Madison Medical Center

All Charges

Charge

Type

Setting

Price

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$24,178.76

Service Code	APR-DRG 6332
Min. Negotiated Rate	$24,178.76
Max. Negotiated Rate	$24,178.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$24,178.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24,178.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24,178.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24,178.76

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$86,128.19

Service Code	APR-DRG 6333
Min. Negotiated Rate	$86,128.19
Max. Negotiated Rate	$86,128.19
Rate for Payer: Aetna Better Health Medicaid/QHP	$86,128.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$86,128.19
Rate for Payer: Home State Health Plan Medicaid Managed Care	$86,128.19
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$86,128.19

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$201,624.84

Service Code	APR-DRG 6334
Min. Negotiated Rate	$201,624.84
Max. Negotiated Rate	$201,624.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$201,624.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$201,624.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$201,624.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$201,624.84

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$6,025.83

Service Code	APR-DRG 6331
Min. Negotiated Rate	$6,025.83
Max. Negotiated Rate	$6,025.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,025.83
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,025.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,025.83
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,025.83

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$319,898.64

Service Code	APR-DRG 6304
Min. Negotiated Rate	$319,898.64
Max. Negotiated Rate	$319,898.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$319,898.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$319,898.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$319,898.64
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$319,898.64

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$128,819.80

Service Code	APR-DRG 6303
Min. Negotiated Rate	$128,819.80
Max. Negotiated Rate	$128,819.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$128,819.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$128,819.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128,819.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$128,819.80

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$70,307.64

Service Code	APR-DRG 6302
Min. Negotiated Rate	$70,307.64
Max. Negotiated Rate	$70,307.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$70,307.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$70,307.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$70,307.64
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$70,307.64

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$43,603.18

Service Code	APR-DRG 6301
Min. Negotiated Rate	$43,603.18
Max. Negotiated Rate	$43,603.18
Rate for Payer: Aetna Better Health Medicaid/QHP	$43,603.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$43,603.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$43,603.18
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$43,603.18

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$37,747.09

Service Code	APR-DRG 6312
Min. Negotiated Rate	$37,747.09
Max. Negotiated Rate	$37,747.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$37,747.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$37,747.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37,747.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$37,747.09

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$93,753.99

Service Code	APR-DRG 6313
Min. Negotiated Rate	$93,753.99
Max. Negotiated Rate	$93,753.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$93,753.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$93,753.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$93,753.99
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$93,753.99

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$32,090.61

Service Code	APR-DRG 6311
Min. Negotiated Rate	$32,090.61
Max. Negotiated Rate	$32,090.61
Rate for Payer: Aetna Better Health Medicaid/QHP	$32,090.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$32,090.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32,090.61
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$32,090.61

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$395,182.23

Service Code	APR-DRG 6314
Min. Negotiated Rate	$395,182.23
Max. Negotiated Rate	$395,182.23
Rate for Payer: Aetna Better Health Medicaid/QHP	$395,182.23
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$395,182.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$395,182.23
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$395,182.23

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$69,353.62

Service Code	APR-DRG 6394
Min. Negotiated Rate	$69,353.62
Max. Negotiated Rate	$69,353.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$69,353.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$69,353.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69,353.62
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$69,353.62

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$20,760.35

Service Code	APR-DRG 6392
Min. Negotiated Rate	$20,760.35
Max. Negotiated Rate	$20,760.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,760.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,760.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,760.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,760.35

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$7,217.17

Service Code	APR-DRG 6391
Min. Negotiated Rate	$7,217.17
Max. Negotiated Rate	$7,217.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,217.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,217.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,217.17
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,217.17

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$54,182.18

Service Code	APR-DRG 6393
Min. Negotiated Rate	$54,182.18
Max. Negotiated Rate	$54,182.18
Rate for Payer: Aetna Better Health Medicaid/QHP	$54,182.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$54,182.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$54,182.18
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$54,182.18

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$28,081.25

Service Code	APR-DRG 6342
Min. Negotiated Rate	$28,081.25
Max. Negotiated Rate	$28,081.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$28,081.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28,081.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28,081.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28,081.25

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$15,940.00

Service Code	APR-DRG 6341
Min. Negotiated Rate	$15,940.00
Max. Negotiated Rate	$15,940.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,940.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,940.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,940.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,940.00

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$55,040.31

Service Code	APR-DRG 6343
Min. Negotiated Rate	$55,040.31
Max. Negotiated Rate	$55,040.31
Rate for Payer: Aetna Better Health Medicaid/QHP	$55,040.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55,040.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$55,040.31
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55,040.31

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$96,491.86

Service Code	APR-DRG 6344
Min. Negotiated Rate	$96,491.86
Max. Negotiated Rate	$96,491.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$96,491.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$96,491.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$96,491.86
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$96,491.86

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$474,063.39

Service Code	APR-DRG 5914
Min. Negotiated Rate	$474,063.39
Max. Negotiated Rate	$474,063.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$474,063.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$474,063.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$474,063.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$474,063.39

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$7,784.54

Service Code	APR-DRG 5911
Min. Negotiated Rate	$7,784.54
Max. Negotiated Rate	$7,784.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,784.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,784.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,784.54
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,784.54

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$323,148.88

Service Code	APR-DRG 5913
Min. Negotiated Rate	$323,148.88
Max. Negotiated Rate	$323,148.88
Rate for Payer: Aetna Better Health Medicaid/QHP	$323,148.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$323,148.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$323,148.88
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$323,148.88

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$298,446.75

Service Code	APR-DRG 5912
Min. Negotiated Rate	$298,446.75
Max. Negotiated Rate	$298,446.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$298,446.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$298,446.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$298,446.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$298,446.75

NEONATE BIRTH WEIGHT < 500 GRAMS, OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS, OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION

Facility

$1,350.08

Service Code	APR-DRG 5894
Min. Negotiated Rate	$1,350.08
Max. Negotiated Rate	$1,350.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,350.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,350.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,350.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,350.08

Know your out-of-pocket cost for care.

All Charges