Madison Medical Center

All Charges

Charge

Type

Setting

Price

POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE

Facility

$12,837.87

Service Code	APR-DRG 7112
Min. Negotiated Rate	$12,837.87
Max. Negotiated Rate	$12,837.87
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,837.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,837.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,837.87
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,837.87

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$11,181.06

Service Code	APR-DRG 7212
Min. Negotiated Rate	$11,181.06
Max. Negotiated Rate	$11,181.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,181.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,181.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,181.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,181.06

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$7,375.72

Service Code	APR-DRG 7211
Min. Negotiated Rate	$7,375.72
Max. Negotiated Rate	$7,375.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,375.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,375.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,375.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,375.72

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$25,931.29

Service Code	APR-DRG 7213
Min. Negotiated Rate	$25,931.29
Max. Negotiated Rate	$25,931.29
Rate for Payer: Aetna Better Health Medicaid/QHP	$25,931.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25,931.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25,931.29
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25,931.29

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$41,583.80

Service Code	APR-DRG 7214
Min. Negotiated Rate	$41,583.80
Max. Negotiated Rate	$41,583.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$41,583.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$41,583.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$41,583.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$41,583.80

POST-OP SHOE

Facility

$27.00

Hospital Charge Code	2814353
Hospital Revenue Code	272
Min. Negotiated Rate	$9.72
Max. Negotiated Rate	$19.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$15.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.28
Rate for Payer: Cash Price	$24.30
Rate for Payer: UnitedHealthcare Commercial	$18.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72

POST-OP SHOE

Facility

$27.00

Hospital Charge Code	2814353
Hospital Revenue Code	272
Rate for Payer: Cash Price	$24.30

POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES

Facility

$30,112.60

Service Code	MSDRG 769
Min. Negotiated Rate	$15,056.30
Max. Negotiated Rate	$30,112.60
Rate for Payer: Aetna Medicare Advantage	$15,056.30
Rate for Payer: Cigna Commercial HMO & PPO	$15,056.30
Rate for Payer: Home State Health Plan Medicare Advantage	$15,056.30
Rate for Payer: Humana Commercial	$30,112.60
Rate for Payer: Humana Medicare Advantage	$15,056.30

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES

Facility

$13,895.96

Service Code	MSDRG 776
Min. Negotiated Rate	$6,947.98
Max. Negotiated Rate	$13,895.96
Rate for Payer: Aetna Medicare Advantage	$6,947.98
Rate for Payer: Cigna Commercial HMO & PPO	$6,947.98
Rate for Payer: Home State Health Plan Medicare Advantage	$6,947.98
Rate for Payer: Humana Commercial	$13,895.96
Rate for Payer: Humana Medicare Advantage	$6,947.98

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE

Facility

$5,722.75

Service Code	APR-DRG 5611
Min. Negotiated Rate	$5,722.75
Max. Negotiated Rate	$5,722.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,722.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,722.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,722.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,722.75

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE

Facility

$21,013.57

Service Code	APR-DRG 5614
Min. Negotiated Rate	$21,013.57
Max. Negotiated Rate	$21,013.57
Rate for Payer: Aetna Better Health Medicaid/QHP	$21,013.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21,013.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21,013.57
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21,013.57

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE

Facility

$11,518.30

Service Code	APR-DRG 5613
Min. Negotiated Rate	$11,518.30
Max. Negotiated Rate	$11,518.30
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,518.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,518.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,518.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,518.30

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE

Facility

$5,722.75

Service Code	APR-DRG 5612
Min. Negotiated Rate	$5,722.75
Max. Negotiated Rate	$5,722.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,722.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,722.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,722.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,722.75

POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE

Facility

$27,276.43

Service Code	APR-DRG 5483
Min. Negotiated Rate	$27,276.43
Max. Negotiated Rate	$27,276.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,276.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,276.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,276.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,276.43

POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE

Facility

$15,616.05

Service Code	APR-DRG 5482
Min. Negotiated Rate	$15,616.05
Max. Negotiated Rate	$15,616.05
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,616.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,616.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,616.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,616.05

POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE

Facility

$3,679.75

Service Code	APR-DRG 5481
Min. Negotiated Rate	$3,679.75
Max. Negotiated Rate	$3,679.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$3,679.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3,679.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,679.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3,679.75

POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE

Facility

$43,155.48

Service Code	APR-DRG 5484
Min. Negotiated Rate	$43,155.48
Max. Negotiated Rate	$43,155.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$43,155.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$43,155.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$43,155.48
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$43,155.48

POST PARTUM CARE

Professional

Both

$608.00

Service Code	CPT 59410PP
Hospital Charge Code	4159410
Hospital Revenue Code	975
Min. Negotiated Rate	$212.80
Max. Negotiated Rate	$212.80
Rate for Payer: Cash Price	$547.20
Rate for Payer: Optum Medicare Advantage	$212.80

POSTPARTUM CURETTAGE

Facility

$616.00

Service Code	CPT 59160
Hospital Charge Code	4259160
Rate for Payer: Cash Price	$554.40

POSTPARTUM TUBAL LIGATION

Facility

$1,067.00

Service Code	CPT 58605
Hospital Charge Code	4258605
Rate for Payer: Cash Price	$960.30

POTAS AC PHOSPHATE (K-PHOS) TAB

Facility

$20.00

Service Code	NDC 486111101
Hospital Charge Code	2626589
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

POTAS AC PHOSPHATE (K-PHOS) TAB

Facility

$20.00

Service Code	NDC 486111101
Hospital Charge Code	2626589
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

POTASSIUM

Facility

$112.00

Service Code	CPT 84132
Hospital Charge Code	2216123
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

POTASSIUM

Facility

$112.00

Service Code	CPT 84132
Hospital Charge Code	2216123
Hospital Revenue Code	301
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.28
Rate for Payer: Aetna Medicare Advantage	$4.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$4.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.58
Rate for Payer: Home State Health Plan Medicare Advantage	$4.76
Rate for Payer: Humana Commercial	$9.52
Rate for Payer: Humana Medicare Advantage	$4.76
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

POTASSIUM 10MEQ (750MG) BOLUS 100ML IVPB

Facility

$126.00

Service Code	HCPCS J3480
Hospital Charge Code	2626415
Hospital Revenue Code	250
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$89.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: UnitedHealthcare Commercial	$84.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

Know your out-of-pocket cost for care.

All Charges