Madison Medical Center

All Charges

Charge

Type

Setting

Price

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$9,377.70

Service Code	APR-DRG 4262
Min. Negotiated Rate	$9,377.70
Max. Negotiated Rate	$9,377.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,377.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,377.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,377.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,377.70

NON-INVASIVE BP CUFF

Facility

$63.00

Hospital Charge Code	2024483
Hospital Revenue Code	271
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

NON-INVASIVE BP CUFF

Facility

$63.00

Hospital Charge Code	2024483
Hospital Revenue Code	271
Rate for Payer: Cash Price	$56.70

NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility

$19,944.88

Service Code	MSDRG 600
Min. Negotiated Rate	$9,972.44
Max. Negotiated Rate	$19,944.88
Rate for Payer: Aetna Medicare Advantage	$9,972.44
Rate for Payer: Cigna Commercial HMO & PPO	$9,972.44
Rate for Payer: Home State Health Plan Medicare Advantage	$9,972.44
Rate for Payer: Humana Commercial	$19,944.88
Rate for Payer: Humana Medicare Advantage	$9,972.44

NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$13,123.72

Service Code	MSDRG 601
Min. Negotiated Rate	$6,561.86
Max. Negotiated Rate	$13,123.72
Rate for Payer: Aetna Medicare Advantage	$6,561.86
Rate for Payer: Cigna Commercial HMO & PPO	$6,561.86
Rate for Payer: Home State Health Plan Medicare Advantage	$6,561.86
Rate for Payer: Humana Commercial	$13,123.72
Rate for Payer: Humana Medicare Advantage	$6,561.86

NON OBSTETRIC D&C

Facility

$665.00

Service Code	CPT 58120
Hospital Charge Code	4258120
Rate for Payer: Cash Price	$598.50

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$9,948.75

Service Code	APR-DRG 0462
Min. Negotiated Rate	$9,948.75
Max. Negotiated Rate	$9,948.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,948.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,948.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,948.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,948.75

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$8,270.75

Service Code	APR-DRG 0461
Min. Negotiated Rate	$8,270.75
Max. Negotiated Rate	$8,270.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,270.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,270.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,270.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,270.75

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$13,068.08

Service Code	APR-DRG 0463
Min. Negotiated Rate	$13,068.08
Max. Negotiated Rate	$13,068.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,068.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,068.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,068.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,068.08

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$23,047.33

Service Code	APR-DRG 0464
Min. Negotiated Rate	$23,047.33
Max. Negotiated Rate	$23,047.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,047.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,047.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,047.33
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,047.33

NONSTRESS TEST

Facility

$119.00

Service Code	CPT 59025
Hospital Charge Code	4259025
Rate for Payer: Cash Price	$107.10

NONTRAUMATIC STUPOR AND COMA WITH MCC

Facility

$32,006.20

Service Code	MSDRG 080
Min. Negotiated Rate	$16,003.10
Max. Negotiated Rate	$32,006.20
Rate for Payer: Aetna Medicare Advantage	$16,003.10
Rate for Payer: Cigna Commercial HMO & PPO	$16,003.10
Rate for Payer: Home State Health Plan Medicare Advantage	$16,003.10
Rate for Payer: Humana Commercial	$32,006.20
Rate for Payer: Humana Medicare Advantage	$16,003.10

NONTRAUMATIC STUPOR AND COMA WITHOUT MCC

Facility

$17,660.10

Service Code	MSDRG 081
Min. Negotiated Rate	$8,830.05
Max. Negotiated Rate	$17,660.10
Rate for Payer: Aetna Medicare Advantage	$8,830.05
Rate for Payer: Cigna Commercial HMO & PPO	$8,830.05
Rate for Payer: Home State Health Plan Medicare Advantage	$8,830.05
Rate for Payer: Humana Commercial	$17,660.10
Rate for Payer: Humana Medicare Advantage	$8,830.05

NOREPINEPHRINE 4MG/250ML PREMIX BAG

Facility

$224.00

Service Code	NDC 8290305200
Hospital Charge Code	2627020
Hospital Revenue Code	250
Min. Negotiated Rate	$80.64
Max. Negotiated Rate	$159.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$132.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$159.94
Rate for Payer: Cash Price	$201.60
Rate for Payer: UnitedHealthcare Commercial	$149.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$80.64

NOREPINEPHRINE 4MG/250ML PREMIX BAG

Facility

$224.00

Service Code	NDC 8290305200
Hospital Charge Code	2627020
Hospital Revenue Code	250
Rate for Payer: Cash Price	$201.60

NOREPINEPHRINE 4MG INJ 4ML VIAL

Facility

$224.00

Service Code	NDC 8290305200
Hospital Charge Code	2698205
Hospital Revenue Code	250
Rate for Payer: Cash Price	$201.60

NOREPINEPHRINE 4MG INJ 4ML VIAL

Facility

$224.00

Service Code	NDC 8290305200
Hospital Charge Code	2698205
Hospital Revenue Code	250
Min. Negotiated Rate	$80.64
Max. Negotiated Rate	$159.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$132.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$159.94
Rate for Payer: Cash Price	$201.60
Rate for Payer: UnitedHealthcare Commercial	$149.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$80.64

NOREPINEPHRINE PLASMA

Facility

$91.00

Service Code	CPT 82491
Hospital Charge Code	2214202
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$64.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

NOREPINEPHRINE PLASMA

Facility

$91.00

Service Code	CPT 82491
Hospital Charge Code	2214202
Hospital Revenue Code	301
Rate for Payer: Cash Price	$81.90

NORETH/ETH ESTRAD 3X28 TABS EMP

Facility

$113.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2622808
Hospital Revenue Code	250
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$80.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: UnitedHealthcare Commercial	$75.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

NORETH/ETH ESTRAD 3X28 TABS EMP

Facility

$113.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2622808
Hospital Revenue Code	250
Rate for Payer: Cash Price	$101.70

NORETH/ETH-ESTRD/FER FUM 5X28 TAB EMP

Facility

$113.00

Service Code	NDC 430042014
Hospital Charge Code	2627284
Hospital Revenue Code	250
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$80.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: UnitedHealthcare Commercial	$75.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

NORETH/ETH-ESTRD/FER FUM 5X28 TAB EMP

Facility

$113.00

Service Code	NDC 430042014
Hospital Charge Code	2627284
Hospital Revenue Code	250
Rate for Payer: Cash Price	$101.70

NORETHINDRONE 5MG TAB EMP

Facility

$13.00

Service Code	NDC 555021110
Hospital Charge Code	2623061
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

NORETHINDRONE 5MG TAB EMP

Facility

$13.00

Service Code	NDC 555021110
Hospital Charge Code	2623061
Hospital Revenue Code	250
Rate for Payer: Cash Price	$11.70

Know your out-of-pocket cost for care.

All Charges