Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 750: FEMALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

$114.04

Service Code	EAPG 00750
Min. Negotiated Rate	$66.91
Max. Negotiated Rate	$114.04
Rate for Payer: Anthem Medicaid	$66.91
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$114.04
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$66.91
Rate for Payer: Dean Health Medicaid	$66.91
Rate for Payer: Independent Care Health Plan Medicaid	$66.91
Rate for Payer: Managed Health Services Medicaid	$69.59
Rate for Payer: Molina Healthcare Medicaid	$114.04
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$66.91
Rate for Payer: United Healthcare Medicaid	$66.91
Rate for Payer: WMAP Medicaid	$66.91

EAPG 751: FEMALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

$120.06

Service Code	EAPG 00751
Min. Negotiated Rate	$73.17
Max. Negotiated Rate	$120.06
Rate for Payer: Anthem Medicaid	$73.17
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$120.06
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$73.17
Rate for Payer: Dean Health Medicaid	$73.17
Rate for Payer: Independent Care Health Plan Medicaid	$73.17
Rate for Payer: Managed Health Services Medicaid	$76.10
Rate for Payer: Molina Healthcare Medicaid	$120.06
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$73.17
Rate for Payer: United Healthcare Medicaid	$73.17
Rate for Payer: WMAP Medicaid	$73.17

EAPG 752: OTHER FEMALE REPRODUCTIVE SYSTEM AND MENSTRUAL DIAGNOSES

Facility

$110.37

Service Code	EAPG 00752
Min. Negotiated Rate	$59.37
Max. Negotiated Rate	$110.37
Rate for Payer: Anthem Medicaid	$59.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$110.37
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$59.37
Rate for Payer: Dean Health Medicaid	$59.37
Rate for Payer: Independent Care Health Plan Medicaid	$59.37
Rate for Payer: Managed Health Services Medicaid	$61.74
Rate for Payer: Molina Healthcare Medicaid	$110.37
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$59.37
Rate for Payer: United Healthcare Medicaid	$59.37
Rate for Payer: WMAP Medicaid	$59.37

EAPG 75: LEVEL I CENTRAL VENOUS ACCESS PROCEDURES

Facility

$474.14

Service Code	EAPG 00075
Min. Negotiated Rate	$455.90
Max. Negotiated Rate	$474.14
Rate for Payer: Anthem Medicaid	$455.90
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$455.90
Rate for Payer: Dean Health Medicaid	$455.90
Rate for Payer: Independent Care Health Plan Medicaid	$455.90
Rate for Payer: Managed Health Services Medicaid	$474.14
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$455.90
Rate for Payer: United Healthcare Medicaid	$455.90
Rate for Payer: WMAP Medicaid	$455.90

EAPG 760: LABOR AND DELIVERY RELATED DIAGNOSES

Facility

$175.39

Service Code	EAPG 00760
Min. Negotiated Rate	$102.24
Max. Negotiated Rate	$175.39
Rate for Payer: Anthem Medicaid	$102.24
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$175.39
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$102.24
Rate for Payer: Dean Health Medicaid	$102.24
Rate for Payer: Independent Care Health Plan Medicaid	$102.24
Rate for Payer: Managed Health Services Medicaid	$106.33
Rate for Payer: Molina Healthcare Medicaid	$175.39
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$102.24
Rate for Payer: United Healthcare Medicaid	$102.24
Rate for Payer: WMAP Medicaid	$102.24

EAPG 761: POSTPARTUM AND POST ABORTION DIAGNOSES

Facility

$138.75

Service Code	EAPG 00761
Min. Negotiated Rate	$88.60
Max. Negotiated Rate	$138.75
Rate for Payer: Anthem Medicaid	$88.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$138.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$88.60
Rate for Payer: Dean Health Medicaid	$88.60
Rate for Payer: Independent Care Health Plan Medicaid	$88.60
Rate for Payer: Managed Health Services Medicaid	$92.14
Rate for Payer: Molina Healthcare Medicaid	$138.75
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$88.60
Rate for Payer: United Healthcare Medicaid	$88.60
Rate for Payer: WMAP Medicaid	$88.60

EAPG 762: PRETERM LABOR DIAGNOSES

Facility

$212.13

Service Code	EAPG 00762
Min. Negotiated Rate	$151.19
Max. Negotiated Rate	$212.13
Rate for Payer: Anthem Medicaid	$151.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$212.13
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$151.19
Rate for Payer: Dean Health Medicaid	$151.19
Rate for Payer: Independent Care Health Plan Medicaid	$151.19
Rate for Payer: Managed Health Services Medicaid	$157.24
Rate for Payer: Molina Healthcare Medicaid	$212.13
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$151.19
Rate for Payer: United Healthcare Medicaid	$151.19
Rate for Payer: WMAP Medicaid	$151.19

EAPG 763: ABORTION RELATED DIAGNOSES

Facility

$203.77

Service Code	EAPG 00763
Min. Negotiated Rate	$141.31
Max. Negotiated Rate	$203.77
Rate for Payer: Anthem Medicaid	$141.31
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$203.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$141.31
Rate for Payer: Dean Health Medicaid	$141.31
Rate for Payer: Independent Care Health Plan Medicaid	$141.31
Rate for Payer: Managed Health Services Medicaid	$146.96
Rate for Payer: Molina Healthcare Medicaid	$203.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$141.31
Rate for Payer: United Healthcare Medicaid	$141.31
Rate for Payer: WMAP Medicaid	$141.31

EAPG 764: FALSE LABOR

Facility

$198.14

Service Code	EAPG 00764
Min. Negotiated Rate	$89.30
Max. Negotiated Rate	$198.14
Rate for Payer: Anthem Medicaid	$89.30
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$198.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$89.30
Rate for Payer: Dean Health Medicaid	$89.30
Rate for Payer: Independent Care Health Plan Medicaid	$89.30
Rate for Payer: Managed Health Services Medicaid	$92.87
Rate for Payer: Molina Healthcare Medicaid	$198.14
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$89.30
Rate for Payer: United Healthcare Medicaid	$89.30
Rate for Payer: WMAP Medicaid	$89.30

EAPG 765: OTHER ANTEPARTUM COMPLICATION DIAGNOSES

Facility

$155.43

Service Code	EAPG 00765
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$155.43
Rate for Payer: Anthem Medicaid	$107.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$155.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$107.25
Rate for Payer: Dean Health Medicaid	$107.25
Rate for Payer: Independent Care Health Plan Medicaid	$107.25
Rate for Payer: Managed Health Services Medicaid	$111.54
Rate for Payer: Molina Healthcare Medicaid	$155.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$107.25
Rate for Payer: United Healthcare Medicaid	$107.25
Rate for Payer: WMAP Medicaid	$107.25

EAPG 766: ROUTINE PRENATAL CARE

Facility

$116.83

Service Code	EAPG 00766
Min. Negotiated Rate	$78.32
Max. Negotiated Rate	$116.83
Rate for Payer: Anthem Medicaid	$78.32
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$116.83
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$78.32
Rate for Payer: Dean Health Medicaid	$78.32
Rate for Payer: Independent Care Health Plan Medicaid	$78.32
Rate for Payer: Managed Health Services Medicaid	$81.45
Rate for Payer: Molina Healthcare Medicaid	$116.83
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$78.32
Rate for Payer: United Healthcare Medicaid	$78.32
Rate for Payer: WMAP Medicaid	$78.32

EAPG 767: COMPLICATIONS OF TREATMENT AFFECTING PREGNANCY

Facility

$165.91

Service Code	EAPG 00767
Min. Negotiated Rate	$159.53
Max. Negotiated Rate	$165.91
Rate for Payer: Anthem Medicaid	$159.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$159.53
Rate for Payer: Dean Health Medicaid	$159.53
Rate for Payer: Independent Care Health Plan Medicaid	$159.53
Rate for Payer: Managed Health Services Medicaid	$165.91
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$159.53
Rate for Payer: United Healthcare Medicaid	$159.53
Rate for Payer: WMAP Medicaid	$159.53

EAPG 768: ANTEPARTUM ENCOUNTERS FOR NON-ROUTINE AND ABNORMAL FINDINGS

Facility

$103.72

Service Code	EAPG 00768
Min. Negotiated Rate	$99.73
Max. Negotiated Rate	$103.72
Rate for Payer: Anthem Medicaid	$99.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$99.73
Rate for Payer: Dean Health Medicaid	$99.73
Rate for Payer: Independent Care Health Plan Medicaid	$99.73
Rate for Payer: Managed Health Services Medicaid	$103.72
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$99.73
Rate for Payer: United Healthcare Medicaid	$99.73
Rate for Payer: WMAP Medicaid	$99.73

EAPG 76: REVISION, REPAIR OR REMOVAL OF CENTRAL VENOUS ACCESS DEVICE

Facility

$318.51

Service Code	EAPG 00076
Min. Negotiated Rate	$306.26
Max. Negotiated Rate	$318.51
Rate for Payer: Anthem Medicaid	$306.26
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$306.26
Rate for Payer: Dean Health Medicaid	$306.26
Rate for Payer: Independent Care Health Plan Medicaid	$306.26
Rate for Payer: Managed Health Services Medicaid	$318.51
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$306.26
Rate for Payer: United Healthcare Medicaid	$306.26
Rate for Payer: WMAP Medicaid	$306.26

EAPG 770: NORMAL NEONATE

Facility

$101.76

Service Code	EAPG 00770
Min. Negotiated Rate	$57.35
Max. Negotiated Rate	$101.76
Rate for Payer: Anthem Medicaid	$57.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$101.76
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$57.35
Rate for Payer: Dean Health Medicaid	$57.35
Rate for Payer: Independent Care Health Plan Medicaid	$57.35
Rate for Payer: Managed Health Services Medicaid	$59.64
Rate for Payer: Molina Healthcare Medicaid	$101.76
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$57.35
Rate for Payer: United Healthcare Medicaid	$57.35
Rate for Payer: WMAP Medicaid	$57.35

EAPG 771: NEONATAL DIAGNOSES

Facility

$103.72

Service Code	EAPG 00771
Min. Negotiated Rate	$97.58
Max. Negotiated Rate	$103.72
Rate for Payer: Anthem Medicaid	$97.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$103.72
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$97.58
Rate for Payer: Dean Health Medicaid	$97.58
Rate for Payer: Independent Care Health Plan Medicaid	$97.58
Rate for Payer: Managed Health Services Medicaid	$101.48
Rate for Payer: Molina Healthcare Medicaid	$103.72
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$97.58
Rate for Payer: United Healthcare Medicaid	$97.58
Rate for Payer: WMAP Medicaid	$97.58

EAPG 777: SUPERFICIAL INJURY TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$84.49

Service Code	EAPG 00777
Min. Negotiated Rate	$81.24
Max. Negotiated Rate	$84.49
Rate for Payer: Anthem Medicaid	$81.24
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$81.24
Rate for Payer: Dean Health Medicaid	$81.24
Rate for Payer: Independent Care Health Plan Medicaid	$81.24
Rate for Payer: Managed Health Services Medicaid	$84.49
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$81.24
Rate for Payer: United Healthcare Medicaid	$81.24
Rate for Payer: WMAP Medicaid	$81.24

EAPG 77: LEVEL I PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$1,592.08

Service Code	EAPG 00077
Min. Negotiated Rate	$1,530.85
Max. Negotiated Rate	$1,592.08
Rate for Payer: Anthem Medicaid	$1,530.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,530.85
Rate for Payer: Dean Health Medicaid	$1,530.85
Rate for Payer: Independent Care Health Plan Medicaid	$1,530.85
Rate for Payer: Managed Health Services Medicaid	$1,592.08
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,530.85
Rate for Payer: United Healthcare Medicaid	$1,530.85
Rate for Payer: WMAP Medicaid	$1,530.85

EAPG 780: OTHER HEMATOLOGICAL DIAGNOSES

Facility

$128.52

Service Code	EAPG 00780
Min. Negotiated Rate	$97.05
Max. Negotiated Rate	$128.52
Rate for Payer: Anthem Medicaid	$97.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$128.52
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$97.05
Rate for Payer: Dean Health Medicaid	$97.05
Rate for Payer: Independent Care Health Plan Medicaid	$97.05
Rate for Payer: Managed Health Services Medicaid	$100.93
Rate for Payer: Molina Healthcare Medicaid	$128.52
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$97.05
Rate for Payer: United Healthcare Medicaid	$97.05
Rate for Payer: WMAP Medicaid	$97.05

EAPG 781: COAGULATION AND PLATELET DISORDERS AND CONGENITAL FACTOR DEFICIENCIES

Facility

$113.80

Service Code	EAPG 00781
Min. Negotiated Rate	$60.04
Max. Negotiated Rate	$113.80
Rate for Payer: Anthem Medicaid	$60.04
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$113.80
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$60.04
Rate for Payer: Dean Health Medicaid	$60.04
Rate for Payer: Independent Care Health Plan Medicaid	$60.04
Rate for Payer: Managed Health Services Medicaid	$62.44
Rate for Payer: Molina Healthcare Medicaid	$113.80
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$60.04
Rate for Payer: United Healthcare Medicaid	$60.04
Rate for Payer: WMAP Medicaid	$60.04

EAPG 783: SICKLE CELL ANEMIA CRISIS

Facility

$287.82

Service Code	EAPG 00783
Min. Negotiated Rate	$117.25
Max. Negotiated Rate	$287.82
Rate for Payer: Anthem Medicaid	$117.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$287.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$117.25
Rate for Payer: Dean Health Medicaid	$117.25
Rate for Payer: Independent Care Health Plan Medicaid	$117.25
Rate for Payer: Managed Health Services Medicaid	$121.94
Rate for Payer: Molina Healthcare Medicaid	$287.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$117.25
Rate for Payer: United Healthcare Medicaid	$117.25
Rate for Payer: WMAP Medicaid	$117.25

EAPG 785: ANEMIA, BLOOD AND BLOOD-FORMING ORGAN DISORDERS

Facility

$120.84

Service Code	EAPG 00785
Min. Negotiated Rate	$72.56
Max. Negotiated Rate	$120.84
Rate for Payer: Anthem Medicaid	$72.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$120.84
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$72.56
Rate for Payer: Dean Health Medicaid	$72.56
Rate for Payer: Independent Care Health Plan Medicaid	$72.56
Rate for Payer: Managed Health Services Medicaid	$75.46
Rate for Payer: Molina Healthcare Medicaid	$120.84
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$72.56
Rate for Payer: United Healthcare Medicaid	$72.56
Rate for Payer: WMAP Medicaid	$72.56

EAPG 787: AFTERCARE, BURNS, CORROSIONS, OTHER INJURIES RELATED TO THE SKIN AND SUB TIS

Facility

$55.48

Service Code	EAPG 00787
Min. Negotiated Rate	$53.35
Max. Negotiated Rate	$55.48
Rate for Payer: Anthem Medicaid	$53.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$53.35
Rate for Payer: Dean Health Medicaid	$53.35
Rate for Payer: Independent Care Health Plan Medicaid	$53.35
Rate for Payer: Managed Health Services Medicaid	$55.48
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$53.35
Rate for Payer: United Healthcare Medicaid	$53.35
Rate for Payer: WMAP Medicaid	$53.35

EAPG 78: LEVEL I PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION

Facility

$1,628.09

Service Code	EAPG 00078
Min. Negotiated Rate	$870.29
Max. Negotiated Rate	$1,628.09
Rate for Payer: Anthem Medicaid	$870.29
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,628.09
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$870.29
Rate for Payer: Dean Health Medicaid	$870.29
Rate for Payer: Independent Care Health Plan Medicaid	$870.29
Rate for Payer: Managed Health Services Medicaid	$905.10
Rate for Payer: Molina Healthcare Medicaid	$1,628.09
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$870.29
Rate for Payer: United Healthcare Medicaid	$870.29
Rate for Payer: WMAP Medicaid	$870.29

EAPG 79: LEVEL II PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$3,910.79

Service Code	EAPG 00079
Min. Negotiated Rate	$2,567.08
Max. Negotiated Rate	$3,910.79
Rate for Payer: Anthem Medicaid	$2,567.08
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3,910.79
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,567.08
Rate for Payer: Dean Health Medicaid	$2,567.08
Rate for Payer: Independent Care Health Plan Medicaid	$2,567.08
Rate for Payer: Managed Health Services Medicaid	$2,669.76
Rate for Payer: Molina Healthcare Medicaid	$3,910.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,567.08
Rate for Payer: United Healthcare Medicaid	$2,567.08
Rate for Payer: WMAP Medicaid	$2,567.08

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