Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

LEVEL II JOINT, TENDON, OR LIGAMENT INJECTION PROCEDURES

Facility

$96.20

Service Code	EAPG 00050
Min. Negotiated Rate	$92.50
Max. Negotiated Rate	$96.20
Rate for Payer: Anthem Medicaid	$92.50
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$92.50
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$92.50
Rate for Payer: Dean Health Medicaid	$92.50
Rate for Payer: Independent Care Health Plan Medicaid	$92.50
Rate for Payer: Managed Health Services Medicaid	$96.20
Rate for Payer: Molina Healthcare Medicaid	$92.50
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$92.50
Rate for Payer: United Healthcare Medicaid	$92.50

LEVEL II KIDNEY AND URETERAL PROCEDURES

Facility

$631.43

Service Code	EAPG 00171
Min. Negotiated Rate	$607.14
Max. Negotiated Rate	$631.43
Rate for Payer: Anthem Medicaid	$607.14
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$607.14
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$607.14
Rate for Payer: Dean Health Medicaid	$607.14
Rate for Payer: Independent Care Health Plan Medicaid	$607.14
Rate for Payer: Managed Health Services Medicaid	$631.43
Rate for Payer: Molina Healthcare Medicaid	$607.14
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$607.14
Rate for Payer: United Healthcare Medicaid	$607.14

LEVEL II KNEE AND LOWER LEG PROCEDURES

Facility

$1,660.65

Service Code	EAPG 00052
Min. Negotiated Rate	$1,596.77
Max. Negotiated Rate	$1,660.65
Rate for Payer: Anthem Medicaid	$1,596.77
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,596.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,596.77
Rate for Payer: Dean Health Medicaid	$1,596.77
Rate for Payer: Independent Care Health Plan Medicaid	$1,596.77
Rate for Payer: Managed Health Services Medicaid	$1,660.65
Rate for Payer: Molina Healthcare Medicaid	$1,596.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,596.77
Rate for Payer: United Healthcare Medicaid	$1,596.77

LEVEL II LOWER AIRWAY ENDOSCOPY

Facility

$835.66

Service Code	EAPG 00071
Min. Negotiated Rate	$803.52
Max. Negotiated Rate	$835.66
Rate for Payer: Anthem Medicaid	$803.52
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$803.52
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$803.52
Rate for Payer: Dean Health Medicaid	$803.52
Rate for Payer: Independent Care Health Plan Medicaid	$803.52
Rate for Payer: Managed Health Services Medicaid	$835.66
Rate for Payer: Molina Healthcare Medicaid	$803.52
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$803.52
Rate for Payer: United Healthcare Medicaid	$803.52

LEVEL II LOWER GI ENDOSCOPY

Facility

$455.08

Service Code	EAPG 00137
Min. Negotiated Rate	$437.58
Max. Negotiated Rate	$455.08
Rate for Payer: Anthem Medicaid	$437.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$437.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$437.58
Rate for Payer: Dean Health Medicaid	$437.58
Rate for Payer: Independent Care Health Plan Medicaid	$437.58
Rate for Payer: Managed Health Services Medicaid	$455.08
Rate for Payer: Molina Healthcare Medicaid	$437.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$437.58
Rate for Payer: United Healthcare Medicaid	$437.58

LEVEL II MAXILLOFACIAL PROSTHETICS

Facility

$724.30

Service Code	EAPG 00360
Min. Negotiated Rate	$696.44
Max. Negotiated Rate	$724.30
Rate for Payer: Anthem Medicaid	$696.44
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$696.44
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$696.44
Rate for Payer: Dean Health Medicaid	$696.44
Rate for Payer: Independent Care Health Plan Medicaid	$696.44
Rate for Payer: Managed Health Services Medicaid	$724.30
Rate for Payer: Molina Healthcare Medicaid	$696.44
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$696.44
Rate for Payer: United Healthcare Medicaid	$696.44

LEVEL II MICROBIOLOGY TESTS

Facility

$10.35

Service Code	EAPG 00397
Min. Negotiated Rate	$9.95
Max. Negotiated Rate	$10.35
Rate for Payer: Anthem Medicaid	$9.95
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$9.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$9.95
Rate for Payer: Dean Health Medicaid	$9.95
Rate for Payer: Independent Care Health Plan Medicaid	$9.95
Rate for Payer: Managed Health Services Medicaid	$10.35
Rate for Payer: Molina Healthcare Medicaid	$9.95
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$9.95
Rate for Payer: United Healthcare Medicaid	$9.95

LEVEL I IMMUNIZATION

Facility

$5.48

Service Code	EAPG 00414
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$5.48
Rate for Payer: Anthem Medicaid	$5.27
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$5.27
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5.27
Rate for Payer: Dean Health Medicaid	$5.27
Rate for Payer: Independent Care Health Plan Medicaid	$5.27
Rate for Payer: Managed Health Services Medicaid	$5.48
Rate for Payer: Molina Healthcare Medicaid	$5.27
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5.27
Rate for Payer: United Healthcare Medicaid	$5.27

LEVEL I IMMUNOLOGY TESTS

Facility

$2.00

Service Code	EAPG 00394
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$2.00
Rate for Payer: Anthem Medicaid	$1.92
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1.92
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1.92
Rate for Payer: Dean Health Medicaid	$1.92
Rate for Payer: Independent Care Health Plan Medicaid	$1.92
Rate for Payer: Managed Health Services Medicaid	$2.00
Rate for Payer: Molina Healthcare Medicaid	$1.92
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1.92
Rate for Payer: United Healthcare Medicaid	$1.92

LEVEL II NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE

Facility

$1,061.18

Service Code	EAPG 00218
Min. Negotiated Rate	$1,020.36
Max. Negotiated Rate	$1,061.18
Rate for Payer: Anthem Medicaid	$1,020.36
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,020.36
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,020.36
Rate for Payer: Dean Health Medicaid	$1,020.36
Rate for Payer: Independent Care Health Plan Medicaid	$1,020.36
Rate for Payer: Managed Health Services Medicaid	$1,061.18
Rate for Payer: Molina Healthcare Medicaid	$1,020.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,020.36
Rate for Payer: United Healthcare Medicaid	$1,020.36

LEVEL II NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP

Facility

$316.45

Service Code	EAPG 00220
Min. Negotiated Rate	$304.28
Max. Negotiated Rate	$316.45
Rate for Payer: Anthem Medicaid	$304.28
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$304.28
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$304.28
Rate for Payer: Dean Health Medicaid	$304.28
Rate for Payer: Independent Care Health Plan Medicaid	$304.28
Rate for Payer: Managed Health Services Medicaid	$316.45
Rate for Payer: Molina Healthcare Medicaid	$304.28
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$304.28
Rate for Payer: United Healthcare Medicaid	$304.28

LEVEL II ORAL AND MAXILLOFACIAL PROCEDURES

Facility

$417.42

Service Code	EAPG 00368
Min. Negotiated Rate	$401.37
Max. Negotiated Rate	$417.42
Rate for Payer: Anthem Medicaid	$401.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$401.37
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$401.37
Rate for Payer: Dean Health Medicaid	$401.37
Rate for Payer: Independent Care Health Plan Medicaid	$401.37
Rate for Payer: Managed Health Services Medicaid	$417.42
Rate for Payer: Molina Healthcare Medicaid	$401.37
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$401.37
Rate for Payer: United Healthcare Medicaid	$401.37

LEVEL II OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES

Facility

$941.69

Service Code	EAPG 00208
Min. Negotiated Rate	$905.47
Max. Negotiated Rate	$941.69
Rate for Payer: Anthem Medicaid	$905.47
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$905.47
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$905.47
Rate for Payer: Dean Health Medicaid	$905.47
Rate for Payer: Independent Care Health Plan Medicaid	$905.47
Rate for Payer: Managed Health Services Medicaid	$941.69
Rate for Payer: Molina Healthcare Medicaid	$905.47
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$905.47
Rate for Payer: United Healthcare Medicaid	$905.47

LEVEL II PATHOLOGY TESTS

Facility

$7.06

Service Code	EAPG 00391
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$7.06
Rate for Payer: Anthem Medicaid	$6.79
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$6.79
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$6.79
Rate for Payer: Dean Health Medicaid	$6.79
Rate for Payer: Independent Care Health Plan Medicaid	$6.79
Rate for Payer: Managed Health Services Medicaid	$7.06
Rate for Payer: Molina Healthcare Medicaid	$6.79
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$6.79
Rate for Payer: United Healthcare Medicaid	$6.79

LEVEL II PENILE PROCEDURES

Facility

$726.91

Service Code	EAPG 00187
Min. Negotiated Rate	$698.95
Max. Negotiated Rate	$726.91
Rate for Payer: Anthem Medicaid	$698.95
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$698.95
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$698.95
Rate for Payer: Dean Health Medicaid	$698.95
Rate for Payer: Independent Care Health Plan Medicaid	$698.95
Rate for Payer: Managed Health Services Medicaid	$726.91
Rate for Payer: Molina Healthcare Medicaid	$698.95
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$698.95
Rate for Payer: United Healthcare Medicaid	$698.95

LEVEL II PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES

Facility

$3,145.06

Service Code	EAPG 00121
Min. Negotiated Rate	$3,024.09
Max. Negotiated Rate	$3,145.06
Rate for Payer: Anthem Medicaid	$3,024.09
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$3,024.09
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$3,024.09
Rate for Payer: Dean Health Medicaid	$3,024.09
Rate for Payer: Independent Care Health Plan Medicaid	$3,024.09
Rate for Payer: Managed Health Services Medicaid	$3,145.06
Rate for Payer: Molina Healthcare Medicaid	$3,024.09
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$3,024.09
Rate for Payer: United Healthcare Medicaid	$3,024.09

LEVEL II PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES

Facility

$1,238.42

Service Code	EAPG 00189
Min. Negotiated Rate	$1,190.78
Max. Negotiated Rate	$1,238.42
Rate for Payer: Anthem Medicaid	$1,190.78
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,190.78
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,190.78
Rate for Payer: Dean Health Medicaid	$1,190.78
Rate for Payer: Independent Care Health Plan Medicaid	$1,190.78
Rate for Payer: Managed Health Services Medicaid	$1,238.42
Rate for Payer: Molina Healthcare Medicaid	$1,190.78
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,190.78
Rate for Payer: United Healthcare Medicaid	$1,190.78

LEVEL II PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$1,416.24

Service Code	EAPG 00079
Min. Negotiated Rate	$1,361.77
Max. Negotiated Rate	$1,416.24
Rate for Payer: Anthem Medicaid	$1,361.77
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$1,361.77
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$1,361.77
Rate for Payer: Dean Health Medicaid	$1,361.77
Rate for Payer: Independent Care Health Plan Medicaid	$1,361.77
Rate for Payer: Managed Health Services Medicaid	$1,416.24
Rate for Payer: Molina Healthcare Medicaid	$1,361.77
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$1,361.77
Rate for Payer: United Healthcare Medicaid	$1,361.77

LEVEL II PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION

Facility

$874.39

Service Code	EAPG 00091
Min. Negotiated Rate	$840.76
Max. Negotiated Rate	$874.39
Rate for Payer: Anthem Medicaid	$840.76
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$840.76
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$840.76
Rate for Payer: Dean Health Medicaid	$840.76
Rate for Payer: Independent Care Health Plan Medicaid	$840.76
Rate for Payer: Managed Health Services Medicaid	$874.39
Rate for Payer: Molina Healthcare Medicaid	$840.76
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$840.76
Rate for Payer: United Healthcare Medicaid	$840.76

LEVEL II POSTERIOR SEGMENT EYE PROCEDURES

Facility

$697.18

Service Code	EAPG 00238
Min. Negotiated Rate	$670.36
Max. Negotiated Rate	$697.18
Rate for Payer: Anthem Medicaid	$670.36
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$670.36
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$670.36
Rate for Payer: Dean Health Medicaid	$670.36
Rate for Payer: Independent Care Health Plan Medicaid	$670.36
Rate for Payer: Managed Health Services Medicaid	$697.18
Rate for Payer: Molina Healthcare Medicaid	$670.36
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$670.36
Rate for Payer: United Healthcare Medicaid	$670.36

LEVEL II PROSTATE PROCEDURES

Facility

$975.41

Service Code	EAPG 00184
Min. Negotiated Rate	$937.89
Max. Negotiated Rate	$975.41
Rate for Payer: Anthem Medicaid	$937.89
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$937.89
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$937.89
Rate for Payer: Dean Health Medicaid	$937.89
Rate for Payer: Independent Care Health Plan Medicaid	$937.89
Rate for Payer: Managed Health Services Medicaid	$975.41
Rate for Payer: Molina Healthcare Medicaid	$937.89
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$937.89
Rate for Payer: United Healthcare Medicaid	$937.89

LEVEL II PROSTHODONTICS, FIXED

Facility

$84.50

Service Code	EAPG 00354
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$84.50
Rate for Payer: Anthem Medicaid	$81.25
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$81.25
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$81.25
Rate for Payer: Dean Health Medicaid	$81.25
Rate for Payer: Independent Care Health Plan Medicaid	$81.25
Rate for Payer: Managed Health Services Medicaid	$84.50
Rate for Payer: Molina Healthcare Medicaid	$81.25
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$81.25
Rate for Payer: United Healthcare Medicaid	$81.25

LEVEL II PROSTHODONTICS, REMOVABLE

Facility

$56.60

Service Code	EAPG 00357
Min. Negotiated Rate	$54.43
Max. Negotiated Rate	$56.60
Rate for Payer: Anthem Medicaid	$54.43
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$54.43
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$54.43
Rate for Payer: Dean Health Medicaid	$54.43
Rate for Payer: Independent Care Health Plan Medicaid	$54.43
Rate for Payer: Managed Health Services Medicaid	$56.60
Rate for Payer: Molina Healthcare Medicaid	$54.43
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$54.43
Rate for Payer: United Healthcare Medicaid	$54.43

LEVEL II RADIATION THERAPY

Facility

$102.53

Service Code	EAPG 00347
Min. Negotiated Rate	$98.58
Max. Negotiated Rate	$102.53
Rate for Payer: Anthem Medicaid	$98.58
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$98.58
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$98.58
Rate for Payer: Dean Health Medicaid	$98.58
Rate for Payer: Independent Care Health Plan Medicaid	$98.58
Rate for Payer: Managed Health Services Medicaid	$102.53
Rate for Payer: Molina Healthcare Medicaid	$98.58
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$98.58
Rate for Payer: United Healthcare Medicaid	$98.58

LEVEL II RADIATION TREATMENT PREPARATION & PLANNING

Facility

$38.34

Service Code	EAPG 00477
Min. Negotiated Rate	$36.86
Max. Negotiated Rate	$38.34
Rate for Payer: Anthem Medicaid	$36.86
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$36.86
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$36.86
Rate for Payer: Dean Health Medicaid	$36.86
Rate for Payer: Independent Care Health Plan Medicaid	$36.86
Rate for Payer: Managed Health Services Medicaid	$38.34
Rate for Payer: Molina Healthcare Medicaid	$36.86
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$36.86
Rate for Payer: United Healthcare Medicaid	$36.86

Know your out-of-pocket cost for care.

All Charges