer: Independent Care Health Plan Medicaid	$57.28
Rate for Payer: Managed Health Services Medicaid	$59.57
Rate for Payer: Molina Healthcare Medicaid	$119.91
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$57.28
Rate for Payer: United Healthcare Medicaid	$57.28
Rate for Payer: WMAP Medicaid	$57.28

EAPG 722: NEPHRITIS AND NEPHROSIS

Facility

$115.66

Service Code	EAPG 00722
Min. Negotiated Rate	$69.24
Max. Negotiated Rate	$115.66
Rate for Payer: Anthem Medicaid	$69.24
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$115.66
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$69.24
Rate for Payer: Dean Health Medicaid	$69.24
Rate for Payer: Independent Care Health Plan Medicaid	$69.24
Rate for Payer: Managed Health Services Medicaid	$72.01
Rate for Payer: Molina Healthcare Medicaid	$115.66
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$69.24
Rate for Payer: United Healthcare Medicaid	$69.24
Rate for Payer: WMAP Medicaid	$69.24

EAPG 723: COMPLEX KIDNEY AND URINARY TRACT INFECTIONS

Facility

$142.81

Service Code	EAPG 00723
Min. Negotiated Rate	$104.13
Max. Negotiated Rate	$142.81
Rate for Payer: Anthem Medicaid	$104.13
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$142.81
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$104.13
Rate for Payer: Dean Health Medicaid	$104.13
Rate for Payer: Independent Care Health Plan Medicaid	$104.13
Rate for Payer: Managed Health Services Medicaid	$108.30
Rate for Payer: Molina Healthcare Medicaid	$142.81
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$104.13
Rate for Payer: United Healthcare Medicaid	$104.13
Rate for Payer: WMAP Medicaid	$104.13

EAPG 724: URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$116.73

Service Code	EAPG 00724
Min. Negotiated Rate	$70.25
Max. Negotiated Rate	$116.73
Rate for Payer: Anthem Medicaid	$70.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$116.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.25
Rate for Payer: Dean Health Medicaid	$70.25
Rate for Payer: Independent Care Health Plan Medicaid	$70.25
Rate for Payer: Managed Health Services Medicaid	$73.06
Rate for Payer: Molina Healthcare Medicaid	$116.73
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.25
Rate for Payer: United Healthcare Medicaid	$70.25
Rate for Payer: WMAP Medicaid	$70.25

EAPG 725: MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC

Facility

$155.87

Service Code	EAPG 00725
Min. Negotiated Rate	$100.67
Max. Negotiated Rate	$155.87
Rate for Payer: Anthem Medicaid	$100.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$155.87
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$100.67
Rate for Payer: Dean Health Medicaid	$100.67
Rate for Payer: Independent Care Health Plan Medicaid	$100.67
Rate for Payer: Managed Health Services Medicaid	$104.70
Rate for Payer: Molina Healthcare Medicaid	$155.87
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$100.67
Rate for Payer: United Healthcare Medicaid	$100.67
Rate for Payer: WMAP Medicaid	$100.67

EAPG 726: OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS

Facility

$118.20

Service Code	EAPG 00726
Min. Negotiated Rate	$68.46
Max. Negotiated Rate	$118.20
Rate for Payer: Anthem Medicaid	$68.46
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$118.20
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$68.46
Rate for Payer: Dean Health Medicaid	$68.46
Rate for Payer: Independent Care Health Plan Medicaid	$68.46
Rate for Payer: Managed Health Services Medicaid	$71.20
Rate for Payer: Molina Healthcare Medicaid	$118.20
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$68.46
Rate for Payer: United Healthcare Medicaid	$68.46
Rate for Payer: WMAP Medicaid	$68.46

EAPG 727: ACUTE LOWER URINARY TRACT INFECTIONS

Facility

$151.42

Service Code	EAPG 00727
Min. Negotiated Rate	$96.98
Max. Negotiated Rate	$151.42
Rate for Payer: Anthem Medicaid	$96.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$151.42
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$96.98
Rate for Payer: Dean Health Medicaid	$96.98
Rate for Payer: Independent Care Health Plan Medicaid	$96.98
Rate for Payer: Managed Health Services Medicaid	$100.86
Rate for Payer: Molina Healthcare Medicaid	$151.42
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$96.98
Rate for Payer: United Healthcare Medicaid	$96.98
Rate for Payer: WMAP Medicaid	$96.98

EAPG 729: ACUTE KIDNEY INJURY

Facility

$117.61

Service Code	EAPG 00729
Min. Negotiated Rate	$113.09
Max. Negotiated Rate	$117.61
Rate for Payer: Anthem Medicaid	$113.09
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$113.09
Rate for Payer: Dean Health Medicaid	$113.09
Rate for Payer: Independent Care Health Plan Medicaid	$113.09
Rate for Payer: Managed Health Services Medicaid	$117.61
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$113.09
Rate for Payer: United Healthcare Medicaid	$113.09
Rate for Payer: WMAP Medicaid	$113.09

EAPG 72: TRACHEOSTOMY AND RELATED TRACHEAL PROCEDURES

Facility

$888.39

Service Code	EAPG 00072
Min. Negotiated Rate	$854.22
Max. Negotiated Rate	$888.39
Rate for Payer: Anthem Medicaid	$854.22
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$854.22
Rate for Payer: Dean Health Medicaid	$854.22
Rate for Payer: Independent Care Health Plan Medicaid	$854.22
Rate for Payer: Managed Health Services Medicaid	$888.39
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$854.22
Rate for Payer: United Healthcare Medicaid	$854.22
Rate for Payer: WMAP Medicaid	$854.22

EAPG 73: DIAPHRAGMATIC PROCEDURES AND RELATED HERNIA REPAIR

Facility

$2,772.63

Service Code	EAPG 00073
Min. Negotiated Rate	$2,665.99
Max. Negotiated Rate	$2,772.63
Rate for Payer: Anthem Medicaid	$2,665.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,665.99
Rate for Payer: Dean Health Medicaid	$2,665.99
Rate for Payer: Independent Care Health Plan Medicaid	$2,665.99
Rate for Payer: Managed Health Services Medicaid	$2,772.63
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,665.99
Rate for Payer: United Healthcare Medicaid	$2,665.99
Rate for Payer: WMAP Medicaid	$2,665.99

EAPG 740: MALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

$114.24

Service Code	EAPG 00740
Min. Negotiated Rate	$58.67
Max. Negotiated Rate	$114.24
Rate for Payer: Anthem Medicaid	$58.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$114.24
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$58.67
Rate for Payer: Dean Health Medicaid	$58.67
Rate for Payer: Independent Care Health Plan Medicaid	$58.67
Rate for Payer: Managed Health Services Medicaid	$61.02
Rate for Payer: Molina Healthcare Medicaid	$114.24
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$58.67
Rate for Payer: United Healthcare Medicaid	$58.67
Rate for Payer: WMAP Medicaid	$58.67

EAPG 741: OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES

Facility

$104.65

Service Code	EAPG 00741
Min. Negotiated Rate	$64.53
Max. Negotiated Rate	$104.65
Rate for Payer: Anthem Medicaid	$64.53
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$104.65
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$64.53
Rate for Payer: Dean Health Medicaid	$64.53
Rate for Payer: Independent Care Health Plan Medicaid	$64.53
Rate for Payer: Managed Health Services Medicaid	$67.11
Rate for Payer: Molina Healthcare Medicaid	$104.65
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$64.53
Rate for Payer: United Healthcare Medicaid	$64.53
Rate for Payer: WMAP Medicaid	$64.53

EAPG 743: PROSTATITIS

Facility

$100.64

Service Code	EAPG 00743
Min. Negotiated Rate	$53.05
Max. Negotiated Rate	$100.64
Rate for Payer: Anthem Medicaid	$53.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$100.64
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$53.05
Rate for Payer: Dean Health Medicaid	$53.05
Rate for Payer: Independent Care Health Plan Medicaid	$53.05
Rate for Payer: Managed Health Services Medicaid	$55.17
Rate for Payer: Molina Healthcare Medicaid	$100.64
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$53.05
Rate for Payer: United Healthcare Medicaid	$53.05
Rate for Payer: WMAP Medicaid	$53.05

EAPG 744: MALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

$115.12

Service Code	EAPG 00744
Min. Negotiated Rate	$63.80
Max. Negotiated Rate	$115.12
Rate for Payer: Anthem Medicaid	$63.80
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$115.12
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$63.80
Rate for Payer: Dean Health Medicaid	$63.80
Rate for Payer: Independent Care Health Plan Medicaid	$63.80
Rate for Payer: Managed Health Services Medicaid	$66.35
Rate for Payer: Molina Healthcare Medicaid	$115.12
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$63.80
Rate for Payer: United Healthcare Medicaid	$63.80
Rate for Payer: WMAP Medicaid	$63.80

EAPG 74: REVISION, REPLACEMENT OR REMOVAL OF CARDIAC DEVICE COMPONENT

Facility

$677.80

Service Code	EAPG 00074
Min. Negotiated Rate	$651.73
Max. Negotiated Rate	$677.80
Rate for Payer: Anthem Medicaid	$651.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$651.73
Rate for Payer: Dean Health Medicaid	$651.73
Rate for Payer: Independent Care Health Plan Medicaid	$651.73
Rate for Payer: Managed Health Services Medicaid	$677.80
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$651.73
Rate for Payer: United Healthcare Medicaid	$651.73
Rate for Payer: WMAP Medicaid	$651.73

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