Madison Medical Center

All Charges

Charge

Type

Setting

Price

ADMIT/DISCHARGE SAME DAY

Facility

$353.00

Service Code	CPT 99234
Hospital Charge Code	4199234
Hospital Revenue Code	521
Rate for Payer: Cash Price	$317.70

ADMIT/DISCHARGE SAME DAY BRIEF

Facility

$355.00

Service Code	CPT 99234
Hospital Charge Code	9899234
Rate for Payer: Cash Price	$319.50

ADMIT/DISCHARGE SAME DAY EXTENDED

Facility

$605.00

Service Code	CPT 99236
Hospital Charge Code	9799236
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$431.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$358.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$431.97
Rate for Payer: Cash Price	$544.50
Rate for Payer: Cash Price	$544.50
Rate for Payer: UnitedHealthcare Commercial	$403.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ADMIT/DISCHARGE SAME DAY EXTENDED

Facility

$605.00

Service Code	CPT 99236
Hospital Charge Code	9799236
Hospital Revenue Code	525
Rate for Payer: Cash Price	$544.50

ADMIT/DISCHARGE SAME DAY EXTENDED

Facility

$605.00

Service Code	CPT 99236
Hospital Charge Code	9899236
Rate for Payer: Cash Price	$544.50

ADMIT/DISCHARGE SAME DAY EXTENDED

Professional

Both

$267.00

Service Code	CPT 99236
Hospital Charge Code	41992536
Hospital Revenue Code	975
Min. Negotiated Rate	$93.45
Max. Negotiated Rate	$191.06
Rate for Payer: Aetna Commercial/Medicare Advantage	$184.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$173.69
Rate for Payer: Cash Price	$240.30
Rate for Payer: Cash Price	$240.30
Rate for Payer: Cigna Commercial HMO & PPO	$184.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$173.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$191.06
Rate for Payer: Home State Health Plan Medicare Advantage	$184.70
Rate for Payer: Optum Medicare Advantage	$93.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$173.69

ADMIT/DISCHARGE SAME DAY INTERMEDIATE

Facility

$470.00

Service Code	CPT 99235
Hospital Charge Code	9899235
Rate for Payer: Cash Price	$423.00

ADMIT/DISCHARGE SAME DAY MODERATE SEVERI

Facility

$465.00

Service Code	CPT 99235
Hospital Charge Code	9499235
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$332.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$275.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$332.01
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: UnitedHealthcare Commercial	$310.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ADMIT/DISCHARGE SAME DAY MODERATE SEVERI

Facility

$465.00

Service Code	CPT 99235
Hospital Charge Code	9499235
Hospital Revenue Code	525
Rate for Payer: Cash Price	$418.50

ADMIT, INPAT (HOSP)

Professional

Both

$355.00

Service Code	CPT 99234
Hospital Charge Code	5299234
Hospital Revenue Code	987
Min. Negotiated Rate	$85.90
Max. Negotiated Rate	$124.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$85.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$106.90
Rate for Payer: Cash Price	$319.50
Rate for Payer: Cash Price	$319.50
Rate for Payer: Cigna Commercial HMO & PPO	$85.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$106.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$117.59
Rate for Payer: Home State Health Plan Medicare Advantage	$85.90
Rate for Payer: Optum Medicare Advantage	$124.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$106.90

ADMIT, INPAT INTER

Professional

Both

$470.00

Service Code	CPT 99235
Hospital Charge Code	5299235
Hospital Revenue Code	987
Min. Negotiated Rate	$135.64
Max. Negotiated Rate	$164.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$139.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$135.64
Rate for Payer: Cash Price	$423.00
Rate for Payer: Cash Price	$423.00
Rate for Payer: Cigna Commercial HMO & PPO	$139.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$135.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$149.20
Rate for Payer: Home State Health Plan Medicare Advantage	$139.10
Rate for Payer: Optum Medicare Advantage	$164.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$135.64

ADMIT SAME DAY EXT

Professional

Both

$605.00

Service Code	CPT 99236
Hospital Charge Code	5299236
Hospital Revenue Code	987
Min. Negotiated Rate	$173.69
Max. Negotiated Rate	$211.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$184.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$173.69
Rate for Payer: Cash Price	$544.50
Rate for Payer: Cash Price	$544.50
Rate for Payer: Cigna Commercial HMO & PPO	$184.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$173.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$191.06
Rate for Payer: Home State Health Plan Medicare Advantage	$184.70
Rate for Payer: Optum Medicare Advantage	$211.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$173.69

ADM PNEUMO VAC

Facility

$8.00

Service Code	CPT G0009
Hospital Charge Code	5200009
Hospital Revenue Code	521
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Medicare Advantage	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.71
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial HMO & PPO	$47.84
Rate for Payer: Home State Health Plan Medicare Advantage	$47.84
Rate for Payer: Humana Commercial	$95.68
Rate for Payer: Humana Medicare Advantage	$47.84
Rate for Payer: UnitedHealthcare Commercial	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ADM PNEUMO VAC

Facility

$8.00

Service Code	CPT G0009
Hospital Charge Code	5200009
Hospital Revenue Code	521
Rate for Payer: Cash Price	$7.20

ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC

Facility

$38,021.00

Service Code	MSDRG 614
Min. Negotiated Rate	$19,010.50
Max. Negotiated Rate	$38,021.00
Rate for Payer: Aetna Medicare Advantage	$19,010.50
Rate for Payer: Cigna Commercial HMO & PPO	$19,010.50
Rate for Payer: Home State Health Plan Medicare Advantage	$19,010.50
Rate for Payer: Humana Commercial	$38,021.00
Rate for Payer: Humana Medicare Advantage	$19,010.50

ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC

Facility

$25,544.54

Service Code	MSDRG 615
Min. Negotiated Rate	$12,772.27
Max. Negotiated Rate	$25,544.54
Rate for Payer: Aetna Medicare Advantage	$12,772.27
Rate for Payer: Cigna Commercial HMO & PPO	$12,772.27
Rate for Payer: Home State Health Plan Medicare Advantage	$12,772.27
Rate for Payer: Humana Commercial	$25,544.54
Rate for Payer: Humana Medicare Advantage	$12,772.27

ADRENAL PROCEDURES

Facility

$33,326.14

Service Code	APR-DRG 4013
Min. Negotiated Rate	$33,326.14
Max. Negotiated Rate	$33,326.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$33,326.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33,326.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33,326.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33,326.14

ADRENAL PROCEDURES

Facility

$19,103.34

Service Code	APR-DRG 4012
Min. Negotiated Rate	$19,103.34
Max. Negotiated Rate	$19,103.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,103.34
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,103.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,103.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,103.34

ADRENAL PROCEDURES

Facility

$5,303.97

Service Code	APR-DRG 4011
Min. Negotiated Rate	$5,303.97
Max. Negotiated Rate	$5,303.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,303.97
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,303.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,303.97
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,303.97

ADRENAL PROCEDURES

Facility

$62,669.44

Service Code	APR-DRG 4014
Min. Negotiated Rate	$62,669.44
Max. Negotiated Rate	$62,669.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$62,669.44
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$62,669.44
Rate for Payer: Home State Health Plan Medicaid Managed Care	$62,669.44
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$62,669.44

ADULT AMBU-BAG #5372

Facility

$135.00

Hospital Charge Code	4500226
Hospital Revenue Code	271
Rate for Payer: Cash Price	$121.50

ADULT AMBU-BAG #5372

Facility

$135.00

Hospital Charge Code	4500226
Hospital Revenue Code	271
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$96.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$48.60

ADULT CO2 DETECTOR

Facility

$91.00

Hospital Charge Code	285250
Hospital Revenue Code	271
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$64.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: UnitedHealthcare Commercial	$60.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

ADULT CO2 DETECTOR

Facility

$91.00

Hospital Charge Code	285250
Hospital Revenue Code	271
Rate for Payer: Cash Price	$81.90

ADULT ET TUBE HOLDER

Facility

$112.00

Hospital Charge Code	2800347
Hospital Revenue Code	271
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$79.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: UnitedHealthcare Commercial	$74.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

Know your out-of-pocket cost for care.

All Charges