Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

LEVEL I LOWER AIRWAY ENDOSCOPY

Facility

$837.28

Service Code	EAPG 00064
Min. Negotiated Rate	$805.08
Max. Negotiated Rate	$837.28
Rate for Payer: Anthem Medicaid	$805.08
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$805.08
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$805.08
Rate for Payer: Dean Health Medicaid	$805.08
Rate for Payer: Independent Care Health Plan Medicaid	$805.08
Rate for Payer: Managed Health Services Medicaid	$837.28
Rate for Payer: Molina Healthcare Medicaid	$805.08
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$805.08
Rate for Payer: United Healthcare Medicaid	$805.08

LEVEL I LOWER GI ENDOSCOPY

Facility

$552.95

Service Code	EAPG 00136
Min. Negotiated Rate	$531.68
Max. Negotiated Rate	$552.95
Rate for Payer: Anthem Medicaid	$531.68
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$531.68
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$531.68
Rate for Payer: Dean Health Medicaid	$531.68
Rate for Payer: Independent Care Health Plan Medicaid	$531.68
Rate for Payer: Managed Health Services Medicaid	$552.95
Rate for Payer: Molina Healthcare Medicaid	$531.68
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$531.68
Rate for Payer: United Healthcare Medicaid	$531.68

LEVEL I MAXILLOFACIAL PROSTHETICS

Facility

$34.07

Service Code	EAPG 00359
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 I MICROBIOLOGY TESTS

Facility

$7.86

Service Code	EAPG 00396
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$7.86
Rate for Payer: Anthem Medicaid	$7.56
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$7.56
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$7.56
Rate for Payer: Dean Health Medicaid	$7.56
Rate for Payer: Independent Care Health Plan Medicaid	$7.56
Rate for Payer: Managed Health Services Medicaid	$7.86
Rate for Payer: Molina Healthcare Medicaid	$7.56
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$7.56
Rate for Payer: United Healthcare Medicaid	$7.56

LEVEL I NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE

Facility

$948.66

Service Code	EAPG 00217
Min. Negotiated Rate	$912.17
Max. Negotiated Rate	$948.66
Rate for Payer: Anthem Medicaid	$912.17
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$912.17
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$912.17
Rate for Payer: Dean Health Medicaid	$912.17
Rate for Payer: Independent Care Health Plan Medicaid	$912.17
Rate for Payer: Managed Health Services Medicaid	$948.66
Rate for Payer: Molina Healthcare Medicaid	$912.17
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$912.17
Rate for Payer: United Healthcare Medicaid	$912.17

LEVEL I NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP

Facility

$331.51

Service Code	EAPG 00214
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$331.51
Rate for Payer: Anthem Medicaid	$318.75
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$318.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$318.75
Rate for Payer: Dean Health Medicaid	$318.75
Rate for Payer: Independent Care Health Plan Medicaid	$318.75
Rate for Payer: Managed Health Services Medicaid	$331.51
Rate for Payer: Molina Healthcare Medicaid	$318.75
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$318.75
Rate for Payer: United Healthcare Medicaid	$318.75

LEVEL I ORAL AND MAXILLOFACIAL PROCEDURES

Facility

$98.27

Service Code	EAPG 00367
Min. Negotiated Rate	$94.49
Max. Negotiated Rate	$98.27
Rate for Payer: Anthem Medicaid	$94.49
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$94.49
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$94.49
Rate for Payer: Dean Health Medicaid	$94.49
Rate for Payer: Independent Care Health Plan Medicaid	$94.49
Rate for Payer: Managed Health Services Medicaid	$98.27
Rate for Payer: Molina Healthcare Medicaid	$94.49
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$94.49
Rate for Payer: United Healthcare Medicaid	$94.49

LEVEL I OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES

Facility

$998.45

Service Code	EAPG 00207
Min. Negotiated Rate	$960.04
Max. Negotiated Rate	$998.45
Rate for Payer: Anthem Medicaid	$960.04
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$960.04
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$960.04
Rate for Payer: Dean Health Medicaid	$960.04
Rate for Payer: Independent Care Health Plan Medicaid	$960.04
Rate for Payer: Managed Health Services Medicaid	$998.45
Rate for Payer: Molina Healthcare Medicaid	$960.04
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$960.04
Rate for Payer: United Healthcare Medicaid	$960.04

LEVEL I PATHOLOGY TESTS

Facility

$30.14

Service Code	EAPG 00390
Min. Negotiated Rate	$28.98
Max. Negotiated Rate	$30.14
Rate for Payer: Anthem Medicaid	$28.98
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$28.98
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$28.98
Rate for Payer: Dean Health Medicaid	$28.98
Rate for Payer: Independent Care Health Plan Medicaid	$28.98
Rate for Payer: Managed Health Services Medicaid	$30.14
Rate for Payer: Molina Healthcare Medicaid	$28.98
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$28.98
Rate for Payer: United Healthcare Medicaid	$28.98

LEVEL I PENILE PROCEDURES

Facility

$676.11

Service Code	EAPG 00183
Min. Negotiated Rate	$650.11
Max. Negotiated Rate	$676.11
Rate for Payer: Anthem Medicaid	$650.11
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$650.11
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$650.11
Rate for Payer: Dean Health Medicaid	$650.11
Rate for Payer: Independent Care Health Plan Medicaid	$650.11
Rate for Payer: Managed Health Services Medicaid	$676.11
Rate for Payer: Molina Healthcare Medicaid	$650.11
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$650.11
Rate for Payer: United Healthcare Medicaid	$650.11

LEVEL I PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES

Facility

$1,909.11

Service Code	EAPG 00099
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 I PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES

Facility

$926.38

Service Code	EAPG 00188
Min. Negotiated Rate	$890.75
Max. Negotiated Rate	$926.38
Rate for Payer: Anthem Medicaid	$890.75
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$890.75
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$890.75
Rate for Payer: Dean Health Medicaid	$890.75
Rate for Payer: Independent Care Health Plan Medicaid	$890.75
Rate for Payer: Managed Health Services Medicaid	$926.38
Rate for Payer: Molina Healthcare Medicaid	$890.75
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$890.75
Rate for Payer: United Healthcare Medicaid	$890.75

LEVEL I PERIODONTICS

Facility

$106.13

Service Code	EAPG 00352
Min. Negotiated Rate	$102.05
Max. Negotiated Rate	$106.13
Rate for Payer: Anthem Medicaid	$102.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$102.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$102.05
Rate for Payer: Dean Health Medicaid	$102.05
Rate for Payer: Independent Care Health Plan Medicaid	$102.05
Rate for Payer: Managed Health Services Medicaid	$106.13
Rate for Payer: Molina Healthcare Medicaid	$102.05
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$102.05
Rate for Payer: United Healthcare Medicaid	$102.05

LEVEL I PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$1,582.84

Service Code	EAPG 00077
Min. Negotiated Rate	$1,521.96
Max. Negotiated Rate	$1,582.84
Rate for Payer: Anthem Medicaid	$1,521.96
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,521.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,521.96
Rate for Payer: Dean Health Medicaid	$1,521.96
Rate for Payer: Independent Care Health Plan Medicaid	$1,521.96
Rate for Payer: Managed Health Services Medicaid	$1,582.84
Rate for Payer: Molina Healthcare Medicaid	$1,521.96
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,521.96
Rate for Payer: United Healthcare Medicaid	$1,521.96

LEVEL I PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION

Facility

$1,827.87

Service Code	EAPG 00078
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 I POSTERIOR SEGMENT EYE PROCEDURES

Facility

$415.37

Service Code	EAPG 00237
Min. Negotiated Rate	$399.39
Max. Negotiated Rate	$415.37
Rate for Payer: Anthem Medicaid	$399.39
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$399.39
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$399.39
Rate for Payer: Dean Health Medicaid	$399.39
Rate for Payer: Independent Care Health Plan Medicaid	$399.39
Rate for Payer: Managed Health Services Medicaid	$415.37
Rate for Payer: Molina Healthcare Medicaid	$399.39
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$399.39
Rate for Payer: United Healthcare Medicaid	$399.39

LEVEL I PROSTATE PROCEDURES

Facility

$1,424.30

Service Code	EAPG 00176
Min. Negotiated Rate	$1,369.51
Max. Negotiated Rate	$1,424.30
Rate for Payer: Anthem Medicaid	$1,369.51
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,369.51
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,369.51
Rate for Payer: Dean Health Medicaid	$1,369.51
Rate for Payer: Independent Care Health Plan Medicaid	$1,369.51
Rate for Payer: Managed Health Services Medicaid	$1,424.30
Rate for Payer: Molina Healthcare Medicaid	$1,369.51
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,369.51
Rate for Payer: United Healthcare Medicaid	$1,369.51

LEVEL I PROSTHODONTICS, FIXED

Facility

$60.27

Service Code	EAPG 00353
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 I PROSTHODONTICS, REMOVABLE

Facility

$120.55

Service Code	EAPG 00356
Min. Negotiated Rate	$115.91
Max. Negotiated Rate	$120.55
Rate for Payer: Anthem Medicaid	$115.91
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$115.91
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$115.91
Rate for Payer: Dean Health Medicaid	$115.91
Rate for Payer: Independent Care Health Plan Medicaid	$115.91
Rate for Payer: Managed Health Services Medicaid	$120.55
Rate for Payer: Molina Healthcare Medicaid	$115.91
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$115.91
Rate for Payer: United Healthcare Medicaid	$115.91

LEVEL I RADIATION THERAPY

Facility

$248.96

Service Code	EAPG 00343
Min. Negotiated Rate	$239.38
Max. Negotiated Rate	$248.96
Rate for Payer: Anthem Medicaid	$239.38
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$239.38
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$239.38
Rate for Payer: Dean Health Medicaid	$239.38
Rate for Payer: Independent Care Health Plan Medicaid	$239.38
Rate for Payer: Managed Health Services Medicaid	$248.96
Rate for Payer: Molina Healthcare Medicaid	$239.38
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$239.38
Rate for Payer: United Healthcare Medicaid	$239.38

LEVEL I RADIATION TREATMENT PREPARATION & PLANNING

Facility

$334.13

Service Code	EAPG 00476
Min. Negotiated Rate	$321.27
Max. Negotiated Rate	$334.13
Rate for Payer: Anthem Medicaid	$321.27
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$321.27
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$321.27
Rate for Payer: Dean Health Medicaid	$321.27
Rate for Payer: Independent Care Health Plan Medicaid	$321.27
Rate for Payer: Managed Health Services Medicaid	$334.13
Rate for Payer: Molina Healthcare Medicaid	$321.27
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$321.27
Rate for Payer: United Healthcare Medicaid	$321.27

LEVEL I REPAIR AND PLASTIC PROCEDURES OF EYE

Facility

$547.71

Service Code	EAPG 00240
Min. Negotiated Rate	$526.64
Max. Negotiated Rate	$547.71
Rate for Payer: Anthem Medicaid	$526.64
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$526.64
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$526.64
Rate for Payer: Dean Health Medicaid	$526.64
Rate for Payer: Independent Care Health Plan Medicaid	$526.64
Rate for Payer: Managed Health Services Medicaid	$547.71
Rate for Payer: Molina Healthcare Medicaid	$526.64
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$526.64
Rate for Payer: United Healthcare Medicaid	$526.64

LEVEL I SKIN EXCISIONS, BIOPSIES, AND REPAIRS

Facility

$450.74

Service Code	EAPG 00009
Min. Negotiated Rate	$433.41
Max. Negotiated Rate	$450.74
Rate for Payer: Anthem Medicaid	$433.41
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$433.41
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$433.41
Rate for Payer: Dean Health Medicaid	$433.41
Rate for Payer: Independent Care Health Plan Medicaid	$433.41
Rate for Payer: Managed Health Services Medicaid	$450.74
Rate for Payer: Molina Healthcare Medicaid	$433.41
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$433.41
Rate for Payer: United Healthcare Medicaid	$433.41

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

Facility

$230.61

Service Code	EAPG 00003
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 I SMALL AND LARGE INTESTINE SURGICAL PROCEDURES

Facility

$1,644.43

Service Code	EAPG 00127
Min. Negotiated Rate	$1,581.17
Max. Negotiated Rate	$1,644.43
Rate for Payer: Anthem Medicaid	$1,581.17
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,581.17
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,581.17
Rate for Payer: Dean Health Medicaid	$1,581.17
Rate for Payer: Independent Care Health Plan Medicaid	$1,581.17
Rate for Payer: Managed Health Services Medicaid	$1,644.43
Rate for Payer: Molina Healthcare Medicaid	$1,581.17
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,581.17
Rate for Payer: United Healthcare Medicaid	$1,581.17

Know your out-of-pocket cost for care.

All Charges