Madison Medical Center

All Charges

Charge

Type

Setting

Price

VERCURONIUM 10mg inj 10ml

Facility

$247.00

Service Code	HCPCS J3490
Hospital Charge Code	2058084
Hospital Revenue Code	370
Rate for Payer: Cash Price	$222.30

VERCURONIUM 10mg inj 10ml

Facility

$247.00

Service Code	HCPCS J3490
Hospital Charge Code	2058084
Hospital Revenue Code	370
Min. Negotiated Rate	$88.92
Max. Negotiated Rate	$176.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$146.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$176.36
Rate for Payer: Cash Price	$222.30
Rate for Payer: UnitedHealthcare Commercial	$164.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$88.92

VERSAPORT/12MM TROCAR B12LP

Facility

$465.00

Hospital Charge Code	1269126
Hospital Revenue Code	271
Min. Negotiated Rate	$167.40
Max. Negotiated Rate	$332.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$275.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$332.01
Rate for Payer: Cash Price	$418.50
Rate for Payer: UnitedHealthcare Commercial	$310.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$167.40

VERSAPORT/12MM TROCAR B12LP

Facility

$465.00

Hospital Charge Code	1269126
Hospital Revenue Code	271
Rate for Payer: Cash Price	$418.50

VERSAPORT 5MM B5LT

Facility

$409.00

Hospital Charge Code	1269128
Hospital Revenue Code	272
Rate for Payer: Cash Price	$368.10

VERSAPORT 5MM B5LT

Facility

$409.00

Hospital Charge Code	1269128
Hospital Revenue Code	272
Min. Negotiated Rate	$147.24
Max. Negotiated Rate	$292.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$242.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$292.03
Rate for Payer: Cash Price	$368.10
Rate for Payer: UnitedHealthcare Commercial	$272.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.24

VERSED 1GM INJ

Facility

$165.00

Service Code	HCPCS J2250
Hospital Charge Code	2058085
Hospital Revenue Code	370
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$117.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: UnitedHealthcare Commercial	$110.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

VERSED 1GM INJ

Facility

$165.00

Service Code	HCPCS J2250
Hospital Charge Code	2058085
Hospital Revenue Code	370
Rate for Payer: Cash Price	$148.50

VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$14,771.96

Service Code	APR-DRG 3102
Min. Negotiated Rate	$14,771.96
Max. Negotiated Rate	$14,771.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,771.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,771.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,771.96
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,771.96

VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$13,217.85

Service Code	APR-DRG 3101
Min. Negotiated Rate	$13,217.85
Max. Negotiated Rate	$13,217.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,217.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,217.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,217.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,217.85

VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$39,181.12

Service Code	APR-DRG 3104
Min. Negotiated Rate	$39,181.12
Max. Negotiated Rate	$39,181.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$39,181.12
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$39,181.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$39,181.12
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$39,181.12

VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$25,903.17

Service Code	APR-DRG 3103
Min. Negotiated Rate	$25,903.17
Max. Negotiated Rate	$25,903.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$25,903.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25,903.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25,903.17
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25,903.17

VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$16,949.21

Service Code	APR-DRG 1114
Min. Negotiated Rate	$16,949.21
Max. Negotiated Rate	$16,949.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$16,949.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16,949.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16,949.21
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16,949.21

VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$4,771.44

Service Code	APR-DRG 1111
Min. Negotiated Rate	$4,771.44
Max. Negotiated Rate	$4,771.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,771.44
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,771.44
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,771.44
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,771.44

VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$4,771.44

Service Code	APR-DRG 1112
Min. Negotiated Rate	$4,771.44
Max. Negotiated Rate	$4,771.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,771.44
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,771.44
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,771.44
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,771.44

VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$8,782.93

Service Code	APR-DRG 1113
Min. Negotiated Rate	$8,782.93
Max. Negotiated Rate	$8,782.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,782.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,782.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,782.93
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,782.93

VEST SAFETY

Facility

$110.00

Hospital Charge Code	2822800
Hospital Revenue Code	271
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$78.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: UnitedHealthcare Commercial	$73.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

VEST SAFETY

Facility

$110.00

Hospital Charge Code	2822800
Hospital Revenue Code	271
Rate for Payer: Cash Price	$99.00

VICRYL

Facility

$110.00

Hospital Charge Code	1269125
Hospital Revenue Code	271
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$78.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: UnitedHealthcare Commercial	$73.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

VICRYL

Facility

$110.00

Hospital Charge Code	1269125
Hospital Revenue Code	271
Rate for Payer: Cash Price	$99.00

VIP

Facility

$409.00

Service Code	CPT 84586
Hospital Charge Code	2284586
Hospital Revenue Code	301
Rate for Payer: Cash Price	$368.10

VIP

Facility

$409.00

Service Code	CPT 84586
Hospital Charge Code	2284586
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$292.03
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.80
Rate for Payer: Aetna Medicare Advantage	$35.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$242.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$292.03
Rate for Payer: Cash Price	$368.10
Rate for Payer: Cash Price	$368.10
Rate for Payer: Cash Price	$368.10
Rate for Payer: Cigna Commercial HMO & PPO	$35.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$34.03
Rate for Payer: Home State Health Plan Medicare Advantage	$35.33
Rate for Payer: Humana Commercial	$70.66
Rate for Payer: Humana Medicare Advantage	$35.33
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.24

VIRAL ILLNESS

Facility

$5,731.02

Service Code	APR-DRG 7232
Min. Negotiated Rate	$5,731.02
Max. Negotiated Rate	$5,731.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,731.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,731.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,731.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,731.02

VIRAL ILLNESS

Facility

$4,070.57

Service Code	APR-DRG 7231
Min. Negotiated Rate	$4,070.57
Max. Negotiated Rate	$4,070.57
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,070.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,070.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,070.57
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,070.57

VIRAL ILLNESS

Facility

$13,893.97

Service Code	APR-DRG 7233
Min. Negotiated Rate	$13,893.97
Max. Negotiated Rate	$13,893.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,893.97
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,893.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,893.97
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,893.97

Know your out-of-pocket cost for care.

All Charges