Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

LEVEL I ENDODONTICS

Facility

$31.03

Service Code	EAPG 00364
Min. Negotiated Rate	$29.83
Max. Negotiated Rate	$31.03
Rate for Payer: Anthem Medicaid	$29.83
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$29.83
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$29.83
Rate for Payer: Dean Health Medicaid	$29.83
Rate for Payer: Independent Care Health Plan Medicaid	$29.83
Rate for Payer: Managed Health Services Medicaid	$31.03
Rate for Payer: Molina Healthcare Medicaid	$29.83
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$29.83
Rate for Payer: United Healthcare Medicaid	$29.83

LEVEL I ENDOSCOPY OF THE UPPER AIRWAY

Facility

$126.21

Service Code	EAPG 00062
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$126.21
Rate for Payer: Anthem Medicaid	$121.36
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$121.36
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$121.36
Rate for Payer: Dean Health Medicaid	$121.36
Rate for Payer: Independent Care Health Plan Medicaid	$121.36
Rate for Payer: Managed Health Services Medicaid	$126.21
Rate for Payer: Molina Healthcare Medicaid	$121.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$121.36
Rate for Payer: United Healthcare Medicaid	$121.36

LEVEL I ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility

$580.77

Service Code	EAPG 00138
Min. Negotiated Rate	$558.43
Max. Negotiated Rate	$580.77
Rate for Payer: Anthem Medicaid	$558.43
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$558.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$558.43
Rate for Payer: Dean Health Medicaid	$558.43
Rate for Payer: Independent Care Health Plan Medicaid	$558.43
Rate for Payer: Managed Health Services Medicaid	$580.77
Rate for Payer: Molina Healthcare Medicaid	$558.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$558.43
Rate for Payer: United Healthcare Medicaid	$558.43

LEVEL I ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES

Facility

$729.35

Service Code	EAPG 00125
Min. Negotiated Rate	$701.29
Max. Negotiated Rate	$729.35
Rate for Payer: Anthem Medicaid	$701.29
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$701.29
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$701.29
Rate for Payer: Dean Health Medicaid	$701.29
Rate for Payer: Independent Care Health Plan Medicaid	$701.29
Rate for Payer: Managed Health Services Medicaid	$729.35
Rate for Payer: Molina Healthcare Medicaid	$701.29
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$701.29
Rate for Payer: United Healthcare Medicaid	$701.29

LEVEL I EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES

Facility

$296.52

Service Code	EAPG 00258
Min. Negotiated Rate	$285.11
Max. Negotiated Rate	$296.52
Rate for Payer: Anthem Medicaid	$285.11
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$285.11
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$285.11
Rate for Payer: Dean Health Medicaid	$285.11
Rate for Payer: Independent Care Health Plan Medicaid	$285.11
Rate for Payer: Managed Health Services Medicaid	$296.52
Rate for Payer: Molina Healthcare Medicaid	$285.11
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$285.11
Rate for Payer: United Healthcare Medicaid	$285.11

LEVEL I FETAL PROCEDURES

Facility

$42.60

Service Code	EAPG 00191
Min. Negotiated Rate	$40.96
Max. Negotiated Rate	$42.60
Rate for Payer: Anthem Medicaid	$40.96
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$40.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$40.96
Rate for Payer: Dean Health Medicaid	$40.96
Rate for Payer: Independent Care Health Plan Medicaid	$40.96
Rate for Payer: Managed Health Services Medicaid	$42.60
Rate for Payer: Molina Healthcare Medicaid	$40.96
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$40.96
Rate for Payer: United Healthcare Medicaid	$40.96

LEVEL I FOOT PROCEDURES

Facility

$471.17

Service Code	EAPG 00035
Min. Negotiated Rate	$453.05
Max. Negotiated Rate	$471.17
Rate for Payer: Anthem Medicaid	$453.05
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$453.05
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$453.05
Rate for Payer: Dean Health Medicaid	$453.05
Rate for Payer: Independent Care Health Plan Medicaid	$453.05
Rate for Payer: Managed Health Services Medicaid	$471.17
Rate for Payer: Molina Healthcare Medicaid	$453.05
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$453.05
Rate for Payer: United Healthcare Medicaid	$453.05

LEVEL I FOREARM AND WRIST PROCEDURES

Facility

$373.49

Service Code	EAPG 00023
Min. Negotiated Rate	$359.13
Max. Negotiated Rate	$373.49
Rate for Payer: Anthem Medicaid	$359.13
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$359.13
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$359.13
Rate for Payer: Dean Health Medicaid	$359.13
Rate for Payer: Independent Care Health Plan Medicaid	$359.13
Rate for Payer: Managed Health Services Medicaid	$373.49
Rate for Payer: Molina Healthcare Medicaid	$359.13
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$359.13
Rate for Payer: United Healthcare Medicaid	$359.13

LEVEL I HAND PROCEDURES

Facility

$287.49

Service Code	EAPG 00033
Min. Negotiated Rate	$276.43
Max. Negotiated Rate	$287.49
Rate for Payer: Anthem Medicaid	$276.43
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$276.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$276.43
Rate for Payer: Dean Health Medicaid	$276.43
Rate for Payer: Independent Care Health Plan Medicaid	$276.43
Rate for Payer: Managed Health Services Medicaid	$287.49
Rate for Payer: Molina Healthcare Medicaid	$276.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$276.43
Rate for Payer: United Healthcare Medicaid	$276.43

LEVEL I HEMATOLOGY TESTS

Facility

$1.06

Service Code	EAPG 00408
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.06
Rate for Payer: Anthem Medicaid	$1.02
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1.02
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1.02
Rate for Payer: Dean Health Medicaid	$1.02
Rate for Payer: Independent Care Health Plan Medicaid	$1.02
Rate for Payer: Managed Health Services Medicaid	$1.06
Rate for Payer: Molina Healthcare Medicaid	$1.02
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1.02
Rate for Payer: United Healthcare Medicaid	$1.02

LEVEL I HEPATOBILIARY AND PANCREAS PROCEDURES

Facility

$495.24

Service Code	EAPG 00151
Min. Negotiated Rate	$476.19
Max. Negotiated Rate	$495.24
Rate for Payer: Anthem Medicaid	$476.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$476.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$476.19
Rate for Payer: Dean Health Medicaid	$476.19
Rate for Payer: Independent Care Health Plan Medicaid	$476.19
Rate for Payer: Managed Health Services Medicaid	$495.24
Rate for Payer: Molina Healthcare Medicaid	$476.19
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$476.19
Rate for Payer: United Healthcare Medicaid	$476.19

LEVEL I HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility

$897.11

Service Code	EAPG 00204
Min. Negotiated Rate	$862.60
Max. Negotiated Rate	$897.11
Rate for Payer: Anthem Medicaid	$862.60
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$862.60
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$862.60
Rate for Payer: Dean Health Medicaid	$862.60
Rate for Payer: Independent Care Health Plan Medicaid	$862.60
Rate for Payer: Managed Health Services Medicaid	$897.11
Rate for Payer: Molina Healthcare Medicaid	$862.60
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$862.60
Rate for Payer: United Healthcare Medicaid	$862.60

LEVEL II ALLERGY TESTS

Facility

$8.23

Service Code	EAPG 02016
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$8.23
Rate for Payer: Anthem Medicaid	$7.92
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$7.92
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$7.92
Rate for Payer: Dean Health Medicaid	$7.92
Rate for Payer: Independent Care Health Plan Medicaid	$7.92
Rate for Payer: Managed Health Services Medicaid	$8.23
Rate for Payer: Molina Healthcare Medicaid	$7.92
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$7.92
Rate for Payer: United Healthcare Medicaid	$7.92

LEVEL II ANAL AND RECTAL PROCEDURES

Facility

$496.04

Service Code	EAPG 00142
Min. Negotiated Rate	$476.96
Max. Negotiated Rate	$496.04
Rate for Payer: Anthem Medicaid	$476.96
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$476.96
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$476.96
Rate for Payer: Dean Health Medicaid	$476.96
Rate for Payer: Independent Care Health Plan Medicaid	$476.96
Rate for Payer: Managed Health Services Medicaid	$496.04
Rate for Payer: Molina Healthcare Medicaid	$476.96
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$476.96
Rate for Payer: United Healthcare Medicaid	$476.96

LEVEL II ANCLLARY THERAPEUTIC SERVICES

Facility

$33.59

Service Code	EAPG 00269
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$33.59
Rate for Payer: Anthem Medicaid	$32.30
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$32.30
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$32.30
Rate for Payer: Dean Health Medicaid	$32.30
Rate for Payer: Independent Care Health Plan Medicaid	$32.30
Rate for Payer: Managed Health Services Medicaid	$33.59
Rate for Payer: Molina Healthcare Medicaid	$32.30
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$32.30
Rate for Payer: United Healthcare Medicaid	$32.30

LEVEL II ANTERIOR SEGMENT EYE PROCEDURES

Facility

$733.09

Service Code	EAPG 00235
Min. Negotiated Rate	$704.89
Max. Negotiated Rate	$733.09
Rate for Payer: Anthem Medicaid	$704.89
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$704.89
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$704.89
Rate for Payer: Dean Health Medicaid	$704.89
Rate for Payer: Independent Care Health Plan Medicaid	$704.89
Rate for Payer: Managed Health Services Medicaid	$733.09
Rate for Payer: Molina Healthcare Medicaid	$704.89
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$704.89
Rate for Payer: United Healthcare Medicaid	$704.89

LEVEL II ARTHROPLASTY

Facility

$2,033.59

Service Code	EAPG 00047
Min. Negotiated Rate	$1,955.37
Max. Negotiated Rate	$2,033.59
Rate for Payer: Anthem Medicaid	$1,955.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,955.37
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,955.37
Rate for Payer: Dean Health Medicaid	$1,955.37
Rate for Payer: Independent Care Health Plan Medicaid	$1,955.37
Rate for Payer: Managed Health Services Medicaid	$2,033.59
Rate for Payer: Molina Healthcare Medicaid	$1,955.37
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,955.37
Rate for Payer: United Healthcare Medicaid	$1,955.37

LEVEL II ARTHROSCOPY

Facility

$1,214.91

Service Code	EAPG 00038
Min. Negotiated Rate	$1,168.18
Max. Negotiated Rate	$1,214.91
Rate for Payer: Anthem Medicaid	$1,168.18
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,168.18
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,168.18
Rate for Payer: Dean Health Medicaid	$1,168.18
Rate for Payer: Independent Care Health Plan Medicaid	$1,168.18
Rate for Payer: Managed Health Services Medicaid	$1,214.91
Rate for Payer: Molina Healthcare Medicaid	$1,168.18
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,168.18
Rate for Payer: United Healthcare Medicaid	$1,168.18

LEVEL II BLADDER AND URETERAL PROCEDURES

Facility

$903.67

Service Code	EAPG 00174
Min. Negotiated Rate	$868.91
Max. Negotiated Rate	$903.67
Rate for Payer: Anthem Medicaid	$868.91
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$868.91
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$868.91
Rate for Payer: Dean Health Medicaid	$868.91
Rate for Payer: Independent Care Health Plan Medicaid	$868.91
Rate for Payer: Managed Health Services Medicaid	$903.67
Rate for Payer: Molina Healthcare Medicaid	$868.91
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$868.91
Rate for Payer: United Healthcare Medicaid	$868.91

LEVEL II BLOOD AND BLOOD PRODUCT EXCHANGE

Facility

$347.49

Service Code	EAPG 00114
Min. Negotiated Rate	$334.13
Max. Negotiated Rate	$347.49
Rate for Payer: Anthem Medicaid	$334.13
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$334.13
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$334.13
Rate for Payer: Dean Health Medicaid	$334.13
Rate for Payer: Independent Care Health Plan Medicaid	$334.13
Rate for Payer: Managed Health Services Medicaid	$347.49
Rate for Payer: Molina Healthcare Medicaid	$334.13
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$334.13
Rate for Payer: United Healthcare Medicaid	$334.13

LEVEL II BLOOD AND TISSUE TYPING TESTS

Facility

$10.96

Service Code	EAPG 00393
Min. Negotiated Rate	$10.53
Max. Negotiated Rate	$10.96
Rate for Payer: Anthem Medicaid	$10.53
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$10.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$10.53
Rate for Payer: Dean Health Medicaid	$10.53
Rate for Payer: Independent Care Health Plan Medicaid	$10.53
Rate for Payer: Managed Health Services Medicaid	$10.96
Rate for Payer: Molina Healthcare Medicaid	$10.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$10.53
Rate for Payer: United Healthcare Medicaid	$10.53

LEVEL II BLOOD PRODUCTS

Facility

$65.88

Service Code	EAPG 02062
Min. Negotiated Rate	$63.34
Max. Negotiated Rate	$65.88
Rate for Payer: Anthem Medicaid	$63.34
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$63.34
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$63.34
Rate for Payer: Dean Health Medicaid	$63.34
Rate for Payer: Independent Care Health Plan Medicaid	$63.34
Rate for Payer: Managed Health Services Medicaid	$65.88
Rate for Payer: Molina Healthcare Medicaid	$63.34
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$63.34
Rate for Payer: United Healthcare Medicaid	$63.34

LEVEL II BRACHYTHERAPY SOURCES

Facility

$710.16

Service Code	EAPG 00336
Min. Negotiated Rate	$682.85
Max. Negotiated Rate	$710.16
Rate for Payer: Anthem Medicaid	$682.85
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$682.85
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$682.85
Rate for Payer: Dean Health Medicaid	$682.85
Rate for Payer: Independent Care Health Plan Medicaid	$682.85
Rate for Payer: Managed Health Services Medicaid	$710.16
Rate for Payer: Molina Healthcare Medicaid	$682.85
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$682.85
Rate for Payer: United Healthcare Medicaid	$682.85

LEVEL II BREAST PROCEDURES

Facility

$710.87

Service Code	EAPG 00021
Min. Negotiated Rate	$683.53
Max. Negotiated Rate	$710.87
Rate for Payer: Anthem Medicaid	$683.53
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$683.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$683.53
Rate for Payer: Dean Health Medicaid	$683.53
Rate for Payer: Independent Care Health Plan Medicaid	$683.53
Rate for Payer: Managed Health Services Medicaid	$710.87
Rate for Payer: Molina Healthcare Medicaid	$683.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$683.53
Rate for Payer: United Healthcare Medicaid	$683.53

LEVEL II CENTRAL VENOUS ACCESS PROCEDURES

Facility

$463.26

Service Code	EAPG 00083
Min. Negotiated Rate	$445.44
Max. Negotiated Rate	$463.26
Rate for Payer: Anthem Medicaid	$445.44
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$445.44
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$445.44
Rate for Payer: Dean Health Medicaid	$445.44
Rate for Payer: Independent Care Health Plan Medicaid	$445.44
Rate for Payer: Managed Health Services Medicaid	$463.26
Rate for Payer: Molina Healthcare Medicaid	$445.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$445.44
Rate for Payer: United Healthcare Medicaid	$445.44

Know your out-of-pocket cost for care.

All Charges