Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

LEVEL I ENDODONTICS

Facility

$82.55

Service Code	EAPG 00364
Min. Negotiated Rate	$79.37
Max. Negotiated Rate	$82.55
Rate for Payer: Anthem Medicaid	$79.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$79.37
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$79.37
Rate for Payer: Dean Health Medicaid	$79.37
Rate for Payer: Independent Care Health Plan Medicaid	$79.37
Rate for Payer: Managed Health Services Medicaid	$82.55
Rate for Payer: Molina Healthcare Medicaid	$79.37
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$79.37
Rate for Payer: United Healthcare Medicaid	$79.37

LEVEL I ENDOSCOPY OF THE UPPER AIRWAY

Facility

$272.54

Service Code	EAPG 00062
Min. Negotiated Rate	$262.06
Max. Negotiated Rate	$272.54
Rate for Payer: Anthem Medicaid	$262.06
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$262.06
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$262.06
Rate for Payer: Dean Health Medicaid	$262.06
Rate for Payer: Independent Care Health Plan Medicaid	$262.06
Rate for Payer: Managed Health Services Medicaid	$272.54
Rate for Payer: Molina Healthcare Medicaid	$262.06
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$262.06
Rate for Payer: United Healthcare Medicaid	$262.06

LEVEL I ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility

$930.31

Service Code	EAPG 00138
Min. Negotiated Rate	$894.53
Max. Negotiated Rate	$930.31
Rate for Payer: Anthem Medicaid	$894.53
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$894.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$894.53
Rate for Payer: Dean Health Medicaid	$894.53
Rate for Payer: Independent Care Health Plan Medicaid	$894.53
Rate for Payer: Managed Health Services Medicaid	$930.31
Rate for Payer: Molina Healthcare Medicaid	$894.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$894.53
Rate for Payer: United Healthcare Medicaid	$894.53

LEVEL I ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES

Facility

$1,281.47

Service Code	EAPG 00125
Min. Negotiated Rate	$1,232.18
Max. Negotiated Rate	$1,281.47
Rate for Payer: Anthem Medicaid	$1,232.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,232.18
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,232.18
Rate for Payer: Dean Health Medicaid	$1,232.18
Rate for Payer: Independent Care Health Plan Medicaid	$1,232.18
Rate for Payer: Managed Health Services Medicaid	$1,281.47
Rate for Payer: Molina Healthcare Medicaid	$1,232.18
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,232.18
Rate for Payer: United Healthcare Medicaid	$1,232.18

LEVEL I EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES

Facility

$851.70

Service Code	EAPG 00258
Min. Negotiated Rate	$818.93
Max. Negotiated Rate	$851.70
Rate for Payer: Anthem Medicaid	$818.93
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$818.93
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$818.93
Rate for Payer: Dean Health Medicaid	$818.93
Rate for Payer: Independent Care Health Plan Medicaid	$818.93
Rate for Payer: Managed Health Services Medicaid	$851.70
Rate for Payer: Molina Healthcare Medicaid	$818.93
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$818.93
Rate for Payer: United Healthcare Medicaid	$818.93

LEVEL I FETAL PROCEDURES

Facility

$170.34

Service Code	EAPG 00191
Min. Negotiated Rate	$163.79
Max. Negotiated Rate	$170.34
Rate for Payer: Anthem Medicaid	$163.79
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$163.79
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$163.79
Rate for Payer: Dean Health Medicaid	$163.79
Rate for Payer: Independent Care Health Plan Medicaid	$163.79
Rate for Payer: Managed Health Services Medicaid	$170.34
Rate for Payer: Molina Healthcare Medicaid	$163.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$163.79
Rate for Payer: United Healthcare Medicaid	$163.79

LEVEL I FOOT PROCEDURES

Facility

$1,166.17

Service Code	EAPG 00035
Min. Negotiated Rate	$1,121.31
Max. Negotiated Rate	$1,166.17
Rate for Payer: Anthem Medicaid	$1,121.31
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,121.31
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,121.31
Rate for Payer: Dean Health Medicaid	$1,121.31
Rate for Payer: Independent Care Health Plan Medicaid	$1,121.31
Rate for Payer: Managed Health Services Medicaid	$1,166.17
Rate for Payer: Molina Healthcare Medicaid	$1,121.31
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,121.31
Rate for Payer: United Healthcare Medicaid	$1,121.31

LEVEL I FOREARM AND WRIST PROCEDURES

Facility

$1,420.37

Service Code	EAPG 00023
Min. Negotiated Rate	$1,365.73
Max. Negotiated Rate	$1,420.37
Rate for Payer: Anthem Medicaid	$1,365.73
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,365.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,365.73
Rate for Payer: Dean Health Medicaid	$1,365.73
Rate for Payer: Independent Care Health Plan Medicaid	$1,365.73
Rate for Payer: Managed Health Services Medicaid	$1,420.37
Rate for Payer: Molina Healthcare Medicaid	$1,365.73
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,365.73
Rate for Payer: United Healthcare Medicaid	$1,365.73

LEVEL I GASTROINTESTINAL PROCEDURES

Facility

$860.87

Service Code	EAPG 00143
Min. Negotiated Rate	$827.75
Max. Negotiated Rate	$860.87
Rate for Payer: Anthem Medicaid	$827.75
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$827.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$827.75
Rate for Payer: Dean Health Medicaid	$827.75
Rate for Payer: Independent Care Health Plan Medicaid	$827.75
Rate for Payer: Managed Health Services Medicaid	$860.87
Rate for Payer: Molina Healthcare Medicaid	$827.75
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$827.75
Rate for Payer: United Healthcare Medicaid	$827.75

LEVEL I HAND PROCEDURES

Facility

$905.42

Service Code	EAPG 00033
Min. Negotiated Rate	$870.59
Max. Negotiated Rate	$905.42
Rate for Payer: Anthem Medicaid	$870.59
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$870.59
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$870.59
Rate for Payer: Dean Health Medicaid	$870.59
Rate for Payer: Independent Care Health Plan Medicaid	$870.59
Rate for Payer: Managed Health Services Medicaid	$905.42
Rate for Payer: Molina Healthcare Medicaid	$870.59
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$870.59
Rate for Payer: United Healthcare Medicaid	$870.59

LEVEL I HEMATOLOGY TESTS

Facility

$9.17

Service Code	EAPG 00408
Min. Negotiated Rate	$8.82
Max. Negotiated Rate	$9.17
Rate for Payer: Anthem Medicaid	$8.82
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$8.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$8.82
Rate for Payer: Dean Health Medicaid	$8.82
Rate for Payer: Independent Care Health Plan Medicaid	$8.82
Rate for Payer: Managed Health Services Medicaid	$9.17
Rate for Payer: Molina Healthcare Medicaid	$8.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$8.82
Rate for Payer: United Healthcare Medicaid	$8.82

LEVEL I HEPATOBILIARY AND PANCREAS PROCEDURES

Facility

$1,035.14

Service Code	EAPG 00151
Min. Negotiated Rate	$995.32
Max. Negotiated Rate	$1,035.14
Rate for Payer: Anthem Medicaid	$995.32
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$995.32
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$995.32
Rate for Payer: Dean Health Medicaid	$995.32
Rate for Payer: Independent Care Health Plan Medicaid	$995.32
Rate for Payer: Managed Health Services Medicaid	$1,035.14
Rate for Payer: Molina Healthcare Medicaid	$995.32
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$995.32
Rate for Payer: United Healthcare Medicaid	$995.32

LEVEL I HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility

$858.25

Service Code	EAPG 00204
Min. Negotiated Rate	$825.23
Max. Negotiated Rate	$858.25
Rate for Payer: Anthem Medicaid	$825.23
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$825.23
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$825.23
Rate for Payer: Dean Health Medicaid	$825.23
Rate for Payer: Independent Care Health Plan Medicaid	$825.23
Rate for Payer: Managed Health Services Medicaid	$858.25
Rate for Payer: Molina Healthcare Medicaid	$825.23
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$825.23
Rate for Payer: United Healthcare Medicaid	$825.23

LEVEL II ADJUNCTIVE GENERAL DENTAL SERVICES

Facility

$171.65

Service Code	EAPG 00351
Min. Negotiated Rate	$165.05
Max. Negotiated Rate	$171.65
Rate for Payer: Anthem Medicaid	$165.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$165.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$165.05
Rate for Payer: Dean Health Medicaid	$165.05
Rate for Payer: Independent Care Health Plan Medicaid	$165.05
Rate for Payer: Managed Health Services Medicaid	$171.65
Rate for Payer: Molina Healthcare Medicaid	$165.05
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$165.05
Rate for Payer: United Healthcare Medicaid	$165.05

LEVEL II ALLERGY TESTS

Facility

$180.82

Service Code	EAPG 02016
Min. Negotiated Rate	$173.87
Max. Negotiated Rate	$180.82
Rate for Payer: Anthem Medicaid	$173.87
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$173.87
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$173.87
Rate for Payer: Dean Health Medicaid	$173.87
Rate for Payer: Independent Care Health Plan Medicaid	$173.87
Rate for Payer: Managed Health Services Medicaid	$180.82
Rate for Payer: Molina Healthcare Medicaid	$173.87
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$173.87
Rate for Payer: United Healthcare Medicaid	$173.87

LEVEL II ANAL AND RECTAL PROCEDURES

Facility

$1,096.72

Service Code	EAPG 00142
Min. Negotiated Rate	$1,054.54
Max. Negotiated Rate	$1,096.72
Rate for Payer: Anthem Medicaid	$1,054.54
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,054.54
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,054.54
Rate for Payer: Dean Health Medicaid	$1,054.54
Rate for Payer: Independent Care Health Plan Medicaid	$1,054.54
Rate for Payer: Managed Health Services Medicaid	$1,096.72
Rate for Payer: Molina Healthcare Medicaid	$1,054.54
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,054.54
Rate for Payer: United Healthcare Medicaid	$1,054.54

LEVEL II ANCLLARY THERAPEUTIC SERVICES

Facility

$51.10

Service Code	EAPG 00269
Min. Negotiated Rate	$49.14
Max. Negotiated Rate	$51.10
Rate for Payer: Anthem Medicaid	$49.14
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$49.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$49.14
Rate for Payer: Dean Health Medicaid	$49.14
Rate for Payer: Independent Care Health Plan Medicaid	$49.14
Rate for Payer: Managed Health Services Medicaid	$51.10
Rate for Payer: Molina Healthcare Medicaid	$49.14
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$49.14
Rate for Payer: United Healthcare Medicaid	$49.14

LEVEL II ANTERIOR SEGMENT EYE PROCEDURES

Facility

$1,568.43

Service Code	EAPG 00235
Min. Negotiated Rate	$1,508.10
Max. Negotiated Rate	$1,568.43
Rate for Payer: Anthem Medicaid	$1,508.10
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,508.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,508.10
Rate for Payer: Dean Health Medicaid	$1,508.10
Rate for Payer: Independent Care Health Plan Medicaid	$1,508.10
Rate for Payer: Managed Health Services Medicaid	$1,568.43
Rate for Payer: Molina Healthcare Medicaid	$1,508.10
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,508.10
Rate for Payer: United Healthcare Medicaid	$1,508.10

LEVEL II ARTHROPLASTY

Facility

$2,498.74

Service Code	EAPG 00047
Min. Negotiated Rate	$2,402.63
Max. Negotiated Rate	$2,498.74
Rate for Payer: Anthem Medicaid	$2,402.63
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,402.63
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,402.63
Rate for Payer: Dean Health Medicaid	$2,402.63
Rate for Payer: Independent Care Health Plan Medicaid	$2,402.63
Rate for Payer: Managed Health Services Medicaid	$2,498.74
Rate for Payer: Molina Healthcare Medicaid	$2,402.63
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,402.63
Rate for Payer: United Healthcare Medicaid	$2,402.63

LEVEL II ARTHROSCOPY

Facility

$2,477.78

Service Code	EAPG 00038
Min. Negotiated Rate	$2,382.47
Max. Negotiated Rate	$2,477.78
Rate for Payer: Anthem Medicaid	$2,382.47
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,382.47
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,382.47
Rate for Payer: Dean Health Medicaid	$2,382.47
Rate for Payer: Independent Care Health Plan Medicaid	$2,382.47
Rate for Payer: Managed Health Services Medicaid	$2,477.78
Rate for Payer: Molina Healthcare Medicaid	$2,382.47
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,382.47
Rate for Payer: United Healthcare Medicaid	$2,382.47

LEVEL II BLADDER AND URETERAL PROCEDURES

Facility

$1,391.54

Service Code	EAPG 00174
Min. Negotiated Rate	$1,338.01
Max. Negotiated Rate	$1,391.54
Rate for Payer: Anthem Medicaid	$1,338.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,338.01
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,338.01
Rate for Payer: Dean Health Medicaid	$1,338.01
Rate for Payer: Independent Care Health Plan Medicaid	$1,338.01
Rate for Payer: Managed Health Services Medicaid	$1,391.54
Rate for Payer: Molina Healthcare Medicaid	$1,338.01
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,338.01
Rate for Payer: United Healthcare Medicaid	$1,338.01

LEVEL II BLOOD AND BLOOD PRODUCT EXCHANGE

Facility

$1,460.98

Service Code	EAPG 00114
Min. Negotiated Rate	$1,404.79
Max. Negotiated Rate	$1,460.98
Rate for Payer: Anthem Medicaid	$1,404.79
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,404.79
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,404.79
Rate for Payer: Dean Health Medicaid	$1,404.79
Rate for Payer: Independent Care Health Plan Medicaid	$1,404.79
Rate for Payer: Managed Health Services Medicaid	$1,460.98
Rate for Payer: Molina Healthcare Medicaid	$1,404.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,404.79
Rate for Payer: United Healthcare Medicaid	$1,404.79

LEVEL II BLOOD AND TISSUE TYPING TESTS

Facility

$34.07

Service Code	EAPG 00393
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$34.07
Rate for Payer: Anthem Medicaid	$32.76
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$32.76
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$32.76
Rate for Payer: Dean Health Medicaid	$32.76
Rate for Payer: Independent Care Health Plan Medicaid	$32.76
Rate for Payer: Managed Health Services Medicaid	$34.07
Rate for Payer: Molina Healthcare Medicaid	$32.76
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$32.76
Rate for Payer: United Healthcare Medicaid	$32.76

LEVEL II BLOOD PRODUCTS

Facility

$476.95

Service Code	EAPG 02062
Min. Negotiated Rate	$458.60
Max. Negotiated Rate	$476.95
Rate for Payer: Anthem Medicaid	$458.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$458.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$458.60
Rate for Payer: Dean Health Medicaid	$458.60
Rate for Payer: Independent Care Health Plan Medicaid	$458.60
Rate for Payer: Managed Health Services Medicaid	$476.95
Rate for Payer: Molina Healthcare Medicaid	$458.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$458.60
Rate for Payer: United Healthcare Medicaid	$458.60

LEVEL II BRACHYTHERAPY SOURCES

Facility

$986.66

Service Code	EAPG 00336
Min. Negotiated Rate	$948.70
Max. Negotiated Rate	$986.66
Rate for Payer: Anthem Medicaid	$948.70
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$948.70
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$948.70
Rate for Payer: Dean Health Medicaid	$948.70
Rate for Payer: Independent Care Health Plan Medicaid	$948.70
Rate for Payer: Managed Health Services Medicaid	$986.66
Rate for Payer: Molina Healthcare Medicaid	$948.70
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$948.70
Rate for Payer: United Healthcare Medicaid	$948.70

Know your out-of-pocket cost for care.

All Charges