Madison Medical Center

All Charges

Charge

Type

Setting

Price

INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE

Facility

$20,198.89

Service Code	APR-DRG 7102
Min. Negotiated Rate	$20,198.89
Max. Negotiated Rate	$20,198.89
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,198.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,198.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,198.89
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,198.89

INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE

Facility

$66,211.28

Service Code	APR-DRG 7104
Min. Negotiated Rate	$66,211.28
Max. Negotiated Rate	$66,211.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$66,211.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$66,211.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$66,211.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$66,211.28

INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE

Facility

$29,968.28

Service Code	APR-DRG 7103
Min. Negotiated Rate	$29,968.28
Max. Negotiated Rate	$29,968.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$29,968.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29,968.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29,968.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29,968.28

INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE

Facility

$9,483.72

Service Code	APR-DRG 7101
Min. Negotiated Rate	$9,483.72
Max. Negotiated Rate	$9,483.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,483.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,483.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,483.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,483.72

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC

Facility

$34,969.50

Service Code	MSDRG 854
Min. Negotiated Rate	$17,484.75
Max. Negotiated Rate	$34,969.50
Rate for Payer: Aetna Medicare Advantage	$17,484.75
Rate for Payer: Cigna Commercial HMO & PPO	$17,484.75
Rate for Payer: Home State Health Plan Medicare Advantage	$17,484.75
Rate for Payer: Humana Commercial	$34,969.50
Rate for Payer: Humana Medicare Advantage	$17,484.75

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC

Facility

$81,533.02

Service Code	MSDRG 853
Min. Negotiated Rate	$40,766.51
Max. Negotiated Rate	$81,533.02
Rate for Payer: Aetna Medicare Advantage	$40,766.51
Rate for Payer: Cigna Commercial HMO & PPO	$40,766.51
Rate for Payer: Home State Health Plan Medicare Advantage	$40,766.51
Rate for Payer: Humana Commercial	$81,533.02
Rate for Payer: Humana Medicare Advantage	$40,766.51

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$27,080.30

Service Code	MSDRG 855
Min. Negotiated Rate	$13,540.15
Max. Negotiated Rate	$27,080.30
Rate for Payer: Aetna Medicare Advantage	$13,540.15
Rate for Payer: Cigna Commercial HMO & PPO	$13,540.15
Rate for Payer: Home State Health Plan Medicare Advantage	$13,540.15
Rate for Payer: Humana Commercial	$27,080.30
Rate for Payer: Humana Medicare Advantage	$13,540.15

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$26,855.96

Service Code	MSDRG 727
Min. Negotiated Rate	$13,427.98
Max. Negotiated Rate	$26,855.96
Rate for Payer: Aetna Medicare Advantage	$13,427.98
Rate for Payer: Cigna Commercial HMO & PPO	$13,427.98
Rate for Payer: Home State Health Plan Medicare Advantage	$13,427.98
Rate for Payer: Humana Commercial	$26,855.96
Rate for Payer: Humana Medicare Advantage	$13,427.98

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC

Facility

$16,339.30

Service Code	MSDRG 728
Min. Negotiated Rate	$8,169.65
Max. Negotiated Rate	$16,339.30
Rate for Payer: Aetna Medicare Advantage	$8,169.65
Rate for Payer: Cigna Commercial HMO & PPO	$8,169.65
Rate for Payer: Home State Health Plan Medicare Advantage	$8,169.65
Rate for Payer: Humana Commercial	$16,339.30
Rate for Payer: Humana Medicare Advantage	$8,169.65

INFLAMMATORY BOWEL DISEASE

Facility

$6,508.56

Service Code	APR-DRG 2451
Min. Negotiated Rate	$6,508.56
Max. Negotiated Rate	$6,508.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,508.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,508.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,508.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,508.56

INFLAMMATORY BOWEL DISEASE

Facility

$17,199.11

Service Code	APR-DRG 2453
Min. Negotiated Rate	$17,199.11
Max. Negotiated Rate	$17,199.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,199.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,199.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,199.11
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,199.11

INFLAMMATORY BOWEL DISEASE

Facility

$31,384.96

Service Code	APR-DRG 2454
Min. Negotiated Rate	$31,384.96
Max. Negotiated Rate	$31,384.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$31,384.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31,384.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$31,384.96
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31,384.96

INFLAMMATORY BOWEL DISEASE

Facility

$9,005.89

Service Code	APR-DRG 2452
Min. Negotiated Rate	$9,005.89
Max. Negotiated Rate	$9,005.89
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,005.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,005.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,005.89
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,005.89

INFLAMMATORY BOWEL DISEASE WITH CC

Facility

$18,923.02

Service Code	MSDRG 386
Min. Negotiated Rate	$9,461.51
Max. Negotiated Rate	$18,923.02
Rate for Payer: Aetna Medicare Advantage	$9,461.51
Rate for Payer: Cigna Commercial HMO & PPO	$9,461.51
Rate for Payer: Home State Health Plan Medicare Advantage	$9,461.51
Rate for Payer: Humana Commercial	$18,923.02
Rate for Payer: Humana Medicare Advantage	$9,461.51

INFLAMMATORY BOWEL DISEASE WITH MCC

Facility

$28,419.06

Service Code	MSDRG 385
Min. Negotiated Rate	$14,209.53
Max. Negotiated Rate	$28,419.06
Rate for Payer: Aetna Medicare Advantage	$14,209.53
Rate for Payer: Cigna Commercial HMO & PPO	$14,209.53
Rate for Payer: Home State Health Plan Medicare Advantage	$14,209.53
Rate for Payer: Humana Commercial	$28,419.06
Rate for Payer: Humana Medicare Advantage	$14,209.53

INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC

Facility

$14,310.34

Service Code	MSDRG 387
Min. Negotiated Rate	$7,155.17
Max. Negotiated Rate	$14,310.34
Rate for Payer: Aetna Medicare Advantage	$7,155.17
Rate for Payer: Cigna Commercial HMO & PPO	$7,155.17
Rate for Payer: Home State Health Plan Medicare Advantage	$7,155.17
Rate for Payer: Humana Commercial	$14,310.34
Rate for Payer: Humana Medicare Advantage	$7,155.17

INFLATION BAG W/ MANOMETER--INFANT

Facility

$74.00

Service Code	CPT 94660
Hospital Charge Code	4500290
Hospital Revenue Code	412
Min. Negotiated Rate	$26.64
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$43.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$52.84
Rate for Payer: Cash Price	$66.60
Rate for Payer: Cash Price	$66.60
Rate for Payer: Cash Price	$66.60
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$49.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.64

INFLATION BAG W/ MANOMETER--INFANT

Facility

$74.00

Service Code	CPT 94660
Hospital Charge Code	4500290
Hospital Revenue Code	412
Rate for Payer: Cash Price	$66.60

INFLIXIMAB PANEL

Facility

$545.00

Service Code	CPT 80230
Hospital Charge Code	222870
Hospital Revenue Code	301
Rate for Payer: Cash Price	$490.50

INFLIXIMAB PANEL

Facility

$545.00

Service Code	CPT 80230
Hospital Charge Code	222870
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$389.13
Rate for Payer: Aetna Better Health Medicaid/QHP	$34.71
Rate for Payer: Aetna Medicare Advantage	$38.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$322.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$389.13
Rate for Payer: Cash Price	$490.50
Rate for Payer: Cash Price	$490.50
Rate for Payer: Cash Price	$490.50
Rate for Payer: Cigna Commercial HMO & PPO	$38.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$34.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37.14
Rate for Payer: Home State Health Plan Medicare Advantage	$38.57
Rate for Payer: Humana Commercial	$77.14
Rate for Payer: Humana Medicare Advantage	$38.57
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$34.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$196.20

INFLIXIMAB (REMICADE) 100MG INJ

Facility

$6,237.00

Service Code	HCPCS J1745
Hospital Charge Code	2619443
Hospital Revenue Code	636
Min. Negotiated Rate	$4,160.08
Max. Negotiated Rate	$4,160.08
Rate for Payer: Cash Price	$5,613.30
Rate for Payer: UnitedHealthcare Commercial	$4,160.08

INFLIXIMAB (REMICADE) 100MG INJ

Facility

$6,237.00

Service Code	HCPCS J1745
Hospital Charge Code	2619443
Hospital Revenue Code	636
Min. Negotiated Rate	$31.48
Max. Negotiated Rate	$4,453.22
Rate for Payer: Aetna Medicare Advantage	$31.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$3,692.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$4,453.22
Rate for Payer: Cash Price	$5,613.30
Rate for Payer: Cash Price	$5,613.30
Rate for Payer: Cigna Commercial HMO & PPO	$31.48
Rate for Payer: Home State Health Plan Medicare Advantage	$31.48
Rate for Payer: Humana Commercial	$62.96
Rate for Payer: Humana Medicare Advantage	$31.48
Rate for Payer: UnitedHealthcare Commercial	$31.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,245.32

INFLUEN VACC 6M - 64Y QUAD 0.5ML PFS

Facility

$193.00

Service Code	HCPCS 90656
Hospital Charge Code	2697173
Hospital Revenue Code	250
Min. Negotiated Rate	$69.48
Max. Negotiated Rate	$137.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$114.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$137.80
Rate for Payer: Cash Price	$173.70
Rate for Payer: UnitedHealthcare Commercial	$128.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$69.48

INFLUEN VACC 6M - 64Y QUAD 0.5ML PFS

Facility

$193.00

Service Code	HCPCS 90656
Hospital Charge Code	2697173
Hospital Revenue Code	250
Rate for Payer: Cash Price	$173.70

INFLUEN VACC 6M - 64Y TRI 0.5ML PFS

Facility

$207.00

Service Code	HCPCS 90661
Hospital Charge Code	2626238
Hospital Revenue Code	250
Min. Negotiated Rate	$74.52
Max. Negotiated Rate	$147.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$122.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$147.80
Rate for Payer: Cash Price	$186.30
Rate for Payer: UnitedHealthcare Commercial	$138.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$74.52

Know your out-of-pocket cost for care.

All Charges