Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

EAPG 830: EATING DISORDERS

Facility

$142.61

Service Code	EAPG 00830
Min. Negotiated Rate	$75.68
Max. Negotiated Rate	$142.61
Rate for Payer: Anthem Medicaid	$75.68
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$142.61
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$75.68
Rate for Payer: Dean Health Medicaid	$75.68
Rate for Payer: Independent Care Health Plan Medicaid	$75.68
Rate for Payer: Managed Health Services Medicaid	$78.71
Rate for Payer: Molina Healthcare Medicaid	$142.61
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$75.68
Rate for Payer: United Healthcare Medicaid	$75.68
Rate for Payer: WMAP Medicaid	$75.68

EAPG 831: OTHER BEHAVIORAL HEALTH DIAGNOSES

Facility

$120.84

Service Code	EAPG 00831
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$120.84
Rate for Payer: Anthem Medicaid	$84.90
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$120.84
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$84.90
Rate for Payer: Dean Health Medicaid	$84.90
Rate for Payer: Independent Care Health Plan Medicaid	$84.90
Rate for Payer: Managed Health Services Medicaid	$88.30
Rate for Payer: Molina Healthcare Medicaid	$120.84
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$84.90
Rate for Payer: United Healthcare Medicaid	$84.90
Rate for Payer: WMAP Medicaid	$84.90

EAPG 832: INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$192.72

Service Code	EAPG 00832
Min. Negotiated Rate	$185.31
Max. Negotiated Rate	$192.72
Rate for Payer: Anthem Medicaid	$185.31
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$185.31
Rate for Payer: Dean Health Medicaid	$185.31
Rate for Payer: Independent Care Health Plan Medicaid	$185.31
Rate for Payer: Managed Health Services Medicaid	$192.72
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$185.31
Rate for Payer: United Healthcare Medicaid	$185.31
Rate for Payer: WMAP Medicaid	$185.31

EAPG 83: LEVEL II CENTRAL VENOUS ACCESS PROCEDURES

Facility

$1,345.21

Service Code	EAPG 00083
Min. Negotiated Rate	$880.46
Max. Negotiated Rate	$1,345.21
Rate for Payer: Anthem Medicaid	$880.46
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,345.21
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$880.46
Rate for Payer: Dean Health Medicaid	$880.46
Rate for Payer: Independent Care Health Plan Medicaid	$880.46
Rate for Payer: Managed Health Services Medicaid	$915.68
Rate for Payer: Molina Healthcare Medicaid	$1,345.21
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$880.46
Rate for Payer: United Healthcare Medicaid	$880.46
Rate for Payer: WMAP Medicaid	$880.46

EAPG 840: OPIOID ABUSE AND DEPENDENCE

Facility

$102.10

Service Code	EAPG 00840
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$102.10
Rate for Payer: Anthem Medicaid	$64.35
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$102.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$64.35
Rate for Payer: Dean Health Medicaid	$64.35
Rate for Payer: Independent Care Health Plan Medicaid	$64.35
Rate for Payer: Managed Health Services Medicaid	$66.92
Rate for Payer: Molina Healthcare Medicaid	$102.10
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$64.35
Rate for Payer: United Healthcare Medicaid	$64.35
Rate for Payer: WMAP Medicaid	$64.35

EAPG 841: COCAINE ABUSE AND DEPENDENCE

Facility

$204.50

Service Code	EAPG 00841
Min. Negotiated Rate	$124.38
Max. Negotiated Rate	$204.50
Rate for Payer: Anthem Medicaid	$124.38
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$204.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$124.38
Rate for Payer: Dean Health Medicaid	$124.38
Rate for Payer: Independent Care Health Plan Medicaid	$124.38
Rate for Payer: Managed Health Services Medicaid	$129.36
Rate for Payer: Molina Healthcare Medicaid	$204.50
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$124.38
Rate for Payer: United Healthcare Medicaid	$124.38
Rate for Payer: WMAP Medicaid	$124.38

EAPG 842: ALCOHOL ABUSE AND DEPENDENCE

Facility

$190.46

Service Code	EAPG 00842
Min. Negotiated Rate	$117.03
Max. Negotiated Rate	$190.46
Rate for Payer: Anthem Medicaid	$117.03
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$190.46
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$117.03
Rate for Payer: Dean Health Medicaid	$117.03
Rate for Payer: Independent Care Health Plan Medicaid	$117.03
Rate for Payer: Managed Health Services Medicaid	$121.71
Rate for Payer: Molina Healthcare Medicaid	$190.46
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$117.03
Rate for Payer: United Healthcare Medicaid	$117.03
Rate for Payer: WMAP Medicaid	$117.03

EAPG 843: OTHER DRUG ABUSE AND DEPENDENCE

Facility

$179.55

Service Code	EAPG 00843
Min. Negotiated Rate	$111.55
Max. Negotiated Rate	$179.55
Rate for Payer: Anthem Medicaid	$111.55
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$179.55
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$111.55
Rate for Payer: Dean Health Medicaid	$111.55
Rate for Payer: Independent Care Health Plan Medicaid	$111.55
Rate for Payer: Managed Health Services Medicaid	$116.01
Rate for Payer: Molina Healthcare Medicaid	$179.55
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$111.55
Rate for Payer: United Healthcare Medicaid	$111.55
Rate for Payer: WMAP Medicaid	$111.55

EAPG 84: CARDIAC CATHETERIZATION PROCEDURES

Facility

$1,925.45

Service Code	EAPG 00084
Min. Negotiated Rate	$1,002.36
Max. Negotiated Rate	$1,925.45
Rate for Payer: Anthem Medicaid	$1,002.36
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,925.45
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,002.36
Rate for Payer: Dean Health Medicaid	$1,002.36
Rate for Payer: Independent Care Health Plan Medicaid	$1,002.36
Rate for Payer: Managed Health Services Medicaid	$1,042.45
Rate for Payer: Molina Healthcare Medicaid	$1,925.45
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,002.36
Rate for Payer: United Healthcare Medicaid	$1,002.36
Rate for Payer: WMAP Medicaid	$1,002.36

EAPG 850: ALLERGIC REACTIONS

Facility

$158.86

Service Code	EAPG 00850
Min. Negotiated Rate	$105.02
Max. Negotiated Rate	$158.86
Rate for Payer: Anthem Medicaid	$105.02
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$158.86
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$105.02
Rate for Payer: Dean Health Medicaid	$105.02
Rate for Payer: Independent Care Health Plan Medicaid	$105.02
Rate for Payer: Managed Health Services Medicaid	$109.22
Rate for Payer: Molina Healthcare Medicaid	$158.86
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$105.02
Rate for Payer: United Healthcare Medicaid	$105.02
Rate for Payer: WMAP Medicaid	$105.02

EAPG 851: POISONING OR TOXIC EFFECTS OF MEDICINAL AGENTS

Facility

$189.68

Service Code	EAPG 00851
Min. Negotiated Rate	$113.71
Max. Negotiated Rate	$189.68
Rate for Payer: Anthem Medicaid	$113.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$189.68
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$113.71
Rate for Payer: Dean Health Medicaid	$113.71
Rate for Payer: Independent Care Health Plan Medicaid	$113.71
Rate for Payer: Managed Health Services Medicaid	$118.26
Rate for Payer: Molina Healthcare Medicaid	$189.68
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$113.71
Rate for Payer: United Healthcare Medicaid	$113.71
Rate for Payer: WMAP Medicaid	$113.71

EAPG 852: OTHER COMPLICATIONS OF TREATMENT

Facility

$134.98

Service Code	EAPG 00852
Min. Negotiated Rate	$72.66
Max. Negotiated Rate	$134.98
Rate for Payer: Anthem Medicaid	$72.66
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$134.98
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$72.66
Rate for Payer: Dean Health Medicaid	$72.66
Rate for Payer: Independent Care Health Plan Medicaid	$72.66
Rate for Payer: Managed Health Services Medicaid	$75.57
Rate for Payer: Molina Healthcare Medicaid	$134.98
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$72.66
Rate for Payer: United Healthcare Medicaid	$72.66
Rate for Payer: WMAP Medicaid	$72.66

EAPG 853: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES

Facility

$134.93

Service Code	EAPG 00853
Min. Negotiated Rate	$70.56
Max. Negotiated Rate	$134.93
Rate for Payer: Anthem Medicaid	$70.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$134.93
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.56
Rate for Payer: Dean Health Medicaid	$70.56
Rate for Payer: Independent Care Health Plan Medicaid	$70.56
Rate for Payer: Managed Health Services Medicaid	$73.38
Rate for Payer: Molina Healthcare Medicaid	$134.93
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.56
Rate for Payer: United Healthcare Medicaid	$70.56
Rate for Payer: WMAP Medicaid	$70.56

EAPG 854: TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES

Facility

$136.60

Service Code	EAPG 00854
Min. Negotiated Rate	$83.69
Max. Negotiated Rate	$136.60
Rate for Payer: Anthem Medicaid	$83.69
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$136.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$83.69
Rate for Payer: Dean Health Medicaid	$83.69
Rate for Payer: Independent Care Health Plan Medicaid	$83.69
Rate for Payer: Managed Health Services Medicaid	$87.04
Rate for Payer: Molina Healthcare Medicaid	$136.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$83.69
Rate for Payer: United Healthcare Medicaid	$83.69
Rate for Payer: WMAP Medicaid	$83.69

EAPG 85: LEVEL III PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$4,622.36

Service Code	EAPG 00085
Min. Negotiated Rate	$3,910.79
Max. Negotiated Rate	$4,622.36
Rate for Payer: Anthem Medicaid	$4,444.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3,910.79
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4,444.58
Rate for Payer: Dean Health Medicaid	$4,444.58
Rate for Payer: Independent Care Health Plan Medicaid	$4,444.58
Rate for Payer: Managed Health Services Medicaid	$4,622.36
Rate for Payer: Molina Healthcare Medicaid	$3,910.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4,444.58
Rate for Payer: United Healthcare Medicaid	$4,444.58
Rate for Payer: WMAP Medicaid	$4,444.58

EAPG 860: EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS

Facility

$162.43

Service Code	EAPG 00860
Min. Negotiated Rate	$82.53
Max. Negotiated Rate	$162.43
Rate for Payer: Anthem Medicaid	$82.53
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$162.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$82.53
Rate for Payer: Dean Health Medicaid	$82.53
Rate for Payer: Independent Care Health Plan Medicaid	$82.53
Rate for Payer: Managed Health Services Medicaid	$85.83
Rate for Payer: Molina Healthcare Medicaid	$162.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$82.53
Rate for Payer: United Healthcare Medicaid	$82.53
Rate for Payer: WMAP Medicaid	$82.53

EAPG 861: PARTIAL THICKNESS BURNS

Facility

$146.33

Service Code	EAPG 00861
Min. Negotiated Rate	$70.97
Max. Negotiated Rate	$146.33
Rate for Payer: Anthem Medicaid	$70.97
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$146.33
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$70.97
Rate for Payer: Dean Health Medicaid	$70.97
Rate for Payer: Independent Care Health Plan Medicaid	$70.97
Rate for Payer: Managed Health Services Medicaid	$73.81
Rate for Payer: Molina Healthcare Medicaid	$146.33
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$70.97
Rate for Payer: United Healthcare Medicaid	$70.97
Rate for Payer: WMAP Medicaid	$70.97

EAPG 867: ENCOUNTERS FOR CONTACT WITH HEALTH SERVICES

Facility

$54.32

Service Code	EAPG 00867
Min. Negotiated Rate	$52.23
Max. Negotiated Rate	$54.32
Rate for Payer: Anthem Medicaid	$52.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$52.23
Rate for Payer: Dean Health Medicaid	$52.23
Rate for Payer: Independent Care Health Plan Medicaid	$52.23
Rate for Payer: Managed Health Services Medicaid	$54.32
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$52.23
Rate for Payer: United Healthcare Medicaid	$52.23
Rate for Payer: WMAP Medicaid	$52.23

EAPG 869: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE INJURIES

Facility

$56.85

Service Code	EAPG 00869
Min. Negotiated Rate	$54.66
Max. Negotiated Rate	$56.85
Rate for Payer: Anthem Medicaid	$54.66
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.66
Rate for Payer: Dean Health Medicaid	$54.66
Rate for Payer: Independent Care Health Plan Medicaid	$54.66
Rate for Payer: Managed Health Services Medicaid	$56.85
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.66
Rate for Payer: United Healthcare Medicaid	$54.66
Rate for Payer: WMAP Medicaid	$54.66

EAPG 86: PACEMAKER AND OTHER CARDIOVASCULAR DEVICE INSERTION AND REPLACEMENT

Facility

$6,357.58

Service Code	EAPG 00086
Min. Negotiated Rate	$3,269.41
Max. Negotiated Rate	$6,357.58
Rate for Payer: Anthem Medicaid	$3,269.41
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$6,357.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$3,269.41
Rate for Payer: Dean Health Medicaid	$3,269.41
Rate for Payer: Independent Care Health Plan Medicaid	$3,269.41
Rate for Payer: Managed Health Services Medicaid	$3,400.19
Rate for Payer: Molina Healthcare Medicaid	$6,357.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$3,269.41
Rate for Payer: United Healthcare Medicaid	$3,269.41
Rate for Payer: WMAP Medicaid	$3,269.41

EAPG 870: REHABILITATION

Facility

$76.86

Service Code	EAPG 00870
Min. Negotiated Rate	$57.19
Max. Negotiated Rate	$76.86
Rate for Payer: Anthem Medicaid	$57.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$76.86
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$57.19
Rate for Payer: Dean Health Medicaid	$57.19
Rate for Payer: Independent Care Health Plan Medicaid	$57.19
Rate for Payer: Managed Health Services Medicaid	$59.48
Rate for Payer: Molina Healthcare Medicaid	$76.86
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$57.19
Rate for Payer: United Healthcare Medicaid	$57.19
Rate for Payer: WMAP Medicaid	$57.19

EAPG 871: SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$111.11

Service Code	EAPG 00871
Min. Negotiated Rate	$71.32
Max. Negotiated Rate	$111.11
Rate for Payer: Anthem Medicaid	$71.32
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$111.11
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$71.32
Rate for Payer: Dean Health Medicaid	$71.32
Rate for Payer: Independent Care Health Plan Medicaid	$71.32
Rate for Payer: Managed Health Services Medicaid	$74.17
Rate for Payer: Molina Healthcare Medicaid	$111.11
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$71.32
Rate for Payer: United Healthcare Medicaid	$71.32
Rate for Payer: WMAP Medicaid	$71.32

EAPG 872: OTHER AFTERCARE AND CONVALESCENCE

Facility

$87.43

Service Code	EAPG 00872
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$87.43
Rate for Payer: Anthem Medicaid	$68.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$87.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$68.25
Rate for Payer: Dean Health Medicaid	$68.25
Rate for Payer: Independent Care Health Plan Medicaid	$68.25
Rate for Payer: Managed Health Services Medicaid	$70.98
Rate for Payer: Molina Healthcare Medicaid	$87.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$68.25
Rate for Payer: United Healthcare Medicaid	$68.25
Rate for Payer: WMAP Medicaid	$68.25

EAPG 873: NEONATAL AFTERCARE

Facility

$88.50

Service Code	EAPG 00873
Min. Negotiated Rate	$45.97
Max. Negotiated Rate	$88.50
Rate for Payer: Anthem Medicaid	$45.97
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$88.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$45.97
Rate for Payer: Dean Health Medicaid	$45.97
Rate for Payer: Independent Care Health Plan Medicaid	$45.97
Rate for Payer: Managed Health Services Medicaid	$47.81
Rate for Payer: Molina Healthcare Medicaid	$88.50
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$45.97
Rate for Payer: United Healthcare Medicaid	$45.97
Rate for Payer: WMAP Medicaid	$45.97

EAPG 874: AFTERCARE FOR JOINT REPLACEMENT

Facility

$96.53

Service Code	EAPG 00874
Min. Negotiated Rate	$51.14
Max. Negotiated Rate	$96.53
Rate for Payer: Anthem Medicaid	$51.14
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$96.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$51.14
Rate for Payer: Dean Health Medicaid	$51.14
Rate for Payer: Independent Care Health Plan Medicaid	$51.14
Rate for Payer: Managed Health Services Medicaid	$53.19
Rate for Payer: Molina Healthcare Medicaid	$96.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$51.14
Rate for Payer: United Healthcare Medicaid	$51.14
Rate for Payer: WMAP Medicaid	$51.14

Know your out-of-pocket cost for care.

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