Madison Medical Center

All Charges

Charge

Type

Setting

Price

MTHFR DNA MUTATION ANALYSIS

Facility

$584.00

Service Code	CPT 81291
Hospital Charge Code	2281291
Hospital Revenue Code	302
Rate for Payer: Cash Price	$525.60

MTHFR DNA MUTATION ANALYSIS

Facility

$584.00

Service Code	CPT 81291
Hospital Charge Code	2281291
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$416.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$58.81
Rate for Payer: Aetna Medicare Advantage	$65.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$345.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$416.98
Rate for Payer: Cash Price	$525.60
Rate for Payer: Cash Price	$525.60
Rate for Payer: Cash Price	$525.60
Rate for Payer: Cigna Commercial HMO & PPO	$65.34
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$62.93
Rate for Payer: Home State Health Plan Medicare Advantage	$65.34
Rate for Payer: Humana Commercial	$130.68
Rate for Payer: Humana Medicare Advantage	$65.34
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$58.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.24

MUCINEX D ER 600MG/60MG TAB EMP #18

Facility

$43.00

Service Code	NDC 6.3824E+10
Hospital Charge Code	2624850
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

MUCINEX D ER 600MG/60MG TAB EMP #18

Facility

$43.00

Service Code	NDC 6.3824E+10
Hospital Charge Code	2624850
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

MULTAQ 400MG TAB EMP

Facility

$24.00

Service Code	NDC 24414260
Hospital Charge Code	2625821
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

MULTAQ 400MG TAB EMP

Facility

$24.00

Service Code	NDC 24414260
Hospital Charge Code	2625821
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

MULTI FLO ADAPTER

Facility

$52.00

Hospital Charge Code	2813849
Hospital Revenue Code	271
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$37.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.13
Rate for Payer: Cash Price	$46.80
Rate for Payer: UnitedHealthcare Commercial	$34.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.72

MULTI FLO ADAPTER

Facility

$52.00

Hospital Charge Code	2813849
Hospital Revenue Code	271
Rate for Payer: Cash Price	$46.80

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

$92,690.43

Service Code	APR-DRG 2994
Min. Negotiated Rate	$92,690.43
Max. Negotiated Rate	$92,690.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$92,690.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$92,690.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$92,690.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$92,690.43

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

$62,094.39

Service Code	APR-DRG 2993
Min. Negotiated Rate	$62,094.39
Max. Negotiated Rate	$62,094.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$62,094.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$62,094.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$62,094.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$62,094.39

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

$40,820.29

Service Code	APR-DRG 2991
Min. Negotiated Rate	$40,820.29
Max. Negotiated Rate	$40,820.29
Rate for Payer: Aetna Better Health Medicaid/QHP	$40,820.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$40,820.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$40,820.29
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$40,820.29

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

$49,271.32

Service Code	APR-DRG 2992
Min. Negotiated Rate	$49,271.32
Max. Negotiated Rate	$49,271.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$49,271.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$49,271.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$49,271.32
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$49,271.32

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC

Facility

$117,727.28

Service Code	MSDRG 427
Min. Negotiated Rate	$58,863.64
Max. Negotiated Rate	$117,727.28
Rate for Payer: Aetna Medicare Advantage	$58,863.64
Rate for Payer: Cigna Commercial HMO & PPO	$58,863.64
Rate for Payer: Home State Health Plan Medicare Advantage	$58,863.64
Rate for Payer: Humana Commercial	$117,727.28
Rate for Payer: Humana Medicare Advantage	$58,863.64

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$178,092.32

Service Code	MSDRG 426
Min. Negotiated Rate	$89,046.16
Max. Negotiated Rate	$178,092.32
Rate for Payer: Aetna Medicare Advantage	$89,046.16
Rate for Payer: Cigna Commercial HMO & PPO	$89,046.16
Rate for Payer: Home State Health Plan Medicare Advantage	$89,046.16
Rate for Payer: Humana Commercial	$178,092.32
Rate for Payer: Humana Medicare Advantage	$89,046.16

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC

Facility

$92,381.78

Service Code	MSDRG 428
Min. Negotiated Rate	$46,190.89
Max. Negotiated Rate	$92,381.78
Rate for Payer: Aetna Medicare Advantage	$46,190.89
Rate for Payer: Cigna Commercial HMO & PPO	$46,190.89
Rate for Payer: Home State Health Plan Medicare Advantage	$46,190.89
Rate for Payer: Humana Commercial	$92,381.78
Rate for Payer: Humana Medicare Advantage	$46,190.89

MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$109,202.56

Service Code	MSDRG 447
Min. Negotiated Rate	$54,601.28
Max. Negotiated Rate	$109,202.56
Rate for Payer: Aetna Medicare Advantage	$54,601.28
Rate for Payer: Cigna Commercial HMO & PPO	$54,601.28
Rate for Payer: Home State Health Plan Medicare Advantage	$54,601.28
Rate for Payer: Humana Commercial	$109,202.56
Rate for Payer: Humana Medicare Advantage	$54,601.28

MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$70,455.68

Service Code	MSDRG 448
Min. Negotiated Rate	$35,227.84
Max. Negotiated Rate	$70,455.68
Rate for Payer: Aetna Medicare Advantage	$35,227.84
Rate for Payer: Cigna Commercial HMO & PPO	$35,227.84
Rate for Payer: Home State Health Plan Medicare Advantage	$35,227.84
Rate for Payer: Humana Commercial	$70,455.68
Rate for Payer: Humana Medicare Advantage	$35,227.84

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC

Facility

$23,063.80

Service Code	MSDRG 059
Min. Negotiated Rate	$11,531.90
Max. Negotiated Rate	$23,063.80
Rate for Payer: Aetna Medicare Advantage	$11,531.90
Rate for Payer: Cigna Commercial HMO & PPO	$11,531.90
Rate for Payer: Home State Health Plan Medicare Advantage	$11,531.90
Rate for Payer: Humana Commercial	$23,063.80
Rate for Payer: Humana Medicare Advantage	$11,531.90

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC

Facility

$30,422.94

Service Code	MSDRG 058
Min. Negotiated Rate	$15,211.47
Max. Negotiated Rate	$30,422.94
Rate for Payer: Aetna Medicare Advantage	$15,211.47
Rate for Payer: Cigna Commercial HMO & PPO	$15,211.47
Rate for Payer: Home State Health Plan Medicare Advantage	$15,211.47
Rate for Payer: Humana Commercial	$30,422.94
Rate for Payer: Humana Medicare Advantage	$15,211.47

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC

Facility

$18,038.82

Service Code	MSDRG 060
Min. Negotiated Rate	$9,019.41
Max. Negotiated Rate	$18,038.82
Rate for Payer: Aetna Medicare Advantage	$9,019.41
Rate for Payer: Cigna Commercial HMO & PPO	$9,019.41
Rate for Payer: Home State Health Plan Medicare Advantage	$9,019.41
Rate for Payer: Humana Commercial	$18,038.82
Rate for Payer: Humana Medicare Advantage	$9,019.41

MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES

Facility

$15,199.09

Service Code	APR-DRG 0432
Min. Negotiated Rate	$15,199.09
Max. Negotiated Rate	$15,199.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,199.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,199.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,199.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,199.09

MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES

Facility

$21,430.35

Service Code	APR-DRG 0433
Min. Negotiated Rate	$21,430.35
Max. Negotiated Rate	$21,430.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$21,430.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21,430.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21,430.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21,430.35

MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES

Facility

$45,222.85

Service Code	APR-DRG 0434
Min. Negotiated Rate	$45,222.85
Max. Negotiated Rate	$45,222.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$45,222.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$45,222.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$45,222.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$45,222.85

MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES

Facility

$10,309.31

Service Code	APR-DRG 0431
Min. Negotiated Rate	$10,309.31
Max. Negotiated Rate	$10,309.31
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,309.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,309.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,309.31
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,309.31

MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$44,612.66

Service Code	APR-DRG 9304
Min. Negotiated Rate	$44,612.66
Max. Negotiated Rate	$44,612.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$44,612.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$44,612.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$44,612.66
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$44,612.66

Know your out-of-pocket cost for care.

All Charges