Madison Medical Center

All Charges

Charge

Type

Setting

Price

ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$11,933.16

Service Code	APR-DRG 1931
Min. Negotiated Rate	$11,933.16
Max. Negotiated Rate	$11,933.16
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,933.16
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,933.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,933.16
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,933.16

ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$27,681.36

Service Code	APR-DRG 1934
Min. Negotiated Rate	$27,681.36
Max. Negotiated Rate	$27,681.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,681.36
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,681.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,681.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,681.36

ACUTE AND SUBACUTE ENDOCARDITIS WITH CC

Facility

$30,381.98

Service Code	MSDRG 289
Min. Negotiated Rate	$15,190.99
Max. Negotiated Rate	$30,381.98
Rate for Payer: Aetna Medicare Advantage	$15,190.99
Rate for Payer: Cigna Commercial HMO & PPO	$15,190.99
Rate for Payer: Home State Health Plan Medicare Advantage	$15,190.99
Rate for Payer: Humana Commercial	$30,381.98
Rate for Payer: Humana Medicare Advantage	$15,190.99

ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC

Facility

$46,139.34

Service Code	MSDRG 288
Min. Negotiated Rate	$23,069.67
Max. Negotiated Rate	$46,139.34
Rate for Payer: Aetna Medicare Advantage	$23,069.67
Rate for Payer: Cigna Commercial HMO & PPO	$23,069.67
Rate for Payer: Home State Health Plan Medicare Advantage	$23,069.67
Rate for Payer: Humana Commercial	$46,139.34
Rate for Payer: Humana Medicare Advantage	$23,069.67

ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC

Facility

$18,193.72

Service Code	MSDRG 290
Min. Negotiated Rate	$9,096.86
Max. Negotiated Rate	$18,193.72
Rate for Payer: Aetna Medicare Advantage	$9,096.86
Rate for Payer: Cigna Commercial HMO & PPO	$9,096.86
Rate for Payer: Home State Health Plan Medicare Advantage	$9,096.86
Rate for Payer: Humana Commercial	$18,193.72
Rate for Payer: Humana Medicare Advantage	$9,096.86

ACUTE ANXIETY AND STRESS SYNDROMES

Facility

$29,157.41

Service Code	APR-DRG 7564
Min. Negotiated Rate	$29,157.41
Max. Negotiated Rate	$29,157.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$29,157.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29,157.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29,157.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29,157.41

ACUTE ANXIETY AND STRESS SYNDROMES

Facility

$20,647.69

Service Code	APR-DRG 7563
Min. Negotiated Rate	$20,647.69
Max. Negotiated Rate	$20,647.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,647.69
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,647.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,647.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,647.69

ACUTE ANXIETY AND STRESS SYNDROMES

Facility

$12,050.99

Service Code	APR-DRG 7562
Min. Negotiated Rate	$12,050.99
Max. Negotiated Rate	$12,050.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,050.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,050.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,050.99
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,050.99

ACUTE ANXIETY AND STRESS SYNDROMES

Facility

$9,122.12

Service Code	APR-DRG 7561
Min. Negotiated Rate	$9,122.12
Max. Negotiated Rate	$9,122.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,122.12
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,122.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,122.12
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,122.12

ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$17,143.40

Service Code	APR-DRG 1454
Min. Negotiated Rate	$17,143.40
Max. Negotiated Rate	$17,143.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,143.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,143.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,143.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,143.40

ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$3,639.42

Service Code	APR-DRG 1451
Min. Negotiated Rate	$3,639.42
Max. Negotiated Rate	$3,639.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$3,639.42
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3,639.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,639.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3,639.42

ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$6,619.98

Service Code	APR-DRG 1452
Min. Negotiated Rate	$6,619.98
Max. Negotiated Rate	$6,619.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,619.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,619.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,619.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,619.98

ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$12,327.99

Service Code	APR-DRG 1453
Min. Negotiated Rate	$12,327.99
Max. Negotiated Rate	$12,327.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,327.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,327.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,327.99
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,327.99

ACUTE CARE INIT. (BRIEF)

Professional

Both

$270.00

Service Code	CPT 99221
Hospital Charge Code	4499221
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

ACUTE CARE INIT. (INTER)

Professional

Both

$500.00

Service Code	CPT 99223
Hospital Charge Code	4499223
Hospital Revenue Code	987
Min. Negotiated Rate	$151.92
Max. Negotiated Rate	$178.83
Rate for Payer: Aetna Commercial/Medicare Advantage	$151.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$162.57
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cigna Commercial HMO & PPO	$151.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$178.83
Rate for Payer: Home State Health Plan Medicare Advantage	$151.92
Rate for Payer: Optum Medicare Advantage	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$162.57

ACUTE CARE INIT. (LIMITED)

Professional

Both

$380.00

Service Code	CPT 99222
Hospital Charge Code	4499222
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

ACUTE CARE INIT. (LIMITED)

Professional

Both

$203.00

Service Code	CPT 99222
Hospital Charge Code	9599222
Hospital Revenue Code	987
Min. Negotiated Rate	$71.05
Max. Negotiated Rate	$121.95
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	$182.70
Rate for Payer: Cash Price	$182.70
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	$71.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$110.86

ACUTE KIDNEY INJURY

Facility

$8,087.86

Service Code	APR-DRG 4692
Min. Negotiated Rate	$8,087.86
Max. Negotiated Rate	$8,087.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,087.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,087.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,087.86
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,087.86

ACUTE KIDNEY INJURY

Facility

$5,126.67

Service Code	APR-DRG 4691
Min. Negotiated Rate	$5,126.67
Max. Negotiated Rate	$5,126.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,126.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,126.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,126.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,126.67

ACUTE KIDNEY INJURY

Facility

$15,943.18

Service Code	APR-DRG 4693
Min. Negotiated Rate	$15,943.18
Max. Negotiated Rate	$15,943.18
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,943.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,943.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,943.18
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,943.18

ACUTE KIDNEY INJURY

Facility

$40,582.21

Service Code	APR-DRG 4694
Min. Negotiated Rate	$40,582.21
Max. Negotiated Rate	$40,582.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$40,582.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$40,582.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$40,582.21
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$40,582.21

ACUTE LEUKEMIA

Facility

$13,426.79

Service Code	APR-DRG 6901
Min. Negotiated Rate	$13,426.79
Max. Negotiated Rate	$13,426.79
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,426.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,426.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,426.79
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,426.79

ACUTE LEUKEMIA

Facility

$32,507.94

Service Code	APR-DRG 6902
Min. Negotiated Rate	$32,507.94
Max. Negotiated Rate	$32,507.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$32,507.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$32,507.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32,507.94
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$32,507.94

ACUTE LEUKEMIA

Facility

$80,718.83

Service Code	APR-DRG 6904
Min. Negotiated Rate	$80,718.83
Max. Negotiated Rate	$80,718.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$80,718.83
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$80,718.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$80,718.83
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$80,718.83

ACUTE LEUKEMIA

Facility

$55,218.75

Service Code	APR-DRG 6903
Min. Negotiated Rate	$55,218.75
Max. Negotiated Rate	$55,218.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$55,218.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55,218.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$55,218.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55,218.75

Know your out-of-pocket cost for care.

All Charges