Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 800: ACUTE LEUKEMIA

Facility

$160.37

Service Code	EAPG 00800
Min. Negotiated Rate	$108.72
Max. Negotiated Rate	$160.37
Rate for Payer: Anthem Medicaid	$108.72
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$160.37
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$108.72
Rate for Payer: Dean Health Medicaid	$108.72
Rate for Payer: Independent Care Health Plan Medicaid	$108.72
Rate for Payer: Managed Health Services Medicaid	$113.07
Rate for Payer: Molina Healthcare Medicaid	$160.37
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$108.72
Rate for Payer: United Healthcare Medicaid	$108.72
Rate for Payer: WMAP Medicaid	$108.72

EAPG 801: LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA

Facility

$134.49

Service Code	EAPG 00801
Min. Negotiated Rate	$79.63
Max. Negotiated Rate	$134.49
Rate for Payer: Anthem Medicaid	$79.63
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$134.49
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$79.63
Rate for Payer: Dean Health Medicaid	$79.63
Rate for Payer: Independent Care Health Plan Medicaid	$79.63
Rate for Payer: Managed Health Services Medicaid	$82.82
Rate for Payer: Molina Healthcare Medicaid	$134.49
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$79.63
Rate for Payer: United Healthcare Medicaid	$79.63
Rate for Payer: WMAP Medicaid	$79.63

EAPG 802: RADIOTHERAPY

Facility

$145.84

Service Code	EAPG 00802
Min. Negotiated Rate	$55.34
Max. Negotiated Rate	$145.84
Rate for Payer: Anthem Medicaid	$55.34
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$145.84
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$55.34
Rate for Payer: Dean Health Medicaid	$55.34
Rate for Payer: Independent Care Health Plan Medicaid	$55.34
Rate for Payer: Managed Health Services Medicaid	$57.55
Rate for Payer: Molina Healthcare Medicaid	$145.84
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$55.34
Rate for Payer: United Healthcare Medicaid	$55.34
Rate for Payer: WMAP Medicaid	$55.34

EAPG 803: CHEMOTHERAPY

Facility

$147.75

Service Code	EAPG 00803
Min. Negotiated Rate	$89.18
Max. Negotiated Rate	$147.75
Rate for Payer: Anthem Medicaid	$89.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$147.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$89.18
Rate for Payer: Dean Health Medicaid	$89.18
Rate for Payer: Independent Care Health Plan Medicaid	$89.18
Rate for Payer: Managed Health Services Medicaid	$92.75
Rate for Payer: Molina Healthcare Medicaid	$147.75
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$89.18
Rate for Payer: United Healthcare Medicaid	$89.18
Rate for Payer: WMAP Medicaid	$89.18

EAPG 804: LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$129.84

Service Code	EAPG 00804
Min. Negotiated Rate	$70.88
Max. Negotiated Rate	$129.84
Rate for Payer: Anthem Medicaid	$70.88
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$129.84
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.88
Rate for Payer: Dean Health Medicaid	$70.88
Rate for Payer: Independent Care Health Plan Medicaid	$70.88
Rate for Payer: Managed Health Services Medicaid	$73.72
Rate for Payer: Molina Healthcare Medicaid	$129.84
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.88
Rate for Payer: United Healthcare Medicaid	$70.88
Rate for Payer: WMAP Medicaid	$70.88

EAPG 805: SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$251.32

Service Code	EAPG 00805
Min. Negotiated Rate	$232.34
Max. Negotiated Rate	$251.32
Rate for Payer: Anthem Medicaid	$241.65
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$232.34
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$241.65
Rate for Payer: Dean Health Medicaid	$241.65
Rate for Payer: Independent Care Health Plan Medicaid	$241.65
Rate for Payer: Managed Health Services Medicaid	$251.32
Rate for Payer: Molina Healthcare Medicaid	$232.34
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$241.65
Rate for Payer: United Healthcare Medicaid	$241.65
Rate for Payer: WMAP Medicaid	$241.65

EAPG 806: INTRAOPERATIVE, POST-OPERATIVE OR POST-TRAUMATIC INFECTIONS AND COMPLICATIONS

Facility

$127.69

Service Code	EAPG 00806
Min. Negotiated Rate	$84.10
Max. Negotiated Rate	$127.69
Rate for Payer: Anthem Medicaid	$84.10
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$127.69
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$84.10
Rate for Payer: Dean Health Medicaid	$84.10
Rate for Payer: Independent Care Health Plan Medicaid	$84.10
Rate for Payer: Managed Health Services Medicaid	$87.46
Rate for Payer: Molina Healthcare Medicaid	$127.69
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$84.10
Rate for Payer: United Healthcare Medicaid	$84.10
Rate for Payer: WMAP Medicaid	$84.10

EAPG 807: FEVER AND OTHER INFLAMMATORY CONDITIONS

Facility

$158.61

Service Code	EAPG 00807
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$158.61
Rate for Payer: Anthem Medicaid	$142.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$158.61
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$142.19
Rate for Payer: Dean Health Medicaid	$142.19
Rate for Payer: Independent Care Health Plan Medicaid	$142.19
Rate for Payer: Managed Health Services Medicaid	$147.88
Rate for Payer: Molina Healthcare Medicaid	$158.61
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$142.19
Rate for Payer: United Healthcare Medicaid	$142.19
Rate for Payer: WMAP Medicaid	$142.19

EAPG 808: VIRAL ILLNESS

Facility

$160.52

Service Code	EAPG 00808
Min. Negotiated Rate	$125.84
Max. Negotiated Rate	$160.52
Rate for Payer: Anthem Medicaid	$125.84
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$160.52
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$125.84
Rate for Payer: Dean Health Medicaid	$125.84
Rate for Payer: Independent Care Health Plan Medicaid	$125.84
Rate for Payer: Managed Health Services Medicaid	$130.87
Rate for Payer: Molina Healthcare Medicaid	$160.52
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$125.84
Rate for Payer: United Healthcare Medicaid	$125.84
Rate for Payer: WMAP Medicaid	$125.84

EAPG 809: OTHER INFECTIOUS AND PARASITIC DISEASES

Facility

$104.35

Service Code	EAPG 00809
Min. Negotiated Rate	$63.80
Max. Negotiated Rate	$104.35
Rate for Payer: Anthem Medicaid	$63.80
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$104.35
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	$104.35
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 80: EXERCISE TOLERANCE TESTS

Facility

$241.24

Service Code	EAPG 00080
Min. Negotiated Rate	$68.86
Max. Negotiated Rate	$241.24
Rate for Payer: Anthem Medicaid	$68.86
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$241.24
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$68.86
Rate for Payer: Dean Health Medicaid	$68.86
Rate for Payer: Independent Care Health Plan Medicaid	$68.86
Rate for Payer: Managed Health Services Medicaid	$71.61
Rate for Payer: Molina Healthcare Medicaid	$241.24
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$68.86
Rate for Payer: United Healthcare Medicaid	$68.86
Rate for Payer: WMAP Medicaid	$68.86

EAPG 810: H. PYLORI INFECTION

Facility

$88.16

Service Code	EAPG 00810
Min. Negotiated Rate	$50.65
Max. Negotiated Rate	$88.16
Rate for Payer: Anthem Medicaid	$50.65
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$88.16
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$50.65
Rate for Payer: Dean Health Medicaid	$50.65
Rate for Payer: Independent Care Health Plan Medicaid	$50.65
Rate for Payer: Managed Health Services Medicaid	$52.68
Rate for Payer: Molina Healthcare Medicaid	$88.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$50.65
Rate for Payer: United Healthcare Medicaid	$50.65
Rate for Payer: WMAP Medicaid	$50.65

EAPG 812: VIRAL MENINGITIS

Facility

$87.46

Service Code	EAPG 00812
Min. Negotiated Rate	$84.10
Max. Negotiated Rate	$87.46
Rate for Payer: Anthem Medicaid	$84.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$84.10
Rate for Payer: Dean Health Medicaid	$84.10
Rate for Payer: Independent Care Health Plan Medicaid	$84.10
Rate for Payer: Managed Health Services Medicaid	$87.46
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$84.10
Rate for Payer: United Healthcare Medicaid	$84.10
Rate for Payer: WMAP Medicaid	$84.10

EAPG 81: ECHOCARDIOGRAPHY

Facility

$383.42

Service Code	EAPG 00081
Min. Negotiated Rate	$179.94
Max. Negotiated Rate	$383.42
Rate for Payer: Anthem Medicaid	$179.94
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$383.42
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$179.94
Rate for Payer: Dean Health Medicaid	$179.94
Rate for Payer: Independent Care Health Plan Medicaid	$179.94
Rate for Payer: Managed Health Services Medicaid	$187.14
Rate for Payer: Molina Healthcare Medicaid	$383.42
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$179.94
Rate for Payer: United Healthcare Medicaid	$179.94
Rate for Payer: WMAP Medicaid	$179.94

EAPG 820: SCHIZOPHRENIA

Facility

$120.99

Service Code	EAPG 00820
Min. Negotiated Rate	$90.32
Max. Negotiated Rate	$120.99
Rate for Payer: Anthem Medicaid	$90.32
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$120.99
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$90.32
Rate for Payer: Dean Health Medicaid	$90.32
Rate for Payer: Independent Care Health Plan Medicaid	$90.32
Rate for Payer: Managed Health Services Medicaid	$93.93
Rate for Payer: Molina Healthcare Medicaid	$120.99
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$90.32
Rate for Payer: United Healthcare Medicaid	$90.32
Rate for Payer: WMAP Medicaid	$90.32

EAPG 821: MAJOR DEPRESSIVE DIAGNOSES AND OTHER OR UNSPECIFIED PSYCHOSES

Facility

$109.35

Service Code	EAPG 00821
Min. Negotiated Rate	$67.11
Max. Negotiated Rate	$109.35
Rate for Payer: Anthem Medicaid	$67.11
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$109.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$67.11
Rate for Payer: Dean Health Medicaid	$67.11
Rate for Payer: Independent Care Health Plan Medicaid	$67.11
Rate for Payer: Managed Health Services Medicaid	$69.79
Rate for Payer: Molina Healthcare Medicaid	$109.35
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$67.11
Rate for Payer: United Healthcare Medicaid	$67.11
Rate for Payer: WMAP Medicaid	$67.11

EAPG 822: PERSONALITY AND IMPULSE CONTROL DIAGNOSES

Facility

$134.05

Service Code	EAPG 00822
Min. Negotiated Rate	$90.61
Max. Negotiated Rate	$134.05
Rate for Payer: Anthem Medicaid	$90.61
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$134.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$90.61
Rate for Payer: Dean Health Medicaid	$90.61
Rate for Payer: Independent Care Health Plan Medicaid	$90.61
Rate for Payer: Managed Health Services Medicaid	$94.23
Rate for Payer: Molina Healthcare Medicaid	$134.05
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$90.61
Rate for Payer: United Healthcare Medicaid	$90.61
Rate for Payer: WMAP Medicaid	$90.61

EAPG 823: BIPOLAR DISORDERS

Facility

$107.19

Service Code	EAPG 00823
Min. Negotiated Rate	$69.88
Max. Negotiated Rate	$107.19
Rate for Payer: Anthem Medicaid	$69.88
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$107.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$69.88
Rate for Payer: Dean Health Medicaid	$69.88
Rate for Payer: Independent Care Health Plan Medicaid	$69.88
Rate for Payer: Managed Health Services Medicaid	$72.68
Rate for Payer: Molina Healthcare Medicaid	$107.19
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$69.88
Rate for Payer: United Healthcare Medicaid	$69.88
Rate for Payer: WMAP Medicaid	$69.88

EAPG 824: DEPRESSION EXCEPT MAJOR DEPRESSIVE DIAGNOSES

Facility

$96.82

Service Code	EAPG 00824
Min. Negotiated Rate	$65.75
Max. Negotiated Rate	$96.82
Rate for Payer: Anthem Medicaid	$65.75
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$96.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$65.75
Rate for Payer: Dean Health Medicaid	$65.75
Rate for Payer: Independent Care Health Plan Medicaid	$65.75
Rate for Payer: Managed Health Services Medicaid	$68.38
Rate for Payer: Molina Healthcare Medicaid	$96.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$65.75
Rate for Payer: United Healthcare Medicaid	$65.75
Rate for Payer: WMAP Medicaid	$65.75

EAPG 825: ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES

Facility

$107.53

Service Code	EAPG 00825
Min. Negotiated Rate	$65.81
Max. Negotiated Rate	$107.53
Rate for Payer: Anthem Medicaid	$65.81
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$107.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$65.81
Rate for Payer: Dean Health Medicaid	$65.81
Rate for Payer: Independent Care Health Plan Medicaid	$65.81
Rate for Payer: Managed Health Services Medicaid	$68.44
Rate for Payer: Molina Healthcare Medicaid	$107.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$65.81
Rate for Payer: United Healthcare Medicaid	$65.81
Rate for Payer: WMAP Medicaid	$65.81

EAPG 826: ACUTE ANXIETY AND DELIRIUM STATES

Facility

$131.80

Service Code	EAPG 00826
Min. Negotiated Rate	$86.97
Max. Negotiated Rate	$131.80
Rate for Payer: Anthem Medicaid	$86.97
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$131.80
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$86.97
Rate for Payer: Dean Health Medicaid	$86.97
Rate for Payer: Independent Care Health Plan Medicaid	$86.97
Rate for Payer: Managed Health Services Medicaid	$90.45
Rate for Payer: Molina Healthcare Medicaid	$131.80
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$86.97
Rate for Payer: United Healthcare Medicaid	$86.97
Rate for Payer: WMAP Medicaid	$86.97

EAPG 827: ORGANIC BEHAVIORAL HEALTH DISTURBANCES

Facility

$114.68

Service Code	EAPG 00827
Min. Negotiated Rate	$59.98
Max. Negotiated Rate	$114.68
Rate for Payer: Anthem Medicaid	$59.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$114.68
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$59.98
Rate for Payer: Dean Health Medicaid	$59.98
Rate for Payer: Independent Care Health Plan Medicaid	$59.98
Rate for Payer: Managed Health Services Medicaid	$62.38
Rate for Payer: Molina Healthcare Medicaid	$114.68
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$59.98
Rate for Payer: United Healthcare Medicaid	$59.98
Rate for Payer: WMAP Medicaid	$59.98

EAPG 828: INTELLECTUAL DISABILITY

Facility

$93.35

Service Code	EAPG 00828
Min. Negotiated Rate	$60.98
Max. Negotiated Rate	$93.35
Rate for Payer: Anthem Medicaid	$60.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$93.35
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$60.98
Rate for Payer: Dean Health Medicaid	$60.98
Rate for Payer: Independent Care Health Plan Medicaid	$60.98
Rate for Payer: Managed Health Services Medicaid	$63.42
Rate for Payer: Molina Healthcare Medicaid	$93.35
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$60.98
Rate for Payer: United Healthcare Medicaid	$60.98
Rate for Payer: WMAP Medicaid	$60.98

EAPG 829: CHILDHOOD BEHAVIORAL DIAGNOSES

Facility

$99.61

Service Code	EAPG 00829
Min. Negotiated Rate	$64.68
Max. Negotiated Rate	$99.61
Rate for Payer: Anthem Medicaid	$64.68
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$99.61
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$64.68
Rate for Payer: Dean Health Medicaid	$64.68
Rate for Payer: Independent Care Health Plan Medicaid	$64.68
Rate for Payer: Managed Health Services Medicaid	$67.27
Rate for Payer: Molina Healthcare Medicaid	$99.61
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$64.68
Rate for Payer: United Healthcare Medicaid	$64.68
Rate for Payer: WMAP Medicaid	$64.68

EAPG 82: COMPREHENSIVE CARDIAC ELECTROPHYSIOLOGIC PROCEDURES WITH ABLATION

Facility

$9,468.16

Service Code	EAPG 00082
Min. Negotiated Rate	$7,261.98
Max. Negotiated Rate	$9,468.16
Rate for Payer: Anthem Medicaid	$7,261.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$9,468.16
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$7,261.98
Rate for Payer: Dean Health Medicaid	$7,261.98
Rate for Payer: Independent Care Health Plan Medicaid	$7,261.98
Rate for Payer: Managed Health Services Medicaid	$7,552.46
Rate for Payer: Molina Healthcare Medicaid	$9,468.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$7,261.98
Rate for Payer: United Healthcare Medicaid	$7,261.98
Rate for Payer: WMAP Medicaid	$7,261.98

Know your out-of-pocket cost for care.

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