Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

LEVEL II BREAST PROCEDURES

Facility

$1,585.46

Service Code	EAPG 00021
Min. Negotiated Rate	$1,524.48
Max. Negotiated Rate	$1,585.46
Rate for Payer: Anthem Medicaid	$1,524.48
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,524.48
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,524.48
Rate for Payer: Dean Health Medicaid	$1,524.48
Rate for Payer: Independent Care Health Plan Medicaid	$1,524.48
Rate for Payer: Managed Health Services Medicaid	$1,585.46
Rate for Payer: Molina Healthcare Medicaid	$1,524.48
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,524.48
Rate for Payer: United Healthcare Medicaid	$1,524.48

LEVEL II CENTRAL VENOUS ACCESS PROCEDURES

Facility

$991.90

Service Code	EAPG 00083
Min. Negotiated Rate	$953.74
Max. Negotiated Rate	$991.90
Rate for Payer: Anthem Medicaid	$953.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$953.74
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$953.74
Rate for Payer: Dean Health Medicaid	$953.74
Rate for Payer: Independent Care Health Plan Medicaid	$953.74
Rate for Payer: Managed Health Services Medicaid	$991.90
Rate for Payer: Molina Healthcare Medicaid	$953.74
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$953.74
Rate for Payer: United Healthcare Medicaid	$953.74

LEVEL II CHEMISTRY TESTS

Facility

$27.52

Service Code	EAPG 00401
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$27.52
Rate for Payer: Anthem Medicaid	$26.46
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$26.46
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$26.46
Rate for Payer: Dean Health Medicaid	$26.46
Rate for Payer: Independent Care Health Plan Medicaid	$26.46
Rate for Payer: Managed Health Services Medicaid	$27.52
Rate for Payer: Molina Healthcare Medicaid	$26.46
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$26.46
Rate for Payer: United Healthcare Medicaid	$26.46

LEVEL II CLOTTING TESTS

Facility

$32.76

Service Code	EAPG 00407
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$32.76
Rate for Payer: Anthem Medicaid	$31.50
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$31.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$31.50
Rate for Payer: Dean Health Medicaid	$31.50
Rate for Payer: Independent Care Health Plan Medicaid	$31.50
Rate for Payer: Managed Health Services Medicaid	$32.76
Rate for Payer: Molina Healthcare Medicaid	$31.50
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$31.50
Rate for Payer: United Healthcare Medicaid	$31.50

LEVEL II COMPUTED TOMOGRAPHY

Facility

$254.20

Service Code	EAPG 00300
Min. Negotiated Rate	$244.42
Max. Negotiated Rate	$254.20
Rate for Payer: Anthem Medicaid	$244.42
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$244.42
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$244.42
Rate for Payer: Dean Health Medicaid	$244.42
Rate for Payer: Independent Care Health Plan Medicaid	$244.42
Rate for Payer: Managed Health Services Medicaid	$254.20
Rate for Payer: Molina Healthcare Medicaid	$244.42
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$244.42
Rate for Payer: United Healthcare Medicaid	$244.42

LEVEL II CONVENTIONAL RADIOLOGY

Facility

$182.13

Service Code	EAPG 00389
Min. Negotiated Rate	$175.13
Max. Negotiated Rate	$182.13
Rate for Payer: Anthem Medicaid	$175.13
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$175.13
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$175.13
Rate for Payer: Dean Health Medicaid	$175.13
Rate for Payer: Independent Care Health Plan Medicaid	$175.13
Rate for Payer: Managed Health Services Medicaid	$182.13
Rate for Payer: Molina Healthcare Medicaid	$175.13
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$175.13
Rate for Payer: United Healthcare Medicaid	$175.13

LEVEL II CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES

Facility

$2,105.65

Service Code	EAPG 00248
Min. Negotiated Rate	$2,024.66
Max. Negotiated Rate	$2,105.65
Rate for Payer: Anthem Medicaid	$2,024.66
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,024.66
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,024.66
Rate for Payer: Dean Health Medicaid	$2,024.66
Rate for Payer: Independent Care Health Plan Medicaid	$2,024.66
Rate for Payer: Managed Health Services Medicaid	$2,105.65
Rate for Payer: Molina Healthcare Medicaid	$2,024.66
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,024.66
Rate for Payer: United Healthcare Medicaid	$2,024.66

LEVEL II CRANIOFACIAL BONE PROCEDURES

Facility

$2,289.09

Service Code	EAPG 00228
Min. Negotiated Rate	$2,201.05
Max. Negotiated Rate	$2,289.09
Rate for Payer: Anthem Medicaid	$2,201.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,201.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,201.05
Rate for Payer: Dean Health Medicaid	$2,201.05
Rate for Payer: Independent Care Health Plan Medicaid	$2,201.05
Rate for Payer: Managed Health Services Medicaid	$2,289.09
Rate for Payer: Molina Healthcare Medicaid	$2,201.05
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,201.05
Rate for Payer: United Healthcare Medicaid	$2,201.05

LEVEL II DENTAL FILM

Facility

$60.27

Service Code	EAPG 00374
Min. Negotiated Rate	$57.96
Max. Negotiated Rate	$60.27
Rate for Payer: Anthem Medicaid	$57.96
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$57.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$57.96
Rate for Payer: Dean Health Medicaid	$57.96
Rate for Payer: Independent Care Health Plan Medicaid	$57.96
Rate for Payer: Managed Health Services Medicaid	$60.27
Rate for Payer: Molina Healthcare Medicaid	$57.96
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$57.96
Rate for Payer: United Healthcare Medicaid	$57.96

LEVEL II DENTAL RESTORATIONS

Facility

$128.41

Service Code	EAPG 00362
Min. Negotiated Rate	$123.47
Max. Negotiated Rate	$128.41
Rate for Payer: Anthem Medicaid	$123.47
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$123.47
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$123.47
Rate for Payer: Dean Health Medicaid	$123.47
Rate for Payer: Independent Care Health Plan Medicaid	$123.47
Rate for Payer: Managed Health Services Medicaid	$128.41
Rate for Payer: Molina Healthcare Medicaid	$123.47
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$123.47
Rate for Payer: United Healthcare Medicaid	$123.47

LEVEL II DEVICE PLACEMENT FOR RADIATION THERAPY

Facility

$911.97

Service Code	EAPG 00338
Min. Negotiated Rate	$876.89
Max. Negotiated Rate	$911.97
Rate for Payer: Anthem Medicaid	$876.89
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$876.89
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$876.89
Rate for Payer: Dean Health Medicaid	$876.89
Rate for Payer: Independent Care Health Plan Medicaid	$876.89
Rate for Payer: Managed Health Services Medicaid	$911.97
Rate for Payer: Molina Healthcare Medicaid	$876.89
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$876.89
Rate for Payer: United Healthcare Medicaid	$876.89

LEVEL II DIAGNOSTIC NUCLEAR MEDICINE

Facility

$533.29

Service Code	EAPG 00332
Min. Negotiated Rate	$512.78
Max. Negotiated Rate	$533.29
Rate for Payer: Anthem Medicaid	$512.78
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$512.78
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$512.78
Rate for Payer: Dean Health Medicaid	$512.78
Rate for Payer: Independent Care Health Plan Medicaid	$512.78
Rate for Payer: Managed Health Services Medicaid	$533.29
Rate for Payer: Molina Healthcare Medicaid	$512.78
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$512.78
Rate for Payer: United Healthcare Medicaid	$512.78

LEVEL II DIAGNOSTIC ULTRASOUND

Facility

$457.29

Service Code	EAPG 00289
Min. Negotiated Rate	$439.71
Max. Negotiated Rate	$457.29
Rate for Payer: Anthem Medicaid	$439.71
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$439.71
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$439.71
Rate for Payer: Dean Health Medicaid	$439.71
Rate for Payer: Independent Care Health Plan Medicaid	$439.71
Rate for Payer: Managed Health Services Medicaid	$457.29
Rate for Payer: Molina Healthcare Medicaid	$439.71
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$439.71
Rate for Payer: United Healthcare Medicaid	$439.71

LEVEL II EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$1,197.61

Service Code	EAPG 00253
Min. Negotiated Rate	$1,151.55
Max. Negotiated Rate	$1,197.61
Rate for Payer: Anthem Medicaid	$1,151.55
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,151.55
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,151.55
Rate for Payer: Dean Health Medicaid	$1,151.55
Rate for Payer: Independent Care Health Plan Medicaid	$1,151.55
Rate for Payer: Managed Health Services Medicaid	$1,197.61
Rate for Payer: Molina Healthcare Medicaid	$1,151.55
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,151.55
Rate for Payer: United Healthcare Medicaid	$1,151.55

LEVEL II ENDOCRINOLOGY TESTS

Facility

$28.83

Service Code	EAPG 00399
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$28.83
Rate for Payer: Anthem Medicaid	$27.72
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$27.72
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$27.72
Rate for Payer: Dean Health Medicaid	$27.72
Rate for Payer: Independent Care Health Plan Medicaid	$27.72
Rate for Payer: Managed Health Services Medicaid	$28.83
Rate for Payer: Molina Healthcare Medicaid	$27.72
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$27.72
Rate for Payer: United Healthcare Medicaid	$27.72

LEVEL II ENDODONTICS

Facility

$146.75

Service Code	EAPG 00365
Min. Negotiated Rate	$141.11
Max. Negotiated Rate	$146.75
Rate for Payer: Anthem Medicaid	$141.11
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$141.11
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$141.11
Rate for Payer: Dean Health Medicaid	$141.11
Rate for Payer: Independent Care Health Plan Medicaid	$141.11
Rate for Payer: Managed Health Services Medicaid	$146.75
Rate for Payer: Molina Healthcare Medicaid	$141.11
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$141.11
Rate for Payer: United Healthcare Medicaid	$141.11

LEVEL II ENDOSCOPY OF THE UPPER AIRWAY

Facility

$1,205.48

Service Code	EAPG 00063
Min. Negotiated Rate	$1,159.11
Max. Negotiated Rate	$1,205.48
Rate for Payer: Anthem Medicaid	$1,159.11
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,159.11
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,159.11
Rate for Payer: Dean Health Medicaid	$1,159.11
Rate for Payer: Independent Care Health Plan Medicaid	$1,159.11
Rate for Payer: Managed Health Services Medicaid	$1,205.48
Rate for Payer: Molina Healthcare Medicaid	$1,159.11
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,159.11
Rate for Payer: United Healthcare Medicaid	$1,159.11

LEVEL II ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility

$1,023.34

Service Code	EAPG 00153
Min. Negotiated Rate	$983.98
Max. Negotiated Rate	$1,023.34
Rate for Payer: Anthem Medicaid	$983.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$983.98
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$983.98
Rate for Payer: Dean Health Medicaid	$983.98
Rate for Payer: Independent Care Health Plan Medicaid	$983.98
Rate for Payer: Managed Health Services Medicaid	$1,023.34
Rate for Payer: Molina Healthcare Medicaid	$983.98
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$983.98
Rate for Payer: United Healthcare Medicaid	$983.98

LEVEL II ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES

Facility

$1,716.49

Service Code	EAPG 00126
Min. Negotiated Rate	$1,650.47
Max. Negotiated Rate	$1,716.49
Rate for Payer: Anthem Medicaid	$1,650.47
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,650.47
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,650.47
Rate for Payer: Dean Health Medicaid	$1,650.47
Rate for Payer: Independent Care Health Plan Medicaid	$1,650.47
Rate for Payer: Managed Health Services Medicaid	$1,716.49
Rate for Payer: Molina Healthcare Medicaid	$1,650.47
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,650.47
Rate for Payer: United Healthcare Medicaid	$1,650.47

LEVEL II EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES

Facility

$1,286.71

Service Code	EAPG 00259
Min. Negotiated Rate	$1,237.22
Max. Negotiated Rate	$1,286.71
Rate for Payer: Anthem Medicaid	$1,237.22
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,237.22
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,237.22
Rate for Payer: Dean Health Medicaid	$1,237.22
Rate for Payer: Independent Care Health Plan Medicaid	$1,237.22
Rate for Payer: Managed Health Services Medicaid	$1,286.71
Rate for Payer: Molina Healthcare Medicaid	$1,237.22
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,237.22
Rate for Payer: United Healthcare Medicaid	$1,237.22

LEVEL II FETAL PROCEDURES

Facility

$509.71

Service Code	EAPG 00192
Min. Negotiated Rate	$490.10
Max. Negotiated Rate	$509.71
Rate for Payer: Anthem Medicaid	$490.10
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$490.10
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$490.10
Rate for Payer: Dean Health Medicaid	$490.10
Rate for Payer: Independent Care Health Plan Medicaid	$490.10
Rate for Payer: Managed Health Services Medicaid	$509.71
Rate for Payer: Molina Healthcare Medicaid	$490.10
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$490.10
Rate for Payer: United Healthcare Medicaid	$490.10

LEVEL II FOOT PROCEDURES

Facility

$1,491.12

Service Code	EAPG 00036
Min. Negotiated Rate	$1,433.77
Max. Negotiated Rate	$1,491.12
Rate for Payer: Anthem Medicaid	$1,433.77
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,433.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,433.77
Rate for Payer: Dean Health Medicaid	$1,433.77
Rate for Payer: Independent Care Health Plan Medicaid	$1,433.77
Rate for Payer: Managed Health Services Medicaid	$1,491.12
Rate for Payer: Molina Healthcare Medicaid	$1,433.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,433.77
Rate for Payer: United Healthcare Medicaid	$1,433.77

LEVEL II FOREARM AND WRIST PROCEDURES

Facility

$1,619.53

Service Code	EAPG 00024
Min. Negotiated Rate	$1,557.24
Max. Negotiated Rate	$1,619.53
Rate for Payer: Anthem Medicaid	$1,557.24
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,557.24
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,557.24
Rate for Payer: Dean Health Medicaid	$1,557.24
Rate for Payer: Independent Care Health Plan Medicaid	$1,557.24
Rate for Payer: Managed Health Services Medicaid	$1,619.53
Rate for Payer: Molina Healthcare Medicaid	$1,557.24
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,557.24
Rate for Payer: United Healthcare Medicaid	$1,557.24

LEVEL II GASTROINTESTINAL PROCEDURES

Facility

$1,728.29

Service Code	EAPG 00144
Min. Negotiated Rate	$1,661.81
Max. Negotiated Rate	$1,728.29
Rate for Payer: Anthem Medicaid	$1,661.81
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,661.81
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,661.81
Rate for Payer: Dean Health Medicaid	$1,661.81
Rate for Payer: Independent Care Health Plan Medicaid	$1,661.81
Rate for Payer: Managed Health Services Medicaid	$1,728.29
Rate for Payer: Molina Healthcare Medicaid	$1,661.81
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,661.81
Rate for Payer: United Healthcare Medicaid	$1,661.81

LEVEL II HAND PROCEDURES

Facility

$1,496.36

Service Code	EAPG 00034
Min. Negotiated Rate	$1,438.81
Max. Negotiated Rate	$1,496.36
Rate for Payer: Anthem Medicaid	$1,438.81
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,438.81
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,438.81
Rate for Payer: Dean Health Medicaid	$1,438.81
Rate for Payer: Independent Care Health Plan Medicaid	$1,438.81
Rate for Payer: Managed Health Services Medicaid	$1,496.36
Rate for Payer: Molina Healthcare Medicaid	$1,438.81
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,438.81
Rate for Payer: United Healthcare Medicaid	$1,438.81

Know your out-of-pocket cost for care.

All Charges