Madison Medical Center

All Charges

Charge

Type

Setting

Price

OT GOAL OCCP THERAPY SELF CARE FUN

Facility

$4.00

Hospital Charge Code	538988
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 GOAL OCCP THERAPY SELF CARE FUN

Facility

$4.00

Hospital Charge Code	538988
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

OT HAND CANE

Facility

$52.00

Hospital Charge Code	5349035
Hospital Revenue Code	271
Rate for Payer: Cash Price	$46.80

OT HAND CANE

Facility

$52.00

Hospital Charge Code	5349035
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

OT HAND EXERCISER

Facility

$39.00

Hospital Charge Code	5349023
Hospital Revenue Code	271
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

OT HAND EXERCISER

Facility

$39.00

Hospital Charge Code	5349023
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

OTHER AFTERCARE AND CONVALESCENCE

Facility

$17,603.63

Service Code	APR-DRG 8622
Min. Negotiated Rate	$17,603.63
Max. Negotiated Rate	$17,603.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,603.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,603.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,603.63
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,603.63

OTHER AFTERCARE AND CONVALESCENCE

Facility

$5,949.02

Service Code	APR-DRG 8621
Min. Negotiated Rate	$5,949.02
Max. Negotiated Rate	$5,949.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,949.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,949.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,949.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,949.02

OTHER AFTERCARE AND CONVALESCENCE

Facility

$17,603.63

Service Code	APR-DRG 8624
Min. Negotiated Rate	$17,603.63
Max. Negotiated Rate	$17,603.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,603.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,603.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,603.63
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,603.63

OTHER AFTERCARE AND CONVALESCENCE

Facility

$17,603.63

Service Code	APR-DRG 8623
Min. Negotiated Rate	$17,603.63
Max. Negotiated Rate	$17,603.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,603.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,603.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,603.63
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,603.63

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$16,031.59

Service Code	APR-DRG 2533
Min. Negotiated Rate	$16,031.59
Max. Negotiated Rate	$16,031.59
Rate for Payer: Aetna Better Health Medicaid/QHP	$16,031.59
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16,031.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16,031.59
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16,031.59

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$29,769.33

Service Code	APR-DRG 2534
Min. Negotiated Rate	$29,769.33
Max. Negotiated Rate	$29,769.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$29,769.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29,769.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29,769.33
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29,769.33

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$10,488.30

Service Code	APR-DRG 2532
Min. Negotiated Rate	$10,488.30
Max. Negotiated Rate	$10,488.30
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,488.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,488.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,488.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,488.30

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$6,461.32

Service Code	APR-DRG 2531
Min. Negotiated Rate	$6,461.32
Max. Negotiated Rate	$6,461.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,461.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,461.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,461.32
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,461.32

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$7,204.95

Service Code	APR-DRG 6631
Min. Negotiated Rate	$7,204.95
Max. Negotiated Rate	$7,204.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,204.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,204.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,204.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,204.95

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$8,894.46

Service Code	APR-DRG 6632
Min. Negotiated Rate	$8,894.46
Max. Negotiated Rate	$8,894.46
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,894.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,894.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,894.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,894.46

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$32,264.23

Service Code	APR-DRG 6634
Min. Negotiated Rate	$32,264.23
Max. Negotiated Rate	$32,264.23
Rate for Payer: Aetna Better Health Medicaid/QHP	$32,264.23
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$32,264.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32,264.23
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$32,264.23

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$15,040.90

Service Code	APR-DRG 6633
Min. Negotiated Rate	$15,040.90
Max. Negotiated Rate	$15,040.90
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,040.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,040.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,040.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,040.90

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility

$21,785.26

Service Code	MSDRG 818
Min. Negotiated Rate	$10,892.63
Max. Negotiated Rate	$21,785.26
Rate for Payer: Aetna Medicare Advantage	$10,892.63
Rate for Payer: Cigna Commercial HMO & PPO	$10,892.63
Rate for Payer: Home State Health Plan Medicare Advantage	$10,892.63
Rate for Payer: Humana Commercial	$21,785.26
Rate for Payer: Humana Medicare Advantage	$10,892.63

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC

Facility

$39,435.68

Service Code	MSDRG 817
Min. Negotiated Rate	$19,717.84
Max. Negotiated Rate	$39,435.68
Rate for Payer: Aetna Medicare Advantage	$19,717.84
Rate for Payer: Cigna Commercial HMO & PPO	$19,717.84
Rate for Payer: Home State Health Plan Medicare Advantage	$19,717.84
Rate for Payer: Humana Commercial	$39,435.68
Rate for Payer: Humana Medicare Advantage	$19,717.84

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$17,101.42

Service Code	MSDRG 819
Min. Negotiated Rate	$8,550.71
Max. Negotiated Rate	$17,101.42
Rate for Payer: Aetna Medicare Advantage	$8,550.71
Rate for Payer: Cigna Commercial HMO & PPO	$8,550.71
Rate for Payer: Home State Health Plan Medicare Advantage	$8,550.71
Rate for Payer: Humana Commercial	$17,101.42
Rate for Payer: Humana Medicare Advantage	$8,550.71

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC

Facility

$14,938.16

Service Code	MSDRG 832
Min. Negotiated Rate	$7,469.08
Max. Negotiated Rate	$14,938.16
Rate for Payer: Aetna Medicare Advantage	$7,469.08
Rate for Payer: Cigna Commercial HMO & PPO	$7,469.08
Rate for Payer: Home State Health Plan Medicare Advantage	$7,469.08
Rate for Payer: Humana Commercial	$14,938.16
Rate for Payer: Humana Medicare Advantage	$7,469.08

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC

Facility

$22,462.86

Service Code	MSDRG 831
Min. Negotiated Rate	$11,231.43
Max. Negotiated Rate	$22,462.86
Rate for Payer: Aetna Medicare Advantage	$11,231.43
Rate for Payer: Cigna Commercial HMO & PPO	$11,231.43
Rate for Payer: Home State Health Plan Medicare Advantage	$11,231.43
Rate for Payer: Humana Commercial	$22,462.86
Rate for Payer: Humana Medicare Advantage	$11,231.43

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$11,857.24

Service Code	MSDRG 833
Min. Negotiated Rate	$5,928.62
Max. Negotiated Rate	$11,857.24
Rate for Payer: Aetna Medicare Advantage	$5,928.62
Rate for Payer: Cigna Commercial HMO & PPO	$5,928.62
Rate for Payer: Home State Health Plan Medicare Advantage	$5,928.62
Rate for Payer: Humana Commercial	$11,857.24
Rate for Payer: Humana Medicare Advantage	$5,928.62

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$22,998.33

Service Code	APR-DRG 3474
Min. Negotiated Rate	$22,998.33
Max. Negotiated Rate	$22,998.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,998.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,998.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,998.33
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,998.33

Know your out-of-pocket cost for care.

All Charges