Madison Medical Center

All Charges

Charge

Type

Setting

Price

ALBUTEROL (VENTOLIN)HFA 60-DOSE INH

Facility

$112.00

Service Code	NDC 173068221
Hospital Charge Code	2654050
Hospital Revenue Code	250
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$79.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: UnitedHealthcare Commercial	$74.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

ALBUTEROL (VENTOLIN)HFA 60-DOSE INH

Facility

$112.00

Service Code	NDC 173068221
Hospital Charge Code	2654050
Hospital Revenue Code	250
Rate for Payer: Cash Price	$100.80

ALBUTEROL (VENTOLIN)HFA 60-DOSE INH EMP

Facility

$112.00

Service Code	NDC 173068221
Hospital Charge Code	2622053
Hospital Revenue Code	250
Rate for Payer: Cash Price	$100.80

ALBUTEROL (VENTOLIN)HFA 60-DOSE INH EMP

Facility

$112.00

Service Code	NDC 173068221
Hospital Charge Code	2622053
Hospital Revenue Code	250
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$79.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: UnitedHealthcare Commercial	$74.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

ALCLOMET DIP. (ACLOVATE) 0.05% OINT EMP

Facility

$75.00

Service Code	NDC 168026445
Hospital Charge Code	2623183
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

ALCLOMET DIP. (ACLOVATE) 0.05% OINT EMP

Facility

$75.00

Service Code	NDC 168026445
Hospital Charge Code	2623183
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

ALCOHOL 4OZ #IA7004

Facility

$9.00

Hospital Charge Code	2819083
Hospital Revenue Code	271
Rate for Payer: Cash Price	$8.10

ALCOHOL 4OZ #IA7004

Facility

$9.00

Hospital Charge Code	2819083
Hospital Revenue Code	271
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

ALCOHOL ABUSE AND DEPENDENCE

Facility

$70,848.63

Service Code	APR-DRG 7754
Min. Negotiated Rate	$70,848.63
Max. Negotiated Rate	$70,848.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$70,848.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$70,848.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$70,848.63
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$70,848.63

ALCOHOL ABUSE AND DEPENDENCE

Facility

$19,389.16

Service Code	APR-DRG 7753
Min. Negotiated Rate	$19,389.16
Max. Negotiated Rate	$19,389.16
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,389.16
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,389.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,389.16
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,389.16

ALCOHOL ABUSE AND DEPENDENCE

Facility

$11,282.39

Service Code	APR-DRG 7752
Min. Negotiated Rate	$11,282.39
Max. Negotiated Rate	$11,282.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,282.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,282.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,282.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,282.39

ALCOHOL ABUSE AND DEPENDENCE

Facility

$8,412.09

Service Code	APR-DRG 7751
Min. Negotiated Rate	$8,412.09
Max. Negotiated Rate	$8,412.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,412.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,412.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,412.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,412.09

ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY

Facility

$8,587.82

Service Code	APR-DRG 7721
Min. Negotiated Rate	$8,587.82
Max. Negotiated Rate	$8,587.82
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,587.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,587.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,587.82
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,587.82

ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY

Facility

$50,334.07

Service Code	APR-DRG 7724
Min. Negotiated Rate	$50,334.07
Max. Negotiated Rate	$50,334.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$50,334.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$50,334.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$50,334.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$50,334.07

ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY

Facility

$26,402.49

Service Code	APR-DRG 7723
Min. Negotiated Rate	$26,402.49
Max. Negotiated Rate	$26,402.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$26,402.49
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26,402.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26,402.49
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26,402.49

ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY

Facility

$10,831.52

Service Code	APR-DRG 7722
Min. Negotiated Rate	$10,831.52
Max. Negotiated Rate	$10,831.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,831.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,831.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,831.52
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,831.52

ALCOHOL BLOOD

Facility

$271.00

Service Code	CPT 80320
Hospital Charge Code	221410
Hospital Revenue Code	301
Rate for Payer: Cash Price	$243.90

ALCOHOL BLOOD

Facility

$271.00

Service Code	CPT 80320
Hospital Charge Code	221410
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$193.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$160.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$193.49
Rate for Payer: Cash Price	$243.90
Rate for Payer: Cash Price	$243.90
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.56

ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility

$13,307.76

Service Code	MSDRG 894
Min. Negotiated Rate	$6,653.88
Max. Negotiated Rate	$13,307.76
Rate for Payer: Aetna Medicare Advantage	$6,653.88
Rate for Payer: Cigna Commercial HMO & PPO	$6,653.88
Rate for Payer: Home State Health Plan Medicare Advantage	$6,653.88
Rate for Payer: Humana Commercial	$13,307.76
Rate for Payer: Humana Medicare Advantage	$6,653.88

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

$30,983.78

Service Code	MSDRG 896
Min. Negotiated Rate	$15,491.89
Max. Negotiated Rate	$30,983.78
Rate for Payer: Aetna Medicare Advantage	$15,491.89
Rate for Payer: Cigna Commercial HMO & PPO	$15,491.89
Rate for Payer: Home State Health Plan Medicare Advantage	$15,491.89
Rate for Payer: Humana Commercial	$30,983.78
Rate for Payer: Humana Medicare Advantage	$15,491.89

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

$17,459.80

Service Code	MSDRG 897
Min. Negotiated Rate	$8,729.90
Max. Negotiated Rate	$17,459.80
Rate for Payer: Aetna Medicare Advantage	$8,729.90
Rate for Payer: Cigna Commercial HMO & PPO	$8,729.90
Rate for Payer: Home State Health Plan Medicare Advantage	$8,729.90
Rate for Payer: Humana Commercial	$17,459.80
Rate for Payer: Humana Medicare Advantage	$8,729.90

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

$25,800.24

Service Code	MSDRG 895
Min. Negotiated Rate	$12,900.12
Max. Negotiated Rate	$25,800.24
Rate for Payer: Aetna Medicare Advantage	$12,900.12
Rate for Payer: Cigna Commercial HMO & PPO	$12,900.12
Rate for Payer: Home State Health Plan Medicare Advantage	$12,900.12
Rate for Payer: Humana Commercial	$25,800.24
Rate for Payer: Humana Medicare Advantage	$12,900.12

ALCOHOLIC LIVER DISEASE

Facility

$6,196.09

Service Code	APR-DRG 2801
Min. Negotiated Rate	$6,196.09
Max. Negotiated Rate	$6,196.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,196.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,196.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,196.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,196.09

ALCOHOLIC LIVER DISEASE

Facility

$37,309.76

Service Code	APR-DRG 2804
Min. Negotiated Rate	$37,309.76
Max. Negotiated Rate	$37,309.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$37,309.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$37,309.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37,309.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$37,309.76

ALCOHOLIC LIVER DISEASE

Facility

$16,746.15

Service Code	APR-DRG 2803
Min. Negotiated Rate	$16,746.15
Max. Negotiated Rate	$16,746.15
Rate for Payer: Aetna Better Health Medicaid/QHP	$16,746.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16,746.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16,746.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16,746.15

Know your out-of-pocket cost for care.

All Charges