Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

$223,772.98

Service Code	APR-DRG 5892
Min. Negotiated Rate	$223,772.98
Max. Negotiated Rate	$223,772.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$223,772.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$223,772.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$223,772.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$223,772.98

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

$223,772.98

Service Code	APR-DRG 5891
Min. Negotiated Rate	$223,772.98
Max. Negotiated Rate	$223,772.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$223,772.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$223,772.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$223,772.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$223,772.98

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

$223,772.98

Service Code	APR-DRG 5893
Min. Negotiated Rate	$223,772.98
Max. Negotiated Rate	$223,772.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$223,772.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$223,772.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$223,772.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$223,772.98

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$212,337.42

Service Code	APR-DRG 5932
Min. Negotiated Rate	$212,337.42
Max. Negotiated Rate	$212,337.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$212,337.42
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$212,337.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$212,337.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$212,337.42

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$117,571.27

Service Code	APR-DRG 5931
Min. Negotiated Rate	$117,571.27
Max. Negotiated Rate	$117,571.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$117,571.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$117,571.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$117,571.27
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$117,571.27

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$340,269.22

Service Code	APR-DRG 5934
Min. Negotiated Rate	$340,269.22
Max. Negotiated Rate	$340,269.22
Rate for Payer: Aetna Better Health Medicaid/QHP	$340,269.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$340,269.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$340,269.22
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$340,269.22

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$213,866.67

Service Code	APR-DRG 5933
Min. Negotiated Rate	$213,866.67
Max. Negotiated Rate	$213,866.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$213,866.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$213,866.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$213,866.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$213,866.67

NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY

Facility

$31,883.34

Service Code	MSDRG 789
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$31,883.34
Rate for Payer: Aetna Medicare Advantage	$15,941.67
Rate for Payer: Cigna Commercial HMO & PPO	$15,941.67
Rate for Payer: Home State Health Plan Medicare Advantage	$15,941.67
Rate for Payer: Humana Commercial	$31,883.34
Rate for Payer: Humana Medicare Advantage	$15,941.67
Rate for Payer: UnitedHealthcare Commercial	$351.00

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$5,304.43

Service Code	APR-DRG 5813
Min. Negotiated Rate	$5,304.43
Max. Negotiated Rate	$5,304.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,304.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,304.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,304.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,304.43

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$4,207.39

Service Code	APR-DRG 5812
Min. Negotiated Rate	$4,207.39
Max. Negotiated Rate	$4,207.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,207.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,207.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,207.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,207.39

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$6,643.50

Service Code	APR-DRG 5814
Min. Negotiated Rate	$6,643.50
Max. Negotiated Rate	$6,643.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,643.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,643.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,643.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,643.50

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$3,423.12

Service Code	APR-DRG 5811
Min. Negotiated Rate	$3,423.12
Max. Negotiated Rate	$3,423.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$3,423.12
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3,423.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,423.12
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3,423.12

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$14,398.18

Service Code	APR-DRG 5803
Min. Negotiated Rate	$14,398.18
Max. Negotiated Rate	$14,398.18
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,398.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,398.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,398.18
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,398.18

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$25,879.32

Service Code	APR-DRG 5804
Min. Negotiated Rate	$25,879.32
Max. Negotiated Rate	$25,879.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$25,879.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25,879.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25,879.32
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25,879.32

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$6,039.98

Service Code	APR-DRG 5802
Min. Negotiated Rate	$6,039.98
Max. Negotiated Rate	$6,039.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,039.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,039.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,039.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,039.98

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$5,282.42

Service Code	APR-DRG 5801
Min. Negotiated Rate	$5,282.42
Max. Negotiated Rate	$5,282.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,282.42
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,282.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,282.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,282.42

NEONATE WITH ECMO

Facility

$421,445.04

Service Code	APR-DRG 5832
Min. Negotiated Rate	$421,445.04
Max. Negotiated Rate	$421,445.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$421,445.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$421,445.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$421,445.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$421,445.04

NEONATE WITH ECMO

Facility

$307,854.84

Service Code	APR-DRG 5831
Min. Negotiated Rate	$307,854.84
Max. Negotiated Rate	$307,854.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$307,854.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$307,854.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$307,854.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$307,854.84

NEONATE WITH ECMO

Facility

$1,112,339.29

Service Code	APR-DRG 5834
Min. Negotiated Rate	$1,112,339.29
Max. Negotiated Rate	$1,112,339.29
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,112,339.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,112,339.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,112,339.29
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,112,339.29

NEONATE WITH ECMO

Facility

$671,601.85

Service Code	APR-DRG 5833
Min. Negotiated Rate	$671,601.85
Max. Negotiated Rate	$671,601.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$671,601.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$671,601.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$671,601.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$671,601.85

NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

$26,746.14

Service Code	MSDRG 794
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$26,746.14
Rate for Payer: Aetna Medicare Advantage	$13,373.07
Rate for Payer: Cigna Commercial HMO & PPO	$13,373.07
Rate for Payer: Home State Health Plan Medicare Advantage	$13,373.07
Rate for Payer: Humana Commercial	$26,746.14
Rate for Payer: Humana Medicare Advantage	$13,373.07
Rate for Payer: UnitedHealthcare Commercial	$351.00

NEO/POL/BAC/HC(CORTISP) OP OI 3.5GM

Facility

$238.00

Service Code	NDC 574414435
Hospital Charge Code	2655944
Hospital Revenue Code	250
Min. Negotiated Rate	$85.68
Max. Negotiated Rate	$169.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$140.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$169.93
Rate for Payer: Cash Price	$214.20
Rate for Payer: UnitedHealthcare Commercial	$158.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.68

NEO/POL/BAC/HC(CORTISP) OP OI 3.5GM

Facility

$238.00

Service Code	NDC 574414435
Hospital Charge Code	2655944
Hospital Revenue Code	250
Rate for Payer: Cash Price	$214.20

NEO/POL/HC (CORTISPOR) OP SUS 7.5ML

Facility

$414.00

Service Code	NDC 6.157E+10
Hospital Charge Code	2655930
Hospital Revenue Code	250
Rate for Payer: Cash Price	$372.60

NEO/POL/HC (CORTISPOR) OP SUS 7.5ML

Facility

$414.00

Service Code	NDC 6.157E+10
Hospital Charge Code	2655930
Hospital Revenue Code	250
Min. Negotiated Rate	$149.04
Max. Negotiated Rate	$295.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$245.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$295.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: UnitedHealthcare Commercial	$276.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$149.04

Know your out-of-pocket cost for care.

All Charges