Madison Medical Center

All Charges

Charge

Type

Setting

Price

COMP HEALTH PROFILE

Facility

$64.00

Service Code	CPT 80050
Hospital Charge Code	4280050
Hospital Revenue Code	521
Min. Negotiated Rate	$37.89
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$45.70
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$57.60
Rate for Payer: UnitedHealthcare Commercial	$42.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

COMP HEALTH PROFILE

Facility

$64.00

Service Code	CPT 80050
Hospital Charge Code	4280050
Hospital Revenue Code	521
Rate for Payer: Cash Price	$57.60

COMPLEAT FORMULA

Facility

$45.00

Hospital Charge Code	283299
Hospital Revenue Code	271
Rate for Payer: Cash Price	$40.50

COMPLEAT FORMULA

Facility

$45.00

Hospital Charge Code	283299
Hospital Revenue Code	271
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

COMPLEMENT C1

Facility

$245.00

Service Code	CPT 86160
Hospital Charge Code	2283883
Hospital Revenue Code	301
Rate for Payer: Cash Price	$220.50

COMPLEMENT C1

Facility

$245.00

Service Code	CPT 86160
Hospital Charge Code	2283883
Hospital Revenue Code	301
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$174.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.80
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$145.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.93
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cigna Commercial HMO & PPO	$12.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.56
Rate for Payer: Home State Health Plan Medicare Advantage	$12.00
Rate for Payer: Humana Commercial	$24.00
Rate for Payer: Humana Medicare Advantage	$12.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$88.20

COMPLEMENT C3

Facility

$169.00

Service Code	CPT 86160
Hospital Charge Code	223900
Hospital Revenue Code	301
Rate for Payer: Cash Price	$152.10

COMPLEMENT C3

Facility

$169.00

Service Code	CPT 86160
Hospital Charge Code	223900
Hospital Revenue Code	301
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$120.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.80
Rate for Payer: Aetna Medicare Advantage	$12.00
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: Cash Price	$152.10
Rate for Payer: Cash Price	$152.10
Rate for Payer: Cigna Commercial HMO & PPO	$12.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.56
Rate for Payer: Home State Health Plan Medicare Advantage	$12.00
Rate for Payer: Humana Commercial	$24.00
Rate for Payer: Humana Medicare Advantage	$12.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.84

COMPLEMENT C4

Facility

$124.00

Service Code	CPT 86160
Hospital Charge Code	223901
Hospital Revenue Code	301
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$88.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.80
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna Commercial HMO & PPO	$12.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.56
Rate for Payer: Home State Health Plan Medicare Advantage	$12.00
Rate for Payer: Humana Commercial	$24.00
Rate for Payer: Humana Medicare Advantage	$12.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

COMPLEMENT C4

Facility

$124.00

Service Code	CPT 86160
Hospital Charge Code	223901
Hospital Revenue Code	301
Rate for Payer: Cash Price	$111.60

COMPLEX AORTIC ARCH PROCEDURES

Facility

$182,816.60

Service Code	MSDRG 209
Min. Negotiated Rate	$91,408.30
Max. Negotiated Rate	$182,816.60
Rate for Payer: Aetna Medicare Advantage	$91,408.30
Rate for Payer: Cigna Commercial HMO & PPO	$91,408.30
Rate for Payer: Home State Health Plan Medicare Advantage	$91,408.30
Rate for Payer: Humana Commercial	$182,816.60
Rate for Payer: Humana Medicare Advantage	$91,408.30

COMPLEX REPAIR,FACE,NECK,GENITALIA,HANDS

Professional

Both

$1,446.00

Service Code	CPT 13131
Hospital Charge Code	1813131
Hospital Revenue Code	981
Min. Negotiated Rate	$194.30
Max. Negotiated Rate	$506.10
Rate for Payer: Aetna Commercial/Medicare Advantage	$194.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$294.97
Rate for Payer: Cash Price	$1,301.40
Rate for Payer: Cash Price	$1,301.40
Rate for Payer: Cigna Commercial HMO & PPO	$194.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$294.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$324.47
Rate for Payer: Home State Health Plan Medicare Advantage	$194.30
Rate for Payer: Optum Medicare Advantage	$506.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$294.97

COMPLEX REPAIR TRUNK 2.6 CM TO 7.5 CM

Facility

$600.00

Service Code	CPT 13101
Hospital Charge Code	9813101
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,510.16
Rate for Payer: Aetna Better Health Medicaid/QHP	$666.23
Rate for Payer: Aetna Medicare Advantage	$755.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$355.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$428.40
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cigna Commercial HMO & PPO	$755.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$599.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$712.87
Rate for Payer: Home State Health Plan Medicare Advantage	$755.08
Rate for Payer: Humana Commercial	$1,510.16
Rate for Payer: Humana Medicare Advantage	$755.08
Rate for Payer: UnitedHealthcare Commercial	$400.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$666.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

COMPLEX REPAIR TRUNK 2.6 CM TO 7.5 CM

Facility

$600.00

Service Code	CPT 13101
Hospital Charge Code	9813101
Hospital Revenue Code	521
Rate for Payer: Cash Price	$540.00

COMPLICATED PEPTIC ULCER WITH CC

Facility

$20,600.60

Service Code	MSDRG 381
Min. Negotiated Rate	$10,300.30
Max. Negotiated Rate	$20,600.60
Rate for Payer: Aetna Medicare Advantage	$10,300.30
Rate for Payer: Cigna Commercial HMO & PPO	$10,300.30
Rate for Payer: Home State Health Plan Medicare Advantage	$10,300.30
Rate for Payer: Humana Commercial	$20,600.60
Rate for Payer: Humana Medicare Advantage	$10,300.30

COMPLICATED PEPTIC ULCER WITH MCC

Facility

$34,403.92

Service Code	MSDRG 380
Min. Negotiated Rate	$17,201.96
Max. Negotiated Rate	$34,403.92
Rate for Payer: Aetna Medicare Advantage	$17,201.96
Rate for Payer: Cigna Commercial HMO & PPO	$17,201.96
Rate for Payer: Home State Health Plan Medicare Advantage	$17,201.96
Rate for Payer: Humana Commercial	$34,403.92
Rate for Payer: Humana Medicare Advantage	$17,201.96

COMPLICATED PEPTIC ULCER WITHOUT CC/MCC

Facility

$16,173.44

Service Code	MSDRG 382
Min. Negotiated Rate	$8,086.72
Max. Negotiated Rate	$16,173.44
Rate for Payer: Aetna Medicare Advantage	$8,086.72
Rate for Payer: Cigna Commercial HMO & PPO	$8,086.72
Rate for Payer: Home State Health Plan Medicare Advantage	$8,086.72
Rate for Payer: Humana Commercial	$16,173.44
Rate for Payer: Humana Medicare Advantage	$8,086.72

COMPLICATIONS OF TREATMENT WITH CC

Facility

$19,329.88

Service Code	MSDRG 920
Min. Negotiated Rate	$9,664.94
Max. Negotiated Rate	$19,329.88
Rate for Payer: Aetna Medicare Advantage	$9,664.94
Rate for Payer: Cigna Commercial HMO & PPO	$9,664.94
Rate for Payer: Home State Health Plan Medicare Advantage	$9,664.94
Rate for Payer: Humana Commercial	$19,329.88
Rate for Payer: Humana Medicare Advantage	$9,664.94

COMPLICATIONS OF TREATMENT WITH MCC

Facility

$32,333.88

Service Code	MSDRG 919
Min. Negotiated Rate	$16,166.94
Max. Negotiated Rate	$32,333.88
Rate for Payer: Aetna Medicare Advantage	$16,166.94
Rate for Payer: Cigna Commercial HMO & PPO	$16,166.94
Rate for Payer: Home State Health Plan Medicare Advantage	$16,166.94
Rate for Payer: Humana Commercial	$32,333.88
Rate for Payer: Humana Medicare Advantage	$16,166.94

COMPLICATIONS OF TREATMENT WITHOUT CC/MCC

Facility

$14,420.96

Service Code	MSDRG 921
Min. Negotiated Rate	$7,210.48
Max. Negotiated Rate	$14,420.96
Rate for Payer: Aetna Medicare Advantage	$7,210.48
Rate for Payer: Cigna Commercial HMO & PPO	$7,210.48
Rate for Payer: Home State Health Plan Medicare Advantage	$7,210.48
Rate for Payer: Humana Commercial	$14,420.96
Rate for Payer: Humana Medicare Advantage	$7,210.48

COMPREHENSIVE 60 MINUTES

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	5499205
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$346.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$287.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$346.29
Rate for Payer: Cash Price	$436.50
Rate for Payer: Cash Price	$436.50
Rate for Payer: UnitedHealthcare Commercial	$323.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

COMPREHENSIVE 60 MINUTES

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	5499205
Hospital Revenue Code	521
Rate for Payer: Cash Price	$436.50

COMPREHENSIVE OB WITH C/S

Facility

$2,592.00

Service Code	CPT 59510
Hospital Charge Code	4259510
Rate for Payer: Cash Price	$2,332.80

COMPREHENSIVE OB WITH FAILED VBAC

Facility

$2,862.00

Service Code	CPT 59618
Hospital Charge Code	4259618
Rate for Payer: Cash Price	$2,575.80

COMPREHENSIVE OB WITH VBAC

Facility

$2,381.00

Service Code	CPT 59610
Hospital Charge Code	4259610
Rate for Payer: Cash Price	$2,142.90

Know your out-of-pocket cost for care.

All Charges