Madison Medical Center

All Charges

Charge

Type

Setting

Price

DISLOCATION/MANIPULATIO/ANESTHESIA

Professional

Both

$2,618.00

Service Code	CPT 23655
Hospital Charge Code	1823655
Hospital Revenue Code	981
Min. Negotiated Rate	$311.64
Max. Negotiated Rate	$916.30
Rate for Payer: Aetna Commercial/Medicare Advantage	$386.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$311.64
Rate for Payer: Cash Price	$2,356.20
Rate for Payer: Cash Price	$2,356.20
Rate for Payer: Cigna Commercial HMO & PPO	$386.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$311.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$342.80
Rate for Payer: Home State Health Plan Medicare Advantage	$386.25
Rate for Payer: Optum Medicare Advantage	$916.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$311.64

DISLOCATION REPAIR

Professional

Both

$3,559.00

Service Code	CPT 25605
Hospital Charge Code	1825605
Hospital Revenue Code	981
Min. Negotiated Rate	$412.16
Max. Negotiated Rate	$1,245.65
Rate for Payer: Aetna Commercial/Medicare Advantage	$506.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$412.16
Rate for Payer: Cash Price	$3,203.10
Rate for Payer: Cash Price	$3,203.10
Rate for Payer: Cigna Commercial HMO & PPO	$506.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$412.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$453.38
Rate for Payer: Home State Health Plan Medicare Advantage	$506.82
Rate for Payer: Optum Medicare Advantage	$1,245.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$412.16

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$13,936.36

Service Code	APR-DRG 2843
Min. Negotiated Rate	$13,936.36
Max. Negotiated Rate	$13,936.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,936.36
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,936.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,936.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,936.36

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$11,010.29

Service Code	APR-DRG 2842
Min. Negotiated Rate	$11,010.29
Max. Negotiated Rate	$11,010.29
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,010.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,010.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,010.29
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,010.29

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$7,868.65

Service Code	APR-DRG 2841
Min. Negotiated Rate	$7,868.65
Max. Negotiated Rate	$7,868.65
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,868.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,868.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,868.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,868.65

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$29,250.97

Service Code	APR-DRG 2844
Min. Negotiated Rate	$29,250.97
Max. Negotiated Rate	$29,250.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$29,250.97
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29,250.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29,250.97
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29,250.97

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$18,047.20

Service Code	APR-DRG 7583
Min. Negotiated Rate	$18,047.20
Max. Negotiated Rate	$18,047.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$18,047.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18,047.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18,047.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18,047.20

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$60,512.36

Service Code	APR-DRG 7584
Min. Negotiated Rate	$60,512.36
Max. Negotiated Rate	$60,512.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$60,512.36
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$60,512.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$60,512.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$60,512.36

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$17,576.81

Service Code	APR-DRG 7582
Min. Negotiated Rate	$17,576.81
Max. Negotiated Rate	$17,576.81
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,576.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,576.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,576.81
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,576.81

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$15,968.59

Service Code	APR-DRG 7581
Min. Negotiated Rate	$15,968.59
Max. Negotiated Rate	$15,968.59
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,968.59
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,968.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,968.59
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,968.59

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC

Facility

$18,750.84

Service Code	MSDRG 442
Min. Negotiated Rate	$9,375.42
Max. Negotiated Rate	$18,750.84
Rate for Payer: Aetna Medicare Advantage	$9,375.42
Rate for Payer: Cigna Commercial HMO & PPO	$9,375.42
Rate for Payer: Home State Health Plan Medicare Advantage	$9,375.42
Rate for Payer: Humana Commercial	$18,750.84
Rate for Payer: Humana Medicare Advantage	$9,375.42

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC

Facility

$31,765.16

Service Code	MSDRG 441
Min. Negotiated Rate	$15,882.58
Max. Negotiated Rate	$31,765.16
Rate for Payer: Aetna Medicare Advantage	$15,882.58
Rate for Payer: Cigna Commercial HMO & PPO	$15,882.58
Rate for Payer: Home State Health Plan Medicare Advantage	$15,882.58
Rate for Payer: Humana Commercial	$31,765.16
Rate for Payer: Humana Medicare Advantage	$15,882.58

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$14,597.00

Service Code	MSDRG 443
Min. Negotiated Rate	$7,298.50
Max. Negotiated Rate	$14,597.00
Rate for Payer: Aetna Medicare Advantage	$7,298.50
Rate for Payer: Cigna Commercial HMO & PPO	$7,298.50
Rate for Payer: Home State Health Plan Medicare Advantage	$7,298.50
Rate for Payer: Humana Commercial	$14,597.00
Rate for Payer: Humana Medicare Advantage	$7,298.50

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$15,010.62

Service Code	APR-DRG 2823
Min. Negotiated Rate	$15,010.62
Max. Negotiated Rate	$15,010.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,010.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,010.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,010.62
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,010.62

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$8,816.95

Service Code	APR-DRG 2822
Min. Negotiated Rate	$8,816.95
Max. Negotiated Rate	$8,816.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,816.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,816.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,816.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,816.95

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$42,242.65

Service Code	APR-DRG 2824
Min. Negotiated Rate	$42,242.65
Max. Negotiated Rate	$42,242.65
Rate for Payer: Aetna Better Health Medicaid/QHP	$42,242.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$42,242.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$42,242.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$42,242.65

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$6,077.40

Service Code	APR-DRG 2821
Min. Negotiated Rate	$6,077.40
Max. Negotiated Rate	$6,077.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,077.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,077.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,077.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,077.40

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC

Facility

$16,808.76

Service Code	MSDRG 439
Min. Negotiated Rate	$8,404.38
Max. Negotiated Rate	$16,808.76
Rate for Payer: Aetna Medicare Advantage	$8,404.38
Rate for Payer: Cigna Commercial HMO & PPO	$8,404.38
Rate for Payer: Home State Health Plan Medicare Advantage	$8,404.38
Rate for Payer: Humana Commercial	$16,808.76
Rate for Payer: Humana Medicare Advantage	$8,404.38

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC

Facility

$29,173.68

Service Code	MSDRG 438
Min. Negotiated Rate	$14,586.84
Max. Negotiated Rate	$29,173.68
Rate for Payer: Aetna Medicare Advantage	$14,586.84
Rate for Payer: Cigna Commercial HMO & PPO	$14,586.84
Rate for Payer: Home State Health Plan Medicare Advantage	$14,586.84
Rate for Payer: Humana Commercial	$29,173.68
Rate for Payer: Humana Medicare Advantage	$14,586.84

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$13,377.58

Service Code	MSDRG 440
Min. Negotiated Rate	$6,688.79
Max. Negotiated Rate	$13,377.58
Rate for Payer: Aetna Medicare Advantage	$6,688.79
Rate for Payer: Cigna Commercial HMO & PPO	$6,688.79
Rate for Payer: Home State Health Plan Medicare Advantage	$6,688.79
Rate for Payer: Humana Commercial	$13,377.58
Rate for Payer: Humana Medicare Advantage	$6,688.79

DISORDERS OF PERSONALITY AND IMPULSE CONTROL

Facility

$34,468.52

Service Code	MSDRG 883
Min. Negotiated Rate	$17,234.26
Max. Negotiated Rate	$34,468.52
Rate for Payer: Aetna Medicare Advantage	$17,234.26
Rate for Payer: Cigna Commercial HMO & PPO	$17,234.26
Rate for Payer: Home State Health Plan Medicare Advantage	$17,234.26
Rate for Payer: Humana Commercial	$34,468.52
Rate for Payer: Humana Medicare Advantage	$17,234.26

DISORDERS OF THE BILIARY TRACT WITH CC

Facility

$20,771.18

Service Code	MSDRG 445
Min. Negotiated Rate	$10,385.59
Max. Negotiated Rate	$20,771.18
Rate for Payer: Aetna Medicare Advantage	$10,385.59
Rate for Payer: Cigna Commercial HMO & PPO	$10,385.59
Rate for Payer: Home State Health Plan Medicare Advantage	$10,385.59
Rate for Payer: Humana Commercial	$20,771.18
Rate for Payer: Humana Medicare Advantage	$10,385.59

DISORDERS OF THE BILIARY TRACT WITH MCC

Facility

$29,814.86

Service Code	MSDRG 444
Min. Negotiated Rate	$14,907.43
Max. Negotiated Rate	$29,814.86
Rate for Payer: Aetna Medicare Advantage	$14,907.43
Rate for Payer: Cigna Commercial HMO & PPO	$14,907.43
Rate for Payer: Home State Health Plan Medicare Advantage	$14,907.43
Rate for Payer: Humana Commercial	$29,814.86
Rate for Payer: Humana Medicare Advantage	$14,907.43

DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC

Facility

$16,591.24

Service Code	MSDRG 446
Min. Negotiated Rate	$8,295.62
Max. Negotiated Rate	$16,591.24
Rate for Payer: Aetna Medicare Advantage	$8,295.62
Rate for Payer: Cigna Commercial HMO & PPO	$8,295.62
Rate for Payer: Home State Health Plan Medicare Advantage	$8,295.62
Rate for Payer: Humana Commercial	$16,591.24
Rate for Payer: Humana Medicare Advantage	$8,295.62

DISP. BOVIE TIP CHO5

Facility

$42.00

Hospital Charge Code	282221
Hospital Revenue Code	271
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

Know your out-of-pocket cost for care.

All Charges