Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

VIRAL ILLNESS WITH MCC

Facility

$27,097.54

Service Code	MSDRG 865
Min. Negotiated Rate	$13,548.77
Max. Negotiated Rate	$27,097.54
Rate for Payer: Aetna Medicare Advantage	$13,548.77
Rate for Payer: Cigna Commercial HMO & PPO	$13,548.77
Rate for Payer: Home State Health Plan Medicare Advantage	$13,548.77
Rate for Payer: Humana Commercial	$27,097.54
Rate for Payer: Humana Medicare Advantage	$13,548.77

VIRAL ILLNESS WITHOUT MCC

Facility

$17,253.22

Service Code	MSDRG 866
Min. Negotiated Rate	$8,626.61
Max. Negotiated Rate	$17,253.22
Rate for Payer: Aetna Medicare Advantage	$8,626.61
Rate for Payer: Cigna Commercial HMO & PPO	$8,626.61
Rate for Payer: Home State Health Plan Medicare Advantage	$8,626.61
Rate for Payer: Humana Commercial	$17,253.22
Rate for Payer: Humana Medicare Advantage	$8,626.61

VIRAL MENINGITIS

Facility

$4,492.04

Service Code	APR-DRG 0511
Min. Negotiated Rate	$4,492.04
Max. Negotiated Rate	$4,492.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,492.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,492.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,492.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,492.04

VIRAL MENINGITIS

Facility

$12,268.64

Service Code	APR-DRG 0512
Min. Negotiated Rate	$12,268.64
Max. Negotiated Rate	$12,268.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,268.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,268.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,268.64
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,268.64

VIRAL MENINGITIS

Facility

$17,712.63

Service Code	APR-DRG 0513
Min. Negotiated Rate	$17,712.63
Max. Negotiated Rate	$17,712.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,712.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,712.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,712.63
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,712.63

VIRAL MENINGITIS

Facility

$33,015.13

Service Code	APR-DRG 0514
Min. Negotiated Rate	$33,015.13
Max. Negotiated Rate	$33,015.13
Rate for Payer: Aetna Better Health Medicaid/QHP	$33,015.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33,015.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33,015.13
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33,015.13

VIRAL MENINGITIS WITH CC/MCC

Facility

$33,699.72

Service Code	MSDRG 075
Min. Negotiated Rate	$16,849.86
Max. Negotiated Rate	$33,699.72
Rate for Payer: Aetna Medicare Advantage	$16,849.86
Rate for Payer: Cigna Commercial HMO & PPO	$16,849.86
Rate for Payer: Home State Health Plan Medicare Advantage	$16,849.86
Rate for Payer: Humana Commercial	$33,699.72
Rate for Payer: Humana Medicare Advantage	$16,849.86

VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$16,558.38

Service Code	MSDRG 076
Min. Negotiated Rate	$8,279.19
Max. Negotiated Rate	$16,558.38
Rate for Payer: Aetna Medicare Advantage	$8,279.19
Rate for Payer: Cigna Commercial HMO & PPO	$8,279.19
Rate for Payer: Home State Health Plan Medicare Advantage	$8,279.19
Rate for Payer: Humana Commercial	$16,558.38
Rate for Payer: Humana Medicare Advantage	$8,279.19

VIRT-GARD TAB EMP

Facility

$10.00

Service Code	NDC 7.6439E+10
Hospital Charge Code	2622741
Hospital Revenue Code	250
Rate for Payer: Cash Price	$9.00

VIRT-GARD TAB EMP

Facility

$10.00

Service Code	NDC 7.6439E+10
Hospital Charge Code	2622741
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$7.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.14
Rate for Payer: Cash Price	$9.00
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.60

VISIT, INIT HOSP

Professional

Both

$270.00

Service Code	CPT 99221
Hospital Charge Code	5299221
Hospital Revenue Code	987
Min. Negotiated Rate	$72.43
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$72.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$82.38
Rate for Payer: Cash Price	$243.00
Rate for Payer: Cash Price	$243.00
Rate for Payer: Cigna Commercial HMO & PPO	$72.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$82.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$90.62
Rate for Payer: Home State Health Plan Medicare Advantage	$72.43
Rate for Payer: Optum Medicare Advantage	$94.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$82.38

VISIT, INIT HOSP INTER

Professional

Both

$380.00

Service Code	CPT 99222
Hospital Charge Code	5299222
Hospital Revenue Code	987
Min. Negotiated Rate	$110.86
Max. Negotiated Rate	$133.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$113.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$110.86
Rate for Payer: Cash Price	$342.00
Rate for Payer: Cash Price	$342.00
Rate for Payer: Cigna Commercial HMO & PPO	$113.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$110.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$121.95
Rate for Payer: Home State Health Plan Medicare Advantage	$113.62
Rate for Payer: Optum Medicare Advantage	$133.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$110.86

VITAMIN A

Facility

$156.00

Service Code	CPT 84590
Hospital Charge Code	2219165
Hospital Revenue Code	301
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$111.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.45
Rate for Payer: Aetna Medicare Advantage	$11.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial HMO & PPO	$11.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.18
Rate for Payer: Home State Health Plan Medicare Advantage	$11.61
Rate for Payer: Humana Commercial	$23.22
Rate for Payer: Humana Medicare Advantage	$11.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.16

VITAMIN A

Facility

$156.00

Service Code	CPT 84590
Hospital Charge Code	2219165
Hospital Revenue Code	301
Rate for Payer: Cash Price	$140.40

VITAMIN B12

Facility

$234.00

Service Code	CPT 82607
Hospital Charge Code	226227
Hospital Revenue Code	301
Rate for Payer: Cash Price	$210.60

VITAMIN B12

Facility

$234.00

Service Code	CPT 82607
Hospital Charge Code	226227
Hospital Revenue Code	301
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$167.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.57
Rate for Payer: Aetna Medicare Advantage	$15.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$138.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.08
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cigna Commercial HMO & PPO	$15.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.52
Rate for Payer: Home State Health Plan Medicare Advantage	$15.08
Rate for Payer: Humana Commercial	$30.16
Rate for Payer: Humana Medicare Advantage	$15.08
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.24

VITAMIN B-12

Facility

$40.00

Service Code	HCPCS J3420
Hospital Charge Code	9603420
Hospital Revenue Code	636
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

VITAMIN B-12

Facility

$40.00

Service Code	HCPCS J3420
Hospital Charge Code	9603420
Hospital Revenue Code	636
Min. Negotiated Rate	$26.68
Max. Negotiated Rate	$26.68
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68

VITAMIN B12 (LABCORP)

Facility

$324.00

Service Code	CPT 82607
Hospital Charge Code	226228
Hospital Revenue Code	301
Rate for Payer: Cash Price	$291.60

VITAMIN B12 (LABCORP)

Facility

$324.00

Service Code	CPT 82607
Hospital Charge Code	226228
Hospital Revenue Code	301
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$231.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.57
Rate for Payer: Aetna Medicare Advantage	$15.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$191.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$231.34
Rate for Payer: Cash Price	$291.60
Rate for Payer: Cash Price	$291.60
Rate for Payer: Cash Price	$291.60
Rate for Payer: Cigna Commercial HMO & PPO	$15.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.52
Rate for Payer: Home State Health Plan Medicare Advantage	$15.08
Rate for Payer: Humana Commercial	$30.16
Rate for Payer: Humana Medicare Advantage	$15.08
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$116.64

VITAMIN B2

Facility

$272.00

Service Code	CPT 84252
Hospital Charge Code	2284252
Hospital Revenue Code	301
Rate for Payer: Cash Price	$244.80

VITAMIN B2

Facility

$272.00

Service Code	CPT 84252
Hospital Charge Code	2284252
Hospital Revenue Code	301
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$194.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.22
Rate for Payer: Aetna Medicare Advantage	$20.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$161.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$194.21
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cigna Commercial HMO & PPO	$20.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19.50
Rate for Payer: Home State Health Plan Medicare Advantage	$20.24
Rate for Payer: Humana Commercial	$40.48
Rate for Payer: Humana Medicare Advantage	$20.24
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.92

VITAMIN B5

Facility

$493.00

Service Code	CPT 84591
Hospital Charge Code	228591
Hospital Revenue Code	301
Rate for Payer: Cash Price	$443.70

VITAMIN B5

Facility

$493.00

Service Code	CPT 84591
Hospital Charge Code	228591
Hospital Revenue Code	301
Min. Negotiated Rate	$15.35
Max. Negotiated Rate	$352.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.35
Rate for Payer: Aetna Medicare Advantage	$17.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$291.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$352.00
Rate for Payer: Cash Price	$443.70
Rate for Payer: Cash Price	$443.70
Rate for Payer: Cash Price	$443.70
Rate for Payer: Cigna Commercial HMO & PPO	$17.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.42
Rate for Payer: Home State Health Plan Medicare Advantage	$17.06
Rate for Payer: Humana Commercial	$34.12
Rate for Payer: Humana Medicare Advantage	$17.06
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$177.48

Know your out-of-pocket cost for care.

All Charges