Madison Medical Center

All Charges

Charge

Type

Setting

Price

ACUTE LEUKEMIA WITH CC

Facility

$36,351.08

Service Code	MSDRG 835
Min. Negotiated Rate	$18,175.54
Max. Negotiated Rate	$36,351.08
Rate for Payer: Aetna Medicare Advantage	$18,175.54
Rate for Payer: Cigna Commercial HMO & PPO	$18,175.54
Rate for Payer: Home State Health Plan Medicare Advantage	$18,175.54
Rate for Payer: Humana Commercial	$36,351.08
Rate for Payer: Humana Medicare Advantage	$18,175.54

ACUTE LEUKEMIA WITH MCC

Facility

$90,284.74

Service Code	MSDRG 834
Min. Negotiated Rate	$45,142.37
Max. Negotiated Rate	$90,284.74
Rate for Payer: Aetna Medicare Advantage	$45,142.37
Rate for Payer: Cigna Commercial HMO & PPO	$45,142.37
Rate for Payer: Home State Health Plan Medicare Advantage	$45,142.37
Rate for Payer: Humana Commercial	$90,284.74
Rate for Payer: Humana Medicare Advantage	$45,142.37

ACUTE LEUKEMIA WITH OTHER PROCEDURES

Facility

$140,601.10

Service Code	MSDRG 850
Min. Negotiated Rate	$70,300.55
Max. Negotiated Rate	$140,601.10
Rate for Payer: Aetna Medicare Advantage	$70,300.55
Rate for Payer: Cigna Commercial HMO & PPO	$70,300.55
Rate for Payer: Home State Health Plan Medicare Advantage	$70,300.55
Rate for Payer: Humana Commercial	$140,601.10
Rate for Payer: Humana Medicare Advantage	$70,300.55

ACUTE LEUKEMIA WITHOUT CC/MCC

Facility

$22,728.92

Service Code	MSDRG 836
Min. Negotiated Rate	$11,364.46
Max. Negotiated Rate	$22,728.92
Rate for Payer: Aetna Medicare Advantage	$11,364.46
Rate for Payer: Cigna Commercial HMO & PPO	$11,364.46
Rate for Payer: Home State Health Plan Medicare Advantage	$11,364.46
Rate for Payer: Humana Commercial	$22,728.92
Rate for Payer: Humana Medicare Advantage	$11,364.46

ACUTE MAJOR EYE INFECTIONS WITH CC/MCC

Facility

$21,849.42

Service Code	MSDRG 121
Min. Negotiated Rate	$10,924.71
Max. Negotiated Rate	$21,849.42
Rate for Payer: Aetna Medicare Advantage	$10,924.71
Rate for Payer: Cigna Commercial HMO & PPO	$10,924.71
Rate for Payer: Home State Health Plan Medicare Advantage	$10,924.71
Rate for Payer: Humana Commercial	$21,849.42
Rate for Payer: Humana Medicare Advantage	$10,924.71

ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC

Facility

$15,941.78

Service Code	MSDRG 122
Min. Negotiated Rate	$7,970.89
Max. Negotiated Rate	$15,941.78
Rate for Payer: Aetna Medicare Advantage	$7,970.89
Rate for Payer: Cigna Commercial HMO & PPO	$7,970.89
Rate for Payer: Home State Health Plan Medicare Advantage	$7,970.89
Rate for Payer: Humana Commercial	$15,941.78
Rate for Payer: Humana Medicare Advantage	$7,970.89

ACUTE MYOCARDIAL INFARCTION

Facility

$15,433.92

Service Code	APR-DRG 1903
Min. Negotiated Rate	$15,433.92
Max. Negotiated Rate	$15,433.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,433.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,433.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,433.92
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,433.92

ACUTE MYOCARDIAL INFARCTION

Facility

$9,617.77

Service Code	APR-DRG 1902
Min. Negotiated Rate	$9,617.77
Max. Negotiated Rate	$9,617.77
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,617.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,617.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,617.77
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,617.77

ACUTE MYOCARDIAL INFARCTION

Facility

$7,950.86

Service Code	APR-DRG 1901
Min. Negotiated Rate	$7,950.86
Max. Negotiated Rate	$7,950.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,950.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,950.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,950.86
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,950.86

ACUTE MYOCARDIAL INFARCTION

Facility

$33,790.24

Service Code	APR-DRG 1904
Min. Negotiated Rate	$33,790.24
Max. Negotiated Rate	$33,790.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$33,790.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33,790.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33,790.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33,790.24

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC

Facility

$18,027.86

Service Code	MSDRG 281
Min. Negotiated Rate	$9,013.93
Max. Negotiated Rate	$18,027.86
Rate for Payer: Aetna Medicare Advantage	$9,013.93
Rate for Payer: Cigna Commercial HMO & PPO	$9,013.93
Rate for Payer: Home State Health Plan Medicare Advantage	$9,013.93
Rate for Payer: Humana Commercial	$18,027.86
Rate for Payer: Humana Medicare Advantage	$9,013.93

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC

Facility

$28,762.52

Service Code	MSDRG 280
Min. Negotiated Rate	$14,381.26
Max. Negotiated Rate	$28,762.52
Rate for Payer: Aetna Medicare Advantage	$14,381.26
Rate for Payer: Cigna Commercial HMO & PPO	$14,381.26
Rate for Payer: Home State Health Plan Medicare Advantage	$14,381.26
Rate for Payer: Humana Commercial	$28,762.52
Rate for Payer: Humana Medicare Advantage	$14,381.26

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC

Facility

$14,961.54

Service Code	MSDRG 282
Min. Negotiated Rate	$7,480.77
Max. Negotiated Rate	$14,961.54
Rate for Payer: Aetna Medicare Advantage	$7,480.77
Rate for Payer: Cigna Commercial HMO & PPO	$7,480.77
Rate for Payer: Home State Health Plan Medicare Advantage	$7,480.77
Rate for Payer: Humana Commercial	$14,961.54
Rate for Payer: Humana Medicare Advantage	$7,480.77

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC

Facility

$14,480.16

Service Code	MSDRG 284
Min. Negotiated Rate	$7,240.08
Max. Negotiated Rate	$14,480.16
Rate for Payer: Aetna Medicare Advantage	$7,240.08
Rate for Payer: Cigna Commercial HMO & PPO	$7,240.08
Rate for Payer: Home State Health Plan Medicare Advantage	$7,240.08
Rate for Payer: Humana Commercial	$14,480.16
Rate for Payer: Humana Medicare Advantage	$7,240.08

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC

Facility

$34,696.94

Service Code	MSDRG 283
Min. Negotiated Rate	$17,348.47
Max. Negotiated Rate	$34,696.94
Rate for Payer: Aetna Medicare Advantage	$17,348.47
Rate for Payer: Cigna Commercial HMO & PPO	$17,348.47
Rate for Payer: Home State Health Plan Medicare Advantage	$17,348.47
Rate for Payer: Humana Commercial	$34,696.94
Rate for Payer: Humana Medicare Advantage	$17,348.47

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC

Facility

$13,029.40

Service Code	MSDRG 285
Min. Negotiated Rate	$6,514.70
Max. Negotiated Rate	$13,029.40
Rate for Payer: Aetna Medicare Advantage	$6,514.70
Rate for Payer: Cigna Commercial HMO & PPO	$6,514.70
Rate for Payer: Home State Health Plan Medicare Advantage	$6,514.70
Rate for Payer: Humana Commercial	$13,029.40
Rate for Payer: Humana Medicare Advantage	$6,514.70

ACYCLOVIR 200MG CAP EMP

Facility

$9.00

Service Code	NDC 93894301
Hospital Charge Code	2622393
Hospital Revenue Code	250
Rate for Payer: Cash Price	$8.10

ACYCLOVIR 200MG CAP EMP

Facility

$9.00

Service Code	NDC 93894301
Hospital Charge Code	2622393
Hospital Revenue Code	250
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$6.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$6.43
Rate for Payer: Cash Price	$8.10
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.24

ACYCLOVIR 5% CRM 5GM EMP

Facility

$423.00

Service Code	NDC 93363020
Hospital Charge Code	2623230
Hospital Revenue Code	250
Rate for Payer: Cash Price	$380.70

ACYCLOVIR 5% CRM 5GM EMP

Facility

$423.00

Service Code	NDC 93363020
Hospital Charge Code	2623230
Hospital Revenue Code	250
Min. Negotiated Rate	$152.28
Max. Negotiated Rate	$302.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$250.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$302.02
Rate for Payer: Cash Price	$380.70
Rate for Payer: UnitedHealthcare Commercial	$282.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$152.28

ACYCLOVIR 5% OINT. 15GM TUBE

Facility

$1,161.00

Service Code	NDC 378870006
Hospital Charge Code	2697394
Hospital Revenue Code	250
Rate for Payer: Cash Price	$1,044.90

ACYCLOVIR 5% OINT. 15GM TUBE

Facility

$1,161.00

Service Code	NDC 378870006
Hospital Charge Code	2697394
Hospital Revenue Code	250
Min. Negotiated Rate	$417.96
Max. Negotiated Rate	$828.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$687.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$828.95
Rate for Payer: Cash Price	$1,044.90
Rate for Payer: UnitedHealthcare Commercial	$774.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$417.96

ACYCLOVIR 5% OINT. 30GM TUBE EMP

Facility

$1,161.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2623560
Hospital Revenue Code	250
Rate for Payer: Cash Price	$1,044.90

ACYCLOVIR 5% OINT. 30GM TUBE EMP

Facility

$1,161.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2623560
Hospital Revenue Code	250
Min. Negotiated Rate	$417.96
Max. Negotiated Rate	$828.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$687.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$828.95
Rate for Payer: Cash Price	$1,044.90
Rate for Payer: UnitedHealthcare Commercial	$774.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$417.96

ACYCLOVIR 5% OINT 5GM

Facility

$423.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2697393
Hospital Revenue Code	250
Rate for Payer: Cash Price	$380.70

Know your out-of-pocket cost for care.

All Charges