Madison Medical Center

All Charges

Charge

Type

Setting

Price

OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$7,456.87

Service Code	APR-DRG 3441
Min. Negotiated Rate	$7,456.87
Max. Negotiated Rate	$7,456.87
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,456.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,456.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,456.87
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,456.87

OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$26,041.50

Service Code	APR-DRG 3443
Min. Negotiated Rate	$26,041.50
Max. Negotiated Rate	$26,041.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$26,041.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26,041.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26,041.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26,041.50

OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$27,586.89

Service Code	APR-DRG 3444
Min. Negotiated Rate	$27,586.89
Max. Negotiated Rate	$27,586.89
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,586.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,586.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,586.89
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,586.89

OSTEOMYELITIS WITH CC

Facility

$23,930.78

Service Code	MSDRG 540
Min. Negotiated Rate	$11,965.39
Max. Negotiated Rate	$23,930.78
Rate for Payer: Aetna Medicare Advantage	$11,965.39
Rate for Payer: Cigna Commercial HMO & PPO	$11,965.39
Rate for Payer: Home State Health Plan Medicare Advantage	$11,965.39
Rate for Payer: Humana Commercial	$23,930.78
Rate for Payer: Humana Medicare Advantage	$11,965.39

OSTEOMYELITIS WITH MCC

Facility

$34,522.08

Service Code	MSDRG 539
Min. Negotiated Rate	$17,261.04
Max. Negotiated Rate	$34,522.08
Rate for Payer: Aetna Medicare Advantage	$17,261.04
Rate for Payer: Cigna Commercial HMO & PPO	$17,261.04
Rate for Payer: Home State Health Plan Medicare Advantage	$17,261.04
Rate for Payer: Humana Commercial	$34,522.08
Rate for Payer: Humana Medicare Advantage	$17,261.04

OSTEOMYELITIS WITHOUT CC/MCC

Facility

$15,966.84

Service Code	MSDRG 541
Min. Negotiated Rate	$7,983.42
Max. Negotiated Rate	$15,966.84
Rate for Payer: Aetna Medicare Advantage	$7,983.42
Rate for Payer: Cigna Commercial HMO & PPO	$7,983.42
Rate for Payer: Home State Health Plan Medicare Advantage	$7,983.42
Rate for Payer: Humana Commercial	$15,966.84
Rate for Payer: Humana Medicare Advantage	$7,983.42

OT ADL RE-TRAINING 15 MIN

Facility

$107.00

Service Code	CPT 97535
Hospital Charge Code	5397535
Hospital Revenue Code	431
Rate for Payer: Cash Price	$96.30

OT ADL RE-TRAINING 15 MIN

Facility

$107.00

Service Code	CPT 97535
Hospital Charge Code	5397535
Hospital Revenue Code	431
Min. Negotiated Rate	$28.42
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$30.41
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

OT BUTTONHOOK

Facility

$35.00

Hospital Charge Code	5349017
Hospital Revenue Code	271
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

OT BUTTONHOOK

Facility

$35.00

Hospital Charge Code	5349017
Hospital Revenue Code	271
Rate for Payer: Cash Price	$31.50

OT COBAN 1 ROLL

Facility

$18.00

Hospital Charge Code	5349043
Hospital Revenue Code	271
Rate for Payer: Cash Price	$16.20

OT COBAN 1 ROLL

Facility

$18.00

Hospital Charge Code	5349043
Hospital Revenue Code	271
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

OT COGNITIVE TRAINING 15 MIN

Facility

$101.00

Service Code	CPT 97770
Hospital Charge Code	5397770
Hospital Revenue Code	431
Rate for Payer: Cash Price	$90.90

OT COGNITIVE TRAINING 15 MIN

Facility

$101.00

Service Code	CPT 97770
Hospital Charge Code	5397770
Hospital Revenue Code	431
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

OT DISCHARGE MOBILITY OCCP THERAPY

Facility

$4.00

Hospital Charge Code	538980
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

OT DISCHARGE MOBILITY OCCP THERAPY

Facility

$4.00

Hospital Charge Code	538980
Hospital Revenue Code	430
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

OT DISCHARGE OCCP THERAPY BODY POSITION

Facility

$4.00

Hospital Charge Code	538983
Hospital Revenue Code	430
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

OT DISCHARGE OCCP THERAPY BODY POSITION

Facility

$4.00

Hospital Charge Code	538983
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

OT DISCHARGE OCCP THERAPY CARRYING MOV

Facility

$4.00

Hospital Charge Code	538986
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

OT DISCHARGE OCCP THERAPY CARRYING MOV

Facility

$4.00

Hospital Charge Code	538986
Hospital Revenue Code	430
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$136.00
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

OT DISCHARGE OCCP THERAPY FUN

Facility

$4.00

Hospital Charge Code	538992
Hospital Revenue Code	430
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

OT DISCHARGE OCCP THERAPY FUN

Facility

$4.00

Hospital Charge Code	538992
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

OT DISCHARGE OCCP THERAPY SELF CARE

Facility

$4.00

Hospital Charge Code	538989
Hospital Revenue Code	430
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

OT DISCHARGE OCCP THERAPY SELF CARE

Facility

$4.00

Hospital Charge Code	538989
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

OT DISCHARGE OCCP THERAPY SUBSQT FUN

Facility

$4.00

Hospital Charge Code	538995
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

Know your out-of-pocket cost for care.

All Charges