Madison Medical Center

All Charges

Charge

Type

Setting

Price

CONVENIENCE BAGS

Facility

$16.00

Hospital Charge Code	285339
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

CONVERTER

Facility

$62.00

Hospital Charge Code	283324
Hospital Revenue Code	271
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$44.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: UnitedHealthcare Commercial	$41.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

CONVERTER

Facility

$62.00

Hospital Charge Code	283324
Hospital Revenue Code	271
Rate for Payer: Cash Price	$55.80

COOMBS INDIRECT

Facility

$129.00

Service Code	CPT 86885
Hospital Charge Code	2286885
Hospital Revenue Code	305
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$164.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$153.58
Rate for Payer: Aetna Medicare Advantage	$5.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cigna Commercial HMO & PPO	$5.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$153.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$164.33
Rate for Payer: Home State Health Plan Medicare Advantage	$5.72
Rate for Payer: Humana Commercial	$11.44
Rate for Payer: Humana Medicare Advantage	$5.72
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$153.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

COOMBS INDIRECT

Facility

$129.00

Service Code	CPT 86885
Hospital Charge Code	2286885
Hospital Revenue Code	305
Rate for Payer: Cash Price	$116.10

COPEPTIN

Facility

$412.00

Service Code	CPT 84588
Hospital Charge Code	2220113
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$294.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$30.55
Rate for Payer: Aetna Medicare Advantage	$33.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$243.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$294.17
Rate for Payer: Cash Price	$370.80
Rate for Payer: Cash Price	$370.80
Rate for Payer: Cash Price	$370.80
Rate for Payer: Cigna Commercial HMO & PPO	$33.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32.69
Rate for Payer: Home State Health Plan Medicare Advantage	$33.94
Rate for Payer: Humana Commercial	$67.88
Rate for Payer: Humana Medicare Advantage	$33.94
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$30.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$148.32

COPEPTIN

Facility

$412.00

Service Code	CPT 84588
Hospital Charge Code	2220113
Hospital Revenue Code	301
Rate for Payer: Cash Price	$370.80

COPPER

Facility

$65.00

Service Code	CPT 82525
Hospital Charge Code	223175
Hospital Revenue Code	301
Min. Negotiated Rate	$11.17
Max. Negotiated Rate	$46.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.17
Rate for Payer: Aetna Medicare Advantage	$12.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial HMO & PPO	$12.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.95
Rate for Payer: Home State Health Plan Medicare Advantage	$12.41
Rate for Payer: Humana Commercial	$24.82
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

COPPER

Facility

$65.00

Service Code	CPT 82525
Hospital Charge Code	223175
Hospital Revenue Code	301
Rate for Payer: Cash Price	$58.50

COPPER URINE

Facility

$65.00

Service Code	CPT 82525
Hospital Charge Code	2282525
Hospital Revenue Code	301
Min. Negotiated Rate	$11.17
Max. Negotiated Rate	$46.41
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.17
Rate for Payer: Aetna Medicare Advantage	$12.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial HMO & PPO	$12.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.95
Rate for Payer: Home State Health Plan Medicare Advantage	$12.41
Rate for Payer: Humana Commercial	$24.82
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

COPPER URINE

Facility

$65.00

Service Code	CPT 82525
Hospital Charge Code	2282525
Hospital Revenue Code	301
Rate for Payer: Cash Price	$58.50

CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$41,066.21

Service Code	APR-DRG 1651
Min. Negotiated Rate	$41,066.21
Max. Negotiated Rate	$41,066.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$41,066.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$41,066.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$41,066.21
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$41,066.21

CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$51,567.82

Service Code	APR-DRG 1653
Min. Negotiated Rate	$51,567.82
Max. Negotiated Rate	$51,567.82
Rate for Payer: Aetna Better Health Medicaid/QHP	$51,567.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$51,567.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$51,567.82
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$51,567.82

CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$41,066.21

Service Code	APR-DRG 1652
Min. Negotiated Rate	$41,066.21
Max. Negotiated Rate	$41,066.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$41,066.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$41,066.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$41,066.21
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$41,066.21

CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$80,312.04

Service Code	APR-DRG 1654
Min. Negotiated Rate	$80,312.04
Max. Negotiated Rate	$80,312.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$80,312.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$80,312.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$80,312.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$80,312.04

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC

Facility

$124,499.40

Service Code	MSDRG 233
Min. Negotiated Rate	$62,249.70
Max. Negotiated Rate	$124,499.40
Rate for Payer: Aetna Medicare Advantage	$62,249.70
Rate for Payer: Cigna Commercial HMO & PPO	$62,249.70
Rate for Payer: Home State Health Plan Medicare Advantage	$62,249.70
Rate for Payer: Humana Commercial	$124,499.40
Rate for Payer: Humana Medicare Advantage	$62,249.70

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC

Facility

$89,852.96

Service Code	MSDRG 234
Min. Negotiated Rate	$44,926.48
Max. Negotiated Rate	$89,852.96
Rate for Payer: Aetna Medicare Advantage	$44,926.48
Rate for Payer: Cigna Commercial HMO & PPO	$44,926.48
Rate for Payer: Home State Health Plan Medicare Advantage	$44,926.48
Rate for Payer: Humana Commercial	$89,852.96
Rate for Payer: Humana Medicare Advantage	$44,926.48

CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$27,740.19

Service Code	APR-DRG 1661
Min. Negotiated Rate	$27,740.19
Max. Negotiated Rate	$27,740.19
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,740.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,740.19
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,740.19
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,740.19

CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$71,149.13

Service Code	APR-DRG 1664
Min. Negotiated Rate	$71,149.13
Max. Negotiated Rate	$71,149.13
Rate for Payer: Aetna Better Health Medicaid/QHP	$71,149.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$71,149.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$71,149.13
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$71,149.13

CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$32,885.14

Service Code	APR-DRG 1662
Min. Negotiated Rate	$32,885.14
Max. Negotiated Rate	$32,885.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$32,885.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$32,885.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32,885.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$32,885.14

CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$50,619.26

Service Code	APR-DRG 1663
Min. Negotiated Rate	$50,619.26
Max. Negotiated Rate	$50,619.26
Rate for Payer: Aetna Better Health Medicaid/QHP	$50,619.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$50,619.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$50,619.26
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$50,619.26

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$96,296.48

Service Code	MSDRG 235
Min. Negotiated Rate	$48,148.24
Max. Negotiated Rate	$96,296.48
Rate for Payer: Aetna Medicare Advantage	$48,148.24
Rate for Payer: Cigna Commercial HMO & PPO	$48,148.24
Rate for Payer: Home State Health Plan Medicare Advantage	$48,148.24
Rate for Payer: Humana Commercial	$96,296.48
Rate for Payer: Humana Medicare Advantage	$48,148.24

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$69,630.20

Service Code	MSDRG 236
Min. Negotiated Rate	$34,815.10
Max. Negotiated Rate	$69,630.20
Rate for Payer: Aetna Medicare Advantage	$34,815.10
Rate for Payer: Cigna Commercial HMO & PPO	$34,815.10
Rate for Payer: Home State Health Plan Medicare Advantage	$34,815.10
Rate for Payer: Humana Commercial	$69,630.20
Rate for Payer: Humana Medicare Advantage	$34,815.10

CORONARY BYPASS WITH PTCA WITH MCC

Facility

$136,956.26

Service Code	MSDRG 231
Min. Negotiated Rate	$68,478.13
Max. Negotiated Rate	$136,956.26
Rate for Payer: Aetna Medicare Advantage	$68,478.13
Rate for Payer: Cigna Commercial HMO & PPO	$68,478.13
Rate for Payer: Home State Health Plan Medicare Advantage	$68,478.13
Rate for Payer: Humana Commercial	$136,956.26
Rate for Payer: Humana Medicare Advantage	$68,478.13

CORONARY BYPASS WITH PTCA WITHOUT MCC

Facility

$99,376.16

Service Code	MSDRG 232
Min. Negotiated Rate	$49,688.08
Max. Negotiated Rate	$99,376.16
Rate for Payer: Aetna Medicare Advantage	$49,688.08
Rate for Payer: Cigna Commercial HMO & PPO	$49,688.08
Rate for Payer: Home State Health Plan Medicare Advantage	$49,688.08
Rate for Payer: Humana Commercial	$99,376.16
Rate for Payer: Humana Medicare Advantage	$49,688.08

Know your out-of-pocket cost for care.

All Charges