Madison Medical Center

All Charges

Charge

Type

Setting

Price

VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C

Facility

$20,414.36

Service Code	MSDRG 768
Min. Negotiated Rate	$3,272.00
Max. Negotiated Rate	$20,414.36
Rate for Payer: Aetna Medicare Advantage	$10,207.18
Rate for Payer: Cigna Commercial HMO & PPO	$10,207.18
Rate for Payer: Home State Health Plan Medicare Advantage	$10,207.18
Rate for Payer: Humana Commercial	$20,414.36
Rate for Payer: Humana Medicare Advantage	$10,207.18
Rate for Payer: UnitedHealthcare Commercial	$3,272.00

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC

Facility

$15,444.14

Service Code	MSDRG 806
Min. Negotiated Rate	$7,722.07
Max. Negotiated Rate	$15,444.14
Rate for Payer: Aetna Medicare Advantage	$7,722.07
Rate for Payer: Cigna Commercial HMO & PPO	$7,722.07
Rate for Payer: Home State Health Plan Medicare Advantage	$7,722.07
Rate for Payer: Humana Commercial	$15,444.14
Rate for Payer: Humana Medicare Advantage	$7,722.07

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC

Facility

$20,533.30

Service Code	MSDRG 805
Min. Negotiated Rate	$10,266.65
Max. Negotiated Rate	$20,533.30
Rate for Payer: Aetna Medicare Advantage	$10,266.65
Rate for Payer: Cigna Commercial HMO & PPO	$10,266.65
Rate for Payer: Home State Health Plan Medicare Advantage	$10,266.65
Rate for Payer: Humana Commercial	$20,533.30
Rate for Payer: Humana Medicare Advantage	$10,266.65

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC

Facility

$14,199.74

Service Code	MSDRG 807
Min. Negotiated Rate	$7,099.87
Max. Negotiated Rate	$14,199.74
Rate for Payer: Aetna Medicare Advantage	$7,099.87
Rate for Payer: Cigna Commercial HMO & PPO	$7,099.87
Rate for Payer: Home State Health Plan Medicare Advantage	$7,099.87
Rate for Payer: Humana Commercial	$14,199.74
Rate for Payer: Humana Medicare Advantage	$7,099.87

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$6,862.84

Service Code	APR-DRG 5412
Min. Negotiated Rate	$6,862.84
Max. Negotiated Rate	$6,862.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,862.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,862.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,862.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,862.84

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$6,206.50

Service Code	APR-DRG 5411
Min. Negotiated Rate	$6,206.50
Max. Negotiated Rate	$6,206.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,206.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,206.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,206.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,206.50

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$12,666.61

Service Code	APR-DRG 5413
Min. Negotiated Rate	$12,666.61
Max. Negotiated Rate	$12,666.61
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,666.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,666.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,666.61
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,666.61

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$23,584.93

Service Code	APR-DRG 5414
Min. Negotiated Rate	$23,584.93
Max. Negotiated Rate	$23,584.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,584.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,584.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,584.93
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,584.93

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC

Facility

$19,300.12

Service Code	MSDRG 797
Min. Negotiated Rate	$9,650.06
Max. Negotiated Rate	$19,300.12
Rate for Payer: Aetna Medicare Advantage	$9,650.06
Rate for Payer: Cigna Commercial HMO & PPO	$9,650.06
Rate for Payer: Home State Health Plan Medicare Advantage	$9,650.06
Rate for Payer: Humana Commercial	$19,300.12
Rate for Payer: Humana Medicare Advantage	$9,650.06

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC

Facility

$21,907.30

Service Code	MSDRG 796
Min. Negotiated Rate	$10,953.65
Max. Negotiated Rate	$21,907.30
Rate for Payer: Aetna Medicare Advantage	$10,953.65
Rate for Payer: Cigna Commercial HMO & PPO	$10,953.65
Rate for Payer: Home State Health Plan Medicare Advantage	$10,953.65
Rate for Payer: Humana Commercial	$21,907.30
Rate for Payer: Humana Medicare Advantage	$10,953.65

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC

Facility

$18,622.52

Service Code	MSDRG 798
Min. Negotiated Rate	$9,311.26
Max. Negotiated Rate	$18,622.52
Rate for Payer: Aetna Medicare Advantage	$9,311.26
Rate for Payer: Cigna Commercial HMO & PPO	$9,311.26
Rate for Payer: Home State Health Plan Medicare Advantage	$9,311.26
Rate for Payer: Humana Commercial	$18,622.52
Rate for Payer: Humana Medicare Advantage	$9,311.26

VAGINAL DEL. ONLY

Facility

$1,153.00

Service Code	CPT 59409
Hospital Charge Code	4259409
Rate for Payer: Cash Price	$1,037.70

VAGINAL DEL (POST CARE)

Facility

$2,315.00

Service Code	CPT 59400
Hospital Charge Code	5259400
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,652.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,370.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,652.91
Rate for Payer: Cash Price	$2,083.50
Rate for Payer: Cash Price	$2,083.50
Rate for Payer: UnitedHealthcare Commercial	$1,544.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

VAGINAL DEL (POST CARE)

Facility

$2,315.00

Service Code	CPT 59400
Hospital Charge Code	5259400
Hospital Revenue Code	521
Rate for Payer: Cash Price	$2,083.50

VAGINAL HYSTERECTOMY W/TUBES/OVARIES

Professional

Both

$3,071.00

Service Code	CPT 58262
Hospital Charge Code	4158262
Hospital Revenue Code	975
Min. Negotiated Rate	$703.54
Max. Negotiated Rate	$1,074.85
Rate for Payer: Aetna Commercial/Medicare Advantage	$787.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$703.54
Rate for Payer: Cash Price	$2,763.90
Rate for Payer: Cash Price	$2,763.90
Rate for Payer: Cigna Commercial HMO & PPO	$787.34
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$703.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$773.89
Rate for Payer: Home State Health Plan Medicare Advantage	$787.34
Rate for Payer: Optum Medicare Advantage	$1,074.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$703.54

VAGINAL YEAST DNA PROBE (ORANGE APTIMA)

Facility

$203.00

Service Code	CPT 87491
Hospital Charge Code	2287801
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$144.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.58
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$120.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$144.94
Rate for Payer: Cash Price	$182.70
Rate for Payer: Cash Price	$182.70
Rate for Payer: Cash Price	$182.70
Rate for Payer: Cigna Commercial HMO & PPO	$35.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33.79
Rate for Payer: Home State Health Plan Medicare Advantage	$35.09
Rate for Payer: Humana Commercial	$70.18
Rate for Payer: Humana Medicare Advantage	$35.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$73.08

VAGINAL YEAST DNA PROBE (ORANGE APTIMA)

Facility

$203.00

Service Code	CPT 87491
Hospital Charge Code	2287801
Hospital Revenue Code	306
Rate for Payer: Cash Price	$182.70

VAGOTOMY-PYLOR,GASTRO-TRUNCAL/SELECT

Professional

Both

$2,885.00

Service Code	CPT 43640
Hospital Charge Code	4143640
Hospital Revenue Code	975
Min. Negotiated Rate	$903.09
Max. Negotiated Rate	$1,073.76
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,073.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$903.09
Rate for Payer: Cash Price	$2,596.50
Rate for Payer: Cash Price	$2,596.50
Rate for Payer: Cigna Commercial HMO & PPO	$1,073.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$903.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$993.40
Rate for Payer: Home State Health Plan Medicare Advantage	$1,073.76
Rate for Payer: Optum Medicare Advantage	$1,009.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$903.09

VAGOTOMY W/PARTIAL DISTAL GASRECTOMY

Professional

Both

$1,620.00

Service Code	CPT 43635
Hospital Charge Code	4143635
Hospital Revenue Code	975
Min. Negotiated Rate	$98.20
Max. Negotiated Rate	$567.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$98.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$100.70
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Cigna Commercial HMO & PPO	$98.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$100.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$110.77
Rate for Payer: Home State Health Plan Medicare Advantage	$98.20
Rate for Payer: Optum Medicare Advantage	$567.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$100.70

VALACYCLOVIR (VALTREX) 1GM TAB EMP

Facility

$45.00

Service Code	NDC 173056504
Hospital Charge Code	2622326
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

VALACYCLOVIR (VALTREX) 1GM TAB EMP

Facility

$45.00

Service Code	NDC 173056504
Hospital Charge Code	2622326
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

VALACYCLOVIR (VALTREX) 500MG TAB

Facility

$45.00

Service Code	NDC 378427593
Hospital Charge Code	2626570
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

VALACYCLOVIR (VALTREX) 500MG TAB

Facility

$45.00

Service Code	NDC 378427593
Hospital Charge Code	2626570
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

VALACYCLOVIR (VALTREX) 500MG TAB EMP

Facility

$45.00

Service Code	NDC 378427593
Hospital Charge Code	2624474
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

VALACYCLOVIR (VALTREX) 500MG TAB EMP

Facility

$45.00

Service Code	NDC 378427593
Hospital Charge Code	2624474
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

Know your out-of-pocket cost for care.

All Charges