Madison Medical Center

All Charges

Charge

Type

Setting

Price

COMPREHENSIVE OB W/VAG DEL

Facility

$2,207.00

Service Code	CPT 59400
Hospital Charge Code	4259400
Rate for Payer: Cash Price	$1,986.30

COMPRESSION SCREW

Facility

$142.00

Hospital Charge Code	283303
Hospital Revenue Code	271
Rate for Payer: Cash Price	$127.80

COMPRESSION SCREW

Facility

$142.00

Hospital Charge Code	283303
Hospital Revenue Code	271
Min. Negotiated Rate	$51.12
Max. Negotiated Rate	$101.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$84.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$101.39
Rate for Payer: Cash Price	$127.80
Rate for Payer: UnitedHealthcare Commercial	$94.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.12

CONCENTRATOR-OXYGEN/NH MONTHLY

Facility

$240.00

Hospital Charge Code	4500232
Hospital Revenue Code	272
Rate for Payer: Cash Price	$216.00

CONCENTRATOR-OXYGEN/NH MONTHLY

Facility

$240.00

Hospital Charge Code	4500232
Hospital Revenue Code	272
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$171.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$142.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$171.36
Rate for Payer: Cash Price	$216.00
Rate for Payer: UnitedHealthcare Commercial	$160.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$86.40

CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES

Facility

$175,757.14

Service Code	MSDRG 212
Min. Negotiated Rate	$87,878.57
Max. Negotiated Rate	$175,757.14
Rate for Payer: Aetna Medicare Advantage	$87,878.57
Rate for Payer: Cigna Commercial HMO & PPO	$87,878.57
Rate for Payer: Home State Health Plan Medicare Advantage	$87,878.57
Rate for Payer: Humana Commercial	$175,757.14
Rate for Payer: Humana Medicare Advantage	$87,878.57

CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION

Facility

$109,280.38

Service Code	MSDRG 317
Min. Negotiated Rate	$54,640.19
Max. Negotiated Rate	$109,280.38
Rate for Payer: Aetna Medicare Advantage	$54,640.19
Rate for Payer: Cigna Commercial HMO & PPO	$54,640.19
Rate for Payer: Home State Health Plan Medicare Advantage	$54,640.19
Rate for Payer: Humana Commercial	$109,280.38
Rate for Payer: Humana Medicare Advantage	$54,640.19

CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA

Facility

$5,702.43

Service Code	APR-DRG 0572
Min. Negotiated Rate	$5,702.43
Max. Negotiated Rate	$5,702.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,702.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,702.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,702.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,702.43

CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA

Facility

$3,391.14

Service Code	APR-DRG 0571
Min. Negotiated Rate	$3,391.14
Max. Negotiated Rate	$3,391.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$3,391.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3,391.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,391.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3,391.14

CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA

Facility

$23,014.98

Service Code	APR-DRG 0574
Min. Negotiated Rate	$23,014.98
Max. Negotiated Rate	$23,014.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,014.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,014.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,014.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,014.98

CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA

Facility

$12,663.14

Service Code	APR-DRG 0573
Min. Negotiated Rate	$12,663.14
Max. Negotiated Rate	$12,663.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,663.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,663.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,663.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,663.14

CONCUSSION WITH CC

Facility

$20,836.92

Service Code	MSDRG 089
Min. Negotiated Rate	$10,418.46
Max. Negotiated Rate	$20,836.92
Rate for Payer: Aetna Medicare Advantage	$10,418.46
Rate for Payer: Cigna Commercial HMO & PPO	$10,418.46
Rate for Payer: Home State Health Plan Medicare Advantage	$10,418.46
Rate for Payer: Humana Commercial	$20,836.92
Rate for Payer: Humana Medicare Advantage	$10,418.46

CONCUSSION WITH MCC

Facility

$24,799.40

Service Code	MSDRG 088
Min. Negotiated Rate	$12,399.70
Max. Negotiated Rate	$24,799.40
Rate for Payer: Aetna Medicare Advantage	$12,399.70
Rate for Payer: Cigna Commercial HMO & PPO	$12,399.70
Rate for Payer: Home State Health Plan Medicare Advantage	$12,399.70
Rate for Payer: Humana Commercial	$24,799.40
Rate for Payer: Humana Medicare Advantage	$12,399.70

CONCUSSION WITHOUT CC/MCC

Facility

$16,527.08

Service Code	MSDRG 090
Min. Negotiated Rate	$8,263.54
Max. Negotiated Rate	$16,527.08
Rate for Payer: Aetna Medicare Advantage	$8,263.54
Rate for Payer: Cigna Commercial HMO & PPO	$8,263.54
Rate for Payer: Home State Health Plan Medicare Advantage	$8,263.54
Rate for Payer: Humana Commercial	$16,527.08
Rate for Payer: Humana Medicare Advantage	$8,263.54

CON EPIDURAL ANES TR

Facility

$326.00

Hospital Charge Code	285270
Hospital Revenue Code	271
Rate for Payer: Cash Price	$293.40

CON EPIDURAL ANES TR

Facility

$326.00

Hospital Charge Code	285270
Hospital Revenue Code	271
Min. Negotiated Rate	$117.36
Max. Negotiated Rate	$232.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$192.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$232.76
Rate for Payer: Cash Price	$293.40
Rate for Payer: UnitedHealthcare Commercial	$217.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$117.36

CONNECTIVE TISSUE DISORDERS

Facility

$23,991.07

Service Code	APR-DRG 3463
Min. Negotiated Rate	$23,991.07
Max. Negotiated Rate	$23,991.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,991.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,991.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,991.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,991.07

CONNECTIVE TISSUE DISORDERS

Facility

$39,965.75

Service Code	APR-DRG 3464
Min. Negotiated Rate	$39,965.75
Max. Negotiated Rate	$39,965.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$39,965.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$39,965.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$39,965.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$39,965.75

CONNECTIVE TISSUE DISORDERS

Facility

$8,837.54

Service Code	APR-DRG 3461
Min. Negotiated Rate	$8,837.54
Max. Negotiated Rate	$8,837.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,837.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,837.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,837.54
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,837.54

CONNECTIVE TISSUE DISORDERS

Facility

$13,751.06

Service Code	APR-DRG 3462
Min. Negotiated Rate	$13,751.06
Max. Negotiated Rate	$13,751.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,751.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,751.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,751.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,751.06

CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$21,694.50

Service Code	MSDRG 546
Min. Negotiated Rate	$10,847.25
Max. Negotiated Rate	$21,694.50
Rate for Payer: Aetna Medicare Advantage	$10,847.25
Rate for Payer: Cigna Commercial HMO & PPO	$10,847.25
Rate for Payer: Home State Health Plan Medicare Advantage	$10,847.25
Rate for Payer: Humana Commercial	$21,694.50
Rate for Payer: Humana Medicare Advantage	$10,847.25

CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$42,589.68

Service Code	MSDRG 545
Min. Negotiated Rate	$21,294.84
Max. Negotiated Rate	$42,589.68
Rate for Payer: Aetna Medicare Advantage	$21,294.84
Rate for Payer: Cigna Commercial HMO & PPO	$21,294.84
Rate for Payer: Home State Health Plan Medicare Advantage	$21,294.84
Rate for Payer: Humana Commercial	$42,589.68
Rate for Payer: Humana Medicare Advantage	$21,294.84

CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$16,730.52

Service Code	MSDRG 547
Min. Negotiated Rate	$8,365.26
Max. Negotiated Rate	$16,730.52
Rate for Payer: Aetna Medicare Advantage	$8,365.26
Rate for Payer: Cigna Commercial HMO & PPO	$8,365.26
Rate for Payer: Home State Health Plan Medicare Advantage	$8,365.26
Rate for Payer: Humana Commercial	$16,730.52
Rate for Payer: Humana Medicare Advantage	$8,365.26

CONNECTOR LUERLOCK

Facility

$28.00

Hospital Charge Code	283720
Hospital Revenue Code	271
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

CONNECTOR LUERLOCK

Facility

$28.00

Hospital Charge Code	283720
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

Know your out-of-pocket cost for care.

All Charges