Madison Medical Center

All Charges

Charge

Type

Setting

Price

HEPARIN 5000U INJ

Facility

$51.00

Service Code	HCPCS J1644
Hospital Charge Code	2655173
Hospital Revenue Code	250
Rate for Payer: Cash Price	$45.90

HEPARIN 5000U INJ

Facility

$51.00

Service Code	HCPCS J1644
Hospital Charge Code	2655173
Hospital Revenue Code	250
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$36.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$36.41
Rate for Payer: Cash Price	$45.90
Rate for Payer: UnitedHealthcare Commercial	$34.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.36

HEPARIN DRIP 25000U/250ML NS

Facility

$542.00

Service Code	NDC 1E+11
Hospital Charge Code	2619730
Hospital Revenue Code	250
Min. Negotiated Rate	$195.12
Max. Negotiated Rate	$386.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$320.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$386.99
Rate for Payer: Cash Price	$487.80
Rate for Payer: UnitedHealthcare Commercial	$361.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$195.12

HEPARIN DRIP 25000U/250ML NS

Facility

$542.00

Service Code	NDC 1E+11
Hospital Charge Code	2619730
Hospital Revenue Code	250
Rate for Payer: Cash Price	$487.80

HEPARIN FLUSH 100U/ML 5ML VIAL

Facility

$55.00

Service Code	HCPCS J1642
Hospital Charge Code	2697055
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

HEPARIN FLUSH 100U/ML 5ML VIAL

Facility

$55.00

Service Code	HCPCS J1642
Hospital Charge Code	2697055
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

HEPARIN FLUSH 100U VIAL 1ML

Facility

$48.00

Service Code	NDC 6.3323E+10
Hospital Charge Code	2655172
Hospital Revenue Code	250
Rate for Payer: Cash Price	$43.20

HEPARIN FLUSH 100U VIAL 1ML

Facility

$48.00

Service Code	NDC 6.3323E+10
Hospital Charge Code	2655172
Hospital Revenue Code	250
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

HEPARIN INDUCED PLATELET ANTIBODY

Facility

$799.00

Service Code	CPT 86022
Hospital Charge Code	2286022
Hospital Revenue Code	301
Min. Negotiated Rate	$16.53
Max. Negotiated Rate	$570.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.53
Rate for Payer: Aetna Medicare Advantage	$18.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$473.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$570.49
Rate for Payer: Cash Price	$719.10
Rate for Payer: Cash Price	$719.10
Rate for Payer: Cash Price	$719.10
Rate for Payer: Cigna Commercial HMO & PPO	$18.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.69
Rate for Payer: Home State Health Plan Medicare Advantage	$18.37
Rate for Payer: Humana Commercial	$36.74
Rate for Payer: Humana Medicare Advantage	$18.37
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$287.64

HEPARIN INDUCED PLATELET ANTIBODY

Facility

$799.00

Service Code	CPT 86022
Hospital Charge Code	2286022
Hospital Revenue Code	301
Rate for Payer: Cash Price	$719.10

HEPARIN IV FLUSH 5ML PFS IV

Facility

$55.00

Service Code	HCPCS J1642
Hospital Charge Code	2626475
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

HEPARIN IV FLUSH 5ML PFS IV

Facility

$55.00

Service Code	HCPCS J1642
Hospital Charge Code	2626475
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

HEPARIN PED FLSH 10U/ML 5ML IN 12ML PFS

Facility

$60.00

Service Code	HCPCS J1642
Hospital Charge Code	2698015
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

HEPARIN PED FLSH 10U/ML 5ML IN 12ML PFS

Facility

$60.00

Service Code	HCPCS J1642
Hospital Charge Code	2698015
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

HEPARIN PORT FLSH 100U 5ML IN 10ML PFS

Facility

$70.00

Service Code	HCPCS J1642
Hospital Charge Code	2626397
Hospital Revenue Code	250
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$49.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

HEPARIN PORT FLSH 100U 5ML IN 10ML PFS

Facility

$70.00

Service Code	HCPCS J1642
Hospital Charge Code	2626397
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.00

HEPARIN VIAL FLUSH 5ML VIAL

Facility

$55.00

Service Code	HCPCS J1642
Hospital Charge Code	2626420
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

HEPARIN VIAL FLUSH 5ML VIAL

Facility

$55.00

Service Code	HCPCS J1642
Hospital Charge Code	2626420
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS

Facility

$38,391.29

Service Code	APR-DRG 2794
Min. Negotiated Rate	$38,391.29
Max. Negotiated Rate	$38,391.29
Rate for Payer: Aetna Better Health Medicaid/QHP	$38,391.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$38,391.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$38,391.29
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$38,391.29

HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS

Facility

$8,326.45

Service Code	APR-DRG 2792
Min. Negotiated Rate	$8,326.45
Max. Negotiated Rate	$8,326.45
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,326.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,326.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,326.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,326.45

HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS

Facility

$15,501.12

Service Code	APR-DRG 2793
Min. Negotiated Rate	$15,501.12
Max. Negotiated Rate	$15,501.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,501.12
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,501.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,501.12
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,501.12

HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS

Facility

$7,111.70

Service Code	APR-DRG 2791
Min. Negotiated Rate	$7,111.70
Max. Negotiated Rate	$7,111.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,111.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,111.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,111.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,111.70

HEPATITIS A IGM

Facility

$178.00

Service Code	CPT 86709
Hospital Charge Code	2286709
Hospital Revenue Code	301
Min. Negotiated Rate	$10.13
Max. Negotiated Rate	$127.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.13
Rate for Payer: Aetna Medicare Advantage	$11.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cigna Commercial HMO & PPO	$11.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10.84
Rate for Payer: Home State Health Plan Medicare Advantage	$11.26
Rate for Payer: Humana Commercial	$22.52
Rate for Payer: Humana Medicare Advantage	$11.26
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

HEPATITIS A IGM

Facility

$178.00

Service Code	CPT 86709
Hospital Charge Code	2286709
Hospital Revenue Code	301
Rate for Payer: Cash Price	$160.20

HEPATITIS A TOTAL, RFX IGM

Facility

$178.00

Service Code	CPT 86708
Hospital Charge Code	228302
Hospital Revenue Code	301
Rate for Payer: Cash Price	$160.20

Know your out-of-pocket cost for care.

All Charges