Madison Medical Center

All Charges

Charge

Type

Setting

Price

PT WORK HARDENINGCONDITION INITIAL 2 HRS

Facility

$357.00

Service Code	CPT 97545
Hospital Charge Code	4697545
Hospital Revenue Code	421
Min. Negotiated Rate	$82.00
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	$321.30
Rate for Payer: Cash Price	$321.30
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$128.52

PT WORK HARDENINGCONDITION INITIAL 2 HRS

Facility

$357.00

Service Code	CPT 97545
Hospital Charge Code	4697545
Hospital Revenue Code	421
Rate for Payer: Cash Price	$321.30

PUDENAL BLOC

Facility

$60.00

Hospital Charge Code	202029
Hospital Revenue Code	370
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

PUDENAL BLOC

Facility

$60.00

Hospital Charge Code	202029
Hospital Revenue Code	370
Rate for Payer: Cash Price	$54.00

PULMICORT FLEXHALER 90MCG INH 60DS EMP

Facility

$60.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2625348
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

PULMICORT FLEXHALER 90MCG INH 60DS EMP

Facility

$60.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2625348
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

PULMOCARE 1000ML RTH

Facility

$39.00

Hospital Charge Code	2851204
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

PULMOCARE 1000ML RTH

Facility

$39.00

Hospital Charge Code	2851204
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

PULMOCORT 0.25MG / BUDESONIDE

Facility

$56.00

Service Code	CPT J7608
Hospital Charge Code	450409
Hospital Revenue Code	250
Rate for Payer: Cash Price	$50.40

PULMOCORT 0.25MG / BUDESONIDE

Facility

$56.00

Service Code	CPT J7608
Hospital Charge Code	450409
Hospital Revenue Code	250
Min. Negotiated Rate	$20.16
Max. Negotiated Rate	$39.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$33.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.98
Rate for Payer: Cash Price	$50.40
Rate for Payer: UnitedHealthcare Commercial	$37.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.16

PULMOCORT / BUDESONIDE 0.5MG

Facility

$63.00

Service Code	CPT J7608
Hospital Charge Code	450408
Hospital Revenue Code	250
Rate for Payer: Cash Price	$56.70

PULMOCORT / BUDESONIDE 0.5MG

Facility

$63.00

Service Code	CPT J7608
Hospital Charge Code	450408
Hospital Revenue Code	250
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

PULMONARY EDEMA AND RESPIRATORY FAILURE

Facility

$22,977.74

Service Code	MSDRG 189
Min. Negotiated Rate	$11,488.87
Max. Negotiated Rate	$22,977.74
Rate for Payer: Aetna Medicare Advantage	$11,488.87
Rate for Payer: Cigna Commercial HMO & PPO	$11,488.87
Rate for Payer: Home State Health Plan Medicare Advantage	$11,488.87
Rate for Payer: Humana Commercial	$22,977.74
Rate for Payer: Humana Medicare Advantage	$11,488.87

PULMONARY EMBOLISM

Facility

$6,669.64

Service Code	APR-DRG 1341
Min. Negotiated Rate	$6,669.64
Max. Negotiated Rate	$6,669.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,669.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,669.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,669.64
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,669.64

PULMONARY EMBOLISM

Facility

$10,477.40

Service Code	APR-DRG 1342
Min. Negotiated Rate	$10,477.40
Max. Negotiated Rate	$10,477.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,477.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,477.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,477.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,477.40

PULMONARY EMBOLISM

Facility

$28,291.76

Service Code	APR-DRG 1344
Min. Negotiated Rate	$28,291.76
Max. Negotiated Rate	$28,291.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$28,291.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28,291.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28,291.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28,291.76

PULMONARY EMBOLISM

Facility

$17,885.82

Service Code	APR-DRG 1343
Min. Negotiated Rate	$17,885.82
Max. Negotiated Rate	$17,885.82
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,885.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,885.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,885.82
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,885.82

PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE

Facility

$25,141.38

Service Code	MSDRG 175
Min. Negotiated Rate	$12,570.69
Max. Negotiated Rate	$25,141.38
Rate for Payer: Aetna Medicare Advantage	$12,570.69
Rate for Payer: Cigna Commercial HMO & PPO	$12,570.69
Rate for Payer: Home State Health Plan Medicare Advantage	$12,570.69
Rate for Payer: Humana Commercial	$25,141.38
Rate for Payer: Humana Medicare Advantage	$12,570.69

PULMONARY EMBOLISM WITHOUT MCC

Facility

$16,242.26

Service Code	MSDRG 176
Min. Negotiated Rate	$8,121.13
Max. Negotiated Rate	$16,242.26
Rate for Payer: Aetna Medicare Advantage	$8,121.13
Rate for Payer: Cigna Commercial HMO & PPO	$8,121.13
Rate for Payer: Home State Health Plan Medicare Advantage	$8,121.13
Rate for Payer: Humana Commercial	$16,242.26
Rate for Payer: Humana Medicare Advantage	$8,121.13

PULMONARY REHAB 1 HOUR

Facility

$352.00

Service Code	CPT 94626
Hospital Charge Code	90424
Hospital Revenue Code	948
Min. Negotiated Rate	$53.18
Max. Negotiated Rate	$251.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$208.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$251.33
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$53.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$234.78
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$126.72

PULMONARY REHAB 1 HOUR

Facility

$352.00

Service Code	CPT 94626
Hospital Charge Code	90424
Hospital Revenue Code	948
Rate for Payer: Cash Price	$316.80

PULMONARY REHAB GROUP

Facility

$127.00

Service Code	CPT G0239
Hospital Charge Code	90239
Hospital Revenue Code	948
Rate for Payer: Cash Price	$114.30

PULMONARY REHAB GROUP

Facility

$127.00

Service Code	CPT G0239
Hospital Charge Code	90239
Hospital Revenue Code	948
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$90.68
Rate for Payer: Aetna Medicare Advantage	$38.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$90.68
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cigna Commercial HMO & PPO	$38.16
Rate for Payer: Home State Health Plan Medicare Advantage	$38.16
Rate for Payer: Humana Commercial	$76.32
Rate for Payer: Humana Medicare Advantage	$38.16
Rate for Payer: UnitedHealthcare Commercial	$84.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.72

PULMONARY REHAB STRENGTH ENDURANCE 15 MI

Facility

$71.00

Service Code	CPT G0237
Hospital Charge Code	90237
Hospital Revenue Code	948
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$59.10
Rate for Payer: Aetna Medicare Advantage	$29.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial HMO & PPO	$29.55
Rate for Payer: Home State Health Plan Medicare Advantage	$29.55
Rate for Payer: Humana Commercial	$59.10
Rate for Payer: Humana Medicare Advantage	$29.55
Rate for Payer: UnitedHealthcare Commercial	$47.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.56

PULMONARY REHAB STRENGTH ENDURANCE 15 MI

Facility

$71.00

Service Code	CPT G0237
Hospital Charge Code	90237
Hospital Revenue Code	948
Rate for Payer: Cash Price	$63.90

Know your out-of-pocket cost for care.

All Charges