Madison Medical Center

All Charges

Charge

Type

Setting

Price

SEPTIC ARTHRITIS WITH CC

Facility

$22,536.42

Service Code	MSDRG 549
Min. Negotiated Rate	$11,268.21
Max. Negotiated Rate	$22,536.42
Rate for Payer: Aetna Medicare Advantage	$11,268.21
Rate for Payer: Cigna Commercial HMO & PPO	$11,268.21
Rate for Payer: Home State Health Plan Medicare Advantage	$11,268.21
Rate for Payer: Humana Commercial	$22,536.42
Rate for Payer: Humana Medicare Advantage	$11,268.21

SEPTIC ARTHRITIS WITH MCC

Facility

$33,910.84

Service Code	MSDRG 548
Min. Negotiated Rate	$16,955.42
Max. Negotiated Rate	$33,910.84
Rate for Payer: Aetna Medicare Advantage	$16,955.42
Rate for Payer: Cigna Commercial HMO & PPO	$16,955.42
Rate for Payer: Home State Health Plan Medicare Advantage	$16,955.42
Rate for Payer: Humana Commercial	$33,910.84
Rate for Payer: Humana Medicare Advantage	$16,955.42

SEPTIC ARTHRITIS WITHOUT CC/MCC

Facility

$17,323.62

Service Code	MSDRG 550
Min. Negotiated Rate	$8,661.81
Max. Negotiated Rate	$17,323.62
Rate for Payer: Aetna Medicare Advantage	$8,661.81
Rate for Payer: Cigna Commercial HMO & PPO	$8,661.81
Rate for Payer: Home State Health Plan Medicare Advantage	$8,661.81
Rate for Payer: Humana Commercial	$17,323.62
Rate for Payer: Humana Medicare Advantage	$8,661.81

SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$20,149.40

Service Code	APR-DRG 7203
Min. Negotiated Rate	$20,149.40
Max. Negotiated Rate	$20,149.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,149.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,149.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,149.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,149.40

SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$42,549.06

Service Code	APR-DRG 7204
Min. Negotiated Rate	$42,549.06
Max. Negotiated Rate	$42,549.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$42,549.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$42,549.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$42,549.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$42,549.06

SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$10,477.40

Service Code	APR-DRG 7202
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

SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$7,094.74

Service Code	APR-DRG 7201
Min. Negotiated Rate	$7,094.74
Max. Negotiated Rate	$7,094.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,094.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,094.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,094.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,094.74

SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS

Facility

$112,856.94

Service Code	MSDRG 870
Min. Negotiated Rate	$56,428.47
Max. Negotiated Rate	$112,856.94
Rate for Payer: Aetna Medicare Advantage	$56,428.47
Rate for Payer: Cigna Commercial HMO & PPO	$56,428.47
Rate for Payer: Home State Health Plan Medicare Advantage	$56,428.47
Rate for Payer: Humana Commercial	$112,856.94
Rate for Payer: Humana Medicare Advantage	$56,428.47

SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC

Facility

$34,093.58

Service Code	MSDRG 871
Min. Negotiated Rate	$17,046.79
Max. Negotiated Rate	$34,093.58
Rate for Payer: Aetna Medicare Advantage	$17,046.79
Rate for Payer: Cigna Commercial HMO & PPO	$17,046.79
Rate for Payer: Home State Health Plan Medicare Advantage	$17,046.79
Rate for Payer: Humana Commercial	$34,093.58
Rate for Payer: Humana Medicare Advantage	$17,046.79

SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC

Facility

$19,658.50

Service Code	MSDRG 872
Min. Negotiated Rate	$9,829.25
Max. Negotiated Rate	$19,658.50
Rate for Payer: Aetna Medicare Advantage	$9,829.25
Rate for Payer: Cigna Commercial HMO & PPO	$9,829.25
Rate for Payer: Home State Health Plan Medicare Advantage	$9,829.25
Rate for Payer: Humana Commercial	$19,658.50
Rate for Payer: Humana Medicare Advantage	$9,829.25

SEQUENTIAL COMP. DEVICE

Facility

$282.00

Hospital Charge Code	1219017
Hospital Revenue Code	271
Min. Negotiated Rate	$101.52
Max. Negotiated Rate	$201.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$166.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$201.35
Rate for Payer: Cash Price	$253.80
Rate for Payer: UnitedHealthcare Commercial	$188.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$101.52

SEQUENTIAL COMP. DEVICE

Facility

$282.00

Hospital Charge Code	1219017
Hospital Revenue Code	271
Rate for Payer: Cash Price	$253.80

SEQUENTIAL STOCKING PUMP/DAY

Facility

$169.00

Hospital Charge Code	1219007
Hospital Revenue Code	940
Rate for Payer: Cash Price	$152.10

SEQUENTIAL STOCKING PUMP/DAY

Facility

$169.00

Hospital Charge Code	1219007
Hospital Revenue Code	940
Min. Negotiated Rate	$60.84
Max. Negotiated Rate	$120.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$120.67
Rate for Payer: Cash Price	$152.10
Rate for Payer: UnitedHealthcare Commercial	$112.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.84

SEROTONIN

Facility

$279.00

Service Code	CPT 84260
Hospital Charge Code	2284260
Hospital Revenue Code	301
Rate for Payer: Cash Price	$251.10

SEROTONIN

Facility

$279.00

Service Code	CPT 84260
Hospital Charge Code	2284260
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$199.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$27.88
Rate for Payer: Aetna Medicare Advantage	$30.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$165.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$199.21
Rate for Payer: Cash Price	$251.10
Rate for Payer: Cash Price	$251.10
Rate for Payer: Cash Price	$251.10
Rate for Payer: Cigna Commercial HMO & PPO	$30.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29.83
Rate for Payer: Home State Health Plan Medicare Advantage	$30.98
Rate for Payer: Humana Commercial	$61.96
Rate for Payer: Humana Medicare Advantage	$30.98
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$100.44

SERTRALINE 100MG TAB EMP

Facility

$15.00

Service Code	NDC 49491041
Hospital Charge Code	2620354
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

SERTRALINE 100MG TAB EMP

Facility

$15.00

Service Code	NDC 49491041
Hospital Charge Code	2620354
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

SERTRALINE (ZOLOFT) 25MG TAB EMP

Facility

$15.00

Service Code	NDC 3.1722E+10
Hospital Charge Code	2697755
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

SERTRALINE (ZOLOFT) 25MG TAB EMP

Facility

$15.00

Service Code	NDC 3.1722E+10
Hospital Charge Code	2697755
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

SERTRALINE (ZOLOFT) 50MG TAB

Facility

$43.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2656181
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

SERTRALINE (ZOLOFT) 50MG TAB

Facility

$43.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2656181
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

SERTRALINE (ZOLOFT) 50MG TAB EMP

Facility

$15.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2697299
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

SERTRALINE (ZOLOFT) 50MG TAB EMP

Facility

$15.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2697299
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

SERUM Fe/TIBC

Facility

$41.00

Service Code	CPT 83550
Hospital Charge Code	4283550
Hospital Revenue Code	521
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.87
Rate for Payer: Aetna Medicare Advantage	$8.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.27
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cigna Commercial HMO & PPO	$8.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.42
Rate for Payer: Home State Health Plan Medicare Advantage	$8.74
Rate for Payer: Humana Commercial	$17.48
Rate for Payer: Humana Medicare Advantage	$8.74
Rate for Payer: UnitedHealthcare Commercial	$27.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges