Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

LEVEL II PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES

Facility

$1,044.31

Service Code	EAPG 00189
Min. Negotiated Rate	$1,004.14
Max. Negotiated Rate	$1,044.31
Rate for Payer: Anthem Medicaid	$1,004.14
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,004.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,004.14
Rate for Payer: Dean Health Medicaid	$1,004.14
Rate for Payer: Independent Care Health Plan Medicaid	$1,004.14
Rate for Payer: Managed Health Services Medicaid	$1,044.31
Rate for Payer: Molina Healthcare Medicaid	$1,004.14
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,004.14
Rate for Payer: United Healthcare Medicaid	$1,004.14

LEVEL II PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$1,909.11

Service Code	EAPG 00079
Min. Negotiated Rate	$1,835.67
Max. Negotiated Rate	$1,909.11
Rate for Payer: Anthem Medicaid	$1,835.67
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,835.67
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,835.67
Rate for Payer: Dean Health Medicaid	$1,835.67
Rate for Payer: Independent Care Health Plan Medicaid	$1,835.67
Rate for Payer: Managed Health Services Medicaid	$1,909.11
Rate for Payer: Molina Healthcare Medicaid	$1,835.67
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,835.67
Rate for Payer: United Healthcare Medicaid	$1,835.67

LEVEL II PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION

Facility

$1,827.87

Service Code	EAPG 00091
Min. Negotiated Rate	$1,757.56
Max. Negotiated Rate	$1,827.87
Rate for Payer: Anthem Medicaid	$1,757.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,757.56
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,757.56
Rate for Payer: Dean Health Medicaid	$1,757.56
Rate for Payer: Independent Care Health Plan Medicaid	$1,757.56
Rate for Payer: Managed Health Services Medicaid	$1,827.87
Rate for Payer: Molina Healthcare Medicaid	$1,757.56
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,757.56
Rate for Payer: United Healthcare Medicaid	$1,757.56

LEVEL II POSTERIOR SEGMENT EYE PROCEDURES

Facility

$1,986.41

Service Code	EAPG 00238
Min. Negotiated Rate	$1,910.01
Max. Negotiated Rate	$1,986.41
Rate for Payer: Anthem Medicaid	$1,910.01
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,910.01
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,910.01
Rate for Payer: Dean Health Medicaid	$1,910.01
Rate for Payer: Independent Care Health Plan Medicaid	$1,910.01
Rate for Payer: Managed Health Services Medicaid	$1,986.41
Rate for Payer: Molina Healthcare Medicaid	$1,910.01
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,910.01
Rate for Payer: United Healthcare Medicaid	$1,910.01

LEVEL II PROSTATE PROCEDURES

Facility

$1,926.14

Service Code	EAPG 00184
Min. Negotiated Rate	$1,852.05
Max. Negotiated Rate	$1,926.14
Rate for Payer: Anthem Medicaid	$1,852.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,852.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,852.05
Rate for Payer: Dean Health Medicaid	$1,852.05
Rate for Payer: Independent Care Health Plan Medicaid	$1,852.05
Rate for Payer: Managed Health Services Medicaid	$1,926.14
Rate for Payer: Molina Healthcare Medicaid	$1,852.05
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,852.05
Rate for Payer: United Healthcare Medicaid	$1,852.05

LEVEL II PROSTHODONTICS, FIXED

Facility

$222.75

Service Code	EAPG 00354
Min. Negotiated Rate	$214.18
Max. Negotiated Rate	$222.75
Rate for Payer: Anthem Medicaid	$214.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$214.18
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$214.18
Rate for Payer: Dean Health Medicaid	$214.18
Rate for Payer: Independent Care Health Plan Medicaid	$214.18
Rate for Payer: Managed Health Services Medicaid	$222.75
Rate for Payer: Molina Healthcare Medicaid	$214.18
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$214.18
Rate for Payer: United Healthcare Medicaid	$214.18

LEVEL II PROSTHODONTICS, REMOVABLE

Facility

$230.61

Service Code	EAPG 00357
Min. Negotiated Rate	$221.74
Max. Negotiated Rate	$230.61
Rate for Payer: Anthem Medicaid	$221.74
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$221.74
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$221.74
Rate for Payer: Dean Health Medicaid	$221.74
Rate for Payer: Independent Care Health Plan Medicaid	$221.74
Rate for Payer: Managed Health Services Medicaid	$230.61
Rate for Payer: Molina Healthcare Medicaid	$221.74
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$221.74
Rate for Payer: United Healthcare Medicaid	$221.74

LEVEL II RADIATION THERAPY

Facility

$115.31

Service Code	EAPG 00347
Min. Negotiated Rate	$110.87
Max. Negotiated Rate	$115.31
Rate for Payer: Anthem Medicaid	$110.87
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$110.87
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$110.87
Rate for Payer: Dean Health Medicaid	$110.87
Rate for Payer: Independent Care Health Plan Medicaid	$110.87
Rate for Payer: Managed Health Services Medicaid	$115.31
Rate for Payer: Molina Healthcare Medicaid	$110.87
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$110.87
Rate for Payer: United Healthcare Medicaid	$110.87

LEVEL II RADIATION TREATMENT PREPARATION & PLANNING

Facility

$315.78

Service Code	EAPG 00477
Min. Negotiated Rate	$303.64
Max. Negotiated Rate	$315.78
Rate for Payer: Anthem Medicaid	$303.64
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$303.64
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$303.64
Rate for Payer: Dean Health Medicaid	$303.64
Rate for Payer: Independent Care Health Plan Medicaid	$303.64
Rate for Payer: Managed Health Services Medicaid	$315.78
Rate for Payer: Molina Healthcare Medicaid	$303.64
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$303.64
Rate for Payer: United Healthcare Medicaid	$303.64

LEVEL II REPAIR AND PLASTIC PROCEDURES OF EYE

Facility

$1,364.02

Service Code	EAPG 00241
Min. Negotiated Rate	$1,311.56
Max. Negotiated Rate	$1,364.02
Rate for Payer: Anthem Medicaid	$1,311.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,311.56
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,311.56
Rate for Payer: Dean Health Medicaid	$1,311.56
Rate for Payer: Independent Care Health Plan Medicaid	$1,311.56
Rate for Payer: Managed Health Services Medicaid	$1,364.02
Rate for Payer: Molina Healthcare Medicaid	$1,311.56
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,311.56
Rate for Payer: United Healthcare Medicaid	$1,311.56

LEVEL II SHOULDER AND UPPER ARM PROCEDURES

Facility

$1,628.70

Service Code	EAPG 00058
Min. Negotiated Rate	$1,566.06
Max. Negotiated Rate	$1,628.70
Rate for Payer: Anthem Medicaid	$1,566.06
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,566.06
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,566.06
Rate for Payer: Dean Health Medicaid	$1,566.06
Rate for Payer: Independent Care Health Plan Medicaid	$1,566.06
Rate for Payer: Managed Health Services Medicaid	$1,628.70
Rate for Payer: Molina Healthcare Medicaid	$1,566.06
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,566.06
Rate for Payer: United Healthcare Medicaid	$1,566.06

LEVEL II SKIN EXCISIONS, BIOPSIES, AND REPAIRS

Facility

$884.45

Service Code	EAPG 00010
Min. Negotiated Rate	$850.43
Max. Negotiated Rate	$884.45
Rate for Payer: Anthem Medicaid	$850.43
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$850.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$850.43
Rate for Payer: Dean Health Medicaid	$850.43
Rate for Payer: Independent Care Health Plan Medicaid	$850.43
Rate for Payer: Managed Health Services Medicaid	$884.45
Rate for Payer: Molina Healthcare Medicaid	$850.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$850.43
Rate for Payer: United Healthcare Medicaid	$850.43

LEVEL II SKIN INCISION AND DRAINAGE, DEBRIDEMENT, DESTRUCTION, OTHER RELATED PX

Facility

$435.02

Service Code	EAPG 00004
Min. Negotiated Rate	$418.29
Max. Negotiated Rate	$435.02
Rate for Payer: Anthem Medicaid	$418.29
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$418.29
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$418.29
Rate for Payer: Dean Health Medicaid	$418.29
Rate for Payer: Independent Care Health Plan Medicaid	$418.29
Rate for Payer: Managed Health Services Medicaid	$435.02
Rate for Payer: Molina Healthcare Medicaid	$418.29
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$418.29
Rate for Payer: United Healthcare Medicaid	$418.29

LEVEL II SMALL AND LARGE INTESTINE SURGICAL PROCEDURES

Facility

$1,802.97

Service Code	EAPG 00128
Min. Negotiated Rate	$1,733.62
Max. Negotiated Rate	$1,802.97
Rate for Payer: Anthem Medicaid	$1,733.62
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,733.62
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,733.62
Rate for Payer: Dean Health Medicaid	$1,733.62
Rate for Payer: Independent Care Health Plan Medicaid	$1,733.62
Rate for Payer: Managed Health Services Medicaid	$1,802.97
Rate for Payer: Molina Healthcare Medicaid	$1,733.62
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,733.62
Rate for Payer: United Healthcare Medicaid	$1,733.62

LEVEL II SPINE PROCEDURES

Facility

$2,798.80

Service Code	EAPG 00029
Min. Negotiated Rate	$2,691.15
Max. Negotiated Rate	$2,798.80
Rate for Payer: Anthem Medicaid	$2,691.15
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$2,691.15
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$2,691.15
Rate for Payer: Dean Health Medicaid	$2,691.15
Rate for Payer: Independent Care Health Plan Medicaid	$2,691.15
Rate for Payer: Managed Health Services Medicaid	$2,798.80
Rate for Payer: Molina Healthcare Medicaid	$2,691.15
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$2,691.15
Rate for Payer: United Healthcare Medicaid	$2,691.15

LEVEL II SURGICAL PATHOLOGY TESTS

Facility

$57.65

Service Code	EAPG 00306
Min. Negotiated Rate	$55.44
Max. Negotiated Rate	$57.65
Rate for Payer: Anthem Medicaid	$55.44
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$55.44
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$55.44
Rate for Payer: Dean Health Medicaid	$55.44
Rate for Payer: Independent Care Health Plan Medicaid	$55.44
Rate for Payer: Managed Health Services Medicaid	$57.65
Rate for Payer: Molina Healthcare Medicaid	$55.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$55.44
Rate for Payer: United Healthcare Medicaid	$55.44

LEVEL II THORACIC AND CHEST PROCEDURES

Facility

$1,666.70

Service Code	EAPG 00070
Min. Negotiated Rate	$1,602.59
Max. Negotiated Rate	$1,666.70
Rate for Payer: Anthem Medicaid	$1,602.59
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,602.59
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,602.59
Rate for Payer: Dean Health Medicaid	$1,602.59
Rate for Payer: Independent Care Health Plan Medicaid	$1,602.59
Rate for Payer: Managed Health Services Medicaid	$1,666.70
Rate for Payer: Molina Healthcare Medicaid	$1,602.59
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,602.59
Rate for Payer: United Healthcare Medicaid	$1,602.59

LEVEL II UPPER GI ENDOSCOPY

Facility

$659.08

Service Code	EAPG 00135
Min. Negotiated Rate	$633.73
Max. Negotiated Rate	$659.08
Rate for Payer: Anthem Medicaid	$633.73
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$633.73
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$633.73
Rate for Payer: Dean Health Medicaid	$633.73
Rate for Payer: Independent Care Health Plan Medicaid	$633.73
Rate for Payer: Managed Health Services Medicaid	$659.08
Rate for Payer: Molina Healthcare Medicaid	$633.73
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$633.73
Rate for Payer: United Healthcare Medicaid	$633.73

LEVEL II URETHRAL PROCEDURES

Facility

$1,809.52

Service Code	EAPG 00167
Min. Negotiated Rate	$1,739.92
Max. Negotiated Rate	$1,809.52
Rate for Payer: Anthem Medicaid	$1,739.92
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,739.92
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,739.92
Rate for Payer: Dean Health Medicaid	$1,739.92
Rate for Payer: Independent Care Health Plan Medicaid	$1,739.92
Rate for Payer: Managed Health Services Medicaid	$1,809.52
Rate for Payer: Molina Healthcare Medicaid	$1,739.92
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,739.92
Rate for Payer: United Healthcare Medicaid	$1,739.92

LEVEL II VARICOSE VEIN AND RELATED PROCEDURES

Facility

$1,713.87

Service Code	EAPG 00103
Min. Negotiated Rate	$1,647.95
Max. Negotiated Rate	$1,713.87
Rate for Payer: Anthem Medicaid	$1,647.95
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,647.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,647.95
Rate for Payer: Dean Health Medicaid	$1,647.95
Rate for Payer: Independent Care Health Plan Medicaid	$1,647.95
Rate for Payer: Managed Health Services Medicaid	$1,713.87
Rate for Payer: Molina Healthcare Medicaid	$1,647.95
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,647.95
Rate for Payer: United Healthcare Medicaid	$1,647.95

LEVEL II VASCULAR RADIOLOGICAL PROCEDURES

Facility

$252.89

Service Code	EAPG 00279
Min. Negotiated Rate	$243.16
Max. Negotiated Rate	$252.89
Rate for Payer: Anthem Medicaid	$243.16
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$243.16
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$243.16
Rate for Payer: Dean Health Medicaid	$243.16
Rate for Payer: Independent Care Health Plan Medicaid	$243.16
Rate for Payer: Managed Health Services Medicaid	$252.89
Rate for Payer: Molina Healthcare Medicaid	$243.16
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$243.16
Rate for Payer: United Healthcare Medicaid	$243.16

LEVEL I JOINT, TENDON, OR LIGAMENT INJECTION PROCEDURES

Facility

$209.65

Service Code	EAPG 00049
Min. Negotiated Rate	$201.58
Max. Negotiated Rate	$209.65
Rate for Payer: Anthem Medicaid	$201.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$201.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$201.58
Rate for Payer: Dean Health Medicaid	$201.58
Rate for Payer: Independent Care Health Plan Medicaid	$201.58
Rate for Payer: Managed Health Services Medicaid	$209.65
Rate for Payer: Molina Healthcare Medicaid	$201.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$201.58
Rate for Payer: United Healthcare Medicaid	$201.58

LEVEL I KIDNEY AND URETERAL PROCEDURES

Facility

$783.56

Service Code	EAPG 00170
Min. Negotiated Rate	$753.42
Max. Negotiated Rate	$783.56
Rate for Payer: Anthem Medicaid	$753.42
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$753.42
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$753.42
Rate for Payer: Dean Health Medicaid	$753.42
Rate for Payer: Independent Care Health Plan Medicaid	$753.42
Rate for Payer: Managed Health Services Medicaid	$783.56
Rate for Payer: Molina Healthcare Medicaid	$753.42
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$753.42
Rate for Payer: United Healthcare Medicaid	$753.42

LEVEL I KNEE AND LOWER LEG PROCEDURES

Facility

$1,255.27

Service Code	EAPG 00026
Min. Negotiated Rate	$1,206.98
Max. Negotiated Rate	$1,255.27
Rate for Payer: Anthem Medicaid	$1,206.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,206.98
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,206.98
Rate for Payer: Dean Health Medicaid	$1,206.98
Rate for Payer: Independent Care Health Plan Medicaid	$1,206.98
Rate for Payer: Managed Health Services Medicaid	$1,255.27
Rate for Payer: Molina Healthcare Medicaid	$1,206.98
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,206.98
Rate for Payer: United Healthcare Medicaid	$1,206.98

LEVEL I LAPAROSCOPY

Facility

$1,328.64

Service Code	EAPG 00145
Min. Negotiated Rate	$1,277.54
Max. Negotiated Rate	$1,328.64
Rate for Payer: Anthem Medicaid	$1,277.54
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,277.54
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,277.54
Rate for Payer: Dean Health Medicaid	$1,277.54
Rate for Payer: Independent Care Health Plan Medicaid	$1,277.54
Rate for Payer: Managed Health Services Medicaid	$1,328.64
Rate for Payer: Molina Healthcare Medicaid	$1,277.54
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,277.54
Rate for Payer: United Healthcare Medicaid	$1,277.54

Know your out-of-pocket cost for care.

All Charges