Madison Medical Center

All Charges

Charge

Type

Setting

Price

EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT

Facility

$64,957.46

Service Code	MSDRG 933
Min. Negotiated Rate	$32,478.73
Max. Negotiated Rate	$64,957.46
Rate for Payer: Aetna Medicare Advantage	$32,478.73
Rate for Payer: Cigna Commercial HMO & PPO	$32,478.73
Rate for Payer: Home State Health Plan Medicare Advantage	$32,478.73
Rate for Payer: Humana Commercial	$64,957.46
Rate for Payer: Humana Medicare Advantage	$32,478.73

EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT

Facility

$342,066.56

Service Code	MSDRG 927
Min. Negotiated Rate	$171,033.28
Max. Negotiated Rate	$342,066.56
Rate for Payer: Aetna Medicare Advantage	$171,033.28
Rate for Payer: Cigna Commercial HMO & PPO	$171,033.28
Rate for Payer: Home State Health Plan Medicare Advantage	$171,033.28
Rate for Payer: Humana Commercial	$342,066.56
Rate for Payer: Humana Medicare Advantage	$171,033.28

EXTENSIVE LYSIS ADHESIONS ABDOMINAL APPR

Professional

Both

$1,744.00

Service Code	CPT 58660
Hospital Charge Code	4158660
Hospital Revenue Code	975
Min. Negotiated Rate	$601.95
Max. Negotiated Rate	$670.46
Rate for Payer: Aetna Commercial/Medicare Advantage	$601.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$609.51
Rate for Payer: Cash Price	$1,569.60
Rate for Payer: Cash Price	$1,569.60
Rate for Payer: Cigna Commercial HMO & PPO	$601.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$609.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$670.46
Rate for Payer: Home State Health Plan Medicare Advantage	$601.95
Rate for Payer: Optum Medicare Advantage	$610.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$609.51

EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$67,638.73

Service Code	APR-DRG 7924
Min. Negotiated Rate	$67,638.73
Max. Negotiated Rate	$67,638.73
Rate for Payer: Aetna Better Health Medicaid/QHP	$67,638.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$67,638.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$67,638.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$67,638.73

EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$32,199.15

Service Code	APR-DRG 7923
Min. Negotiated Rate	$32,199.15
Max. Negotiated Rate	$32,199.15
Rate for Payer: Aetna Better Health Medicaid/QHP	$32,199.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$32,199.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32,199.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$32,199.15

EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$21,994.31

Service Code	APR-DRG 7922
Min. Negotiated Rate	$21,994.31
Max. Negotiated Rate	$21,994.31
Rate for Payer: Aetna Better Health Medicaid/QHP	$21,994.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21,994.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21,994.31
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21,994.31

EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$17,098.98

Service Code	APR-DRG 7921
Min. Negotiated Rate	$17,098.98
Max. Negotiated Rate	$17,098.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,098.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,098.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,098.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,098.98

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$42,223.62

Service Code	MSDRG 982
Min. Negotiated Rate	$21,111.81
Max. Negotiated Rate	$42,223.62
Rate for Payer: Aetna Medicare Advantage	$21,111.81
Rate for Payer: Cigna Commercial HMO & PPO	$21,111.81
Rate for Payer: Home State Health Plan Medicare Advantage	$21,111.81
Rate for Payer: Humana Commercial	$42,223.62
Rate for Payer: Humana Medicare Advantage	$21,111.81

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$77,615.16

Service Code	MSDRG 981
Min. Negotiated Rate	$38,807.58
Max. Negotiated Rate	$77,615.16
Rate for Payer: Aetna Medicare Advantage	$38,807.58
Rate for Payer: Cigna Commercial HMO & PPO	$38,807.58
Rate for Payer: Home State Health Plan Medicare Advantage	$38,807.58
Rate for Payer: Humana Commercial	$77,615.16
Rate for Payer: Humana Medicare Advantage	$38,807.58

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$30,493.84

Service Code	MSDRG 983
Min. Negotiated Rate	$15,246.92
Max. Negotiated Rate	$30,493.84
Rate for Payer: Aetna Medicare Advantage	$15,246.92
Rate for Payer: Cigna Commercial HMO & PPO	$15,246.92
Rate for Payer: Home State Health Plan Medicare Advantage	$15,246.92
Rate for Payer: Humana Commercial	$30,493.84
Rate for Payer: Humana Medicare Advantage	$15,246.92

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$66,880.63

Service Code	APR-DRG 9504
Min. Negotiated Rate	$66,880.63
Max. Negotiated Rate	$66,880.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$66,880.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$66,880.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$66,880.63
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$66,880.63

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$22,676.60

Service Code	APR-DRG 9502
Min. Negotiated Rate	$22,676.60
Max. Negotiated Rate	$22,676.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,676.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,676.60
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,676.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,676.60

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$37,286.78

Service Code	APR-DRG 9503
Min. Negotiated Rate	$37,286.78
Max. Negotiated Rate	$37,286.78
Rate for Payer: Aetna Better Health Medicaid/QHP	$37,286.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$37,286.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37,286.78
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$37,286.78

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$17,027.79

Service Code	APR-DRG 9501
Min. Negotiated Rate	$17,027.79
Max. Negotiated Rate	$17,027.79
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,027.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,027.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,027.79
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,027.79

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$6,253.45

Service Code	APR-DRG 8431
Min. Negotiated Rate	$6,253.45
Max. Negotiated Rate	$6,253.45
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,253.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,253.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,253.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,253.45

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$23,477.24

Service Code	APR-DRG 8434
Min. Negotiated Rate	$23,477.24
Max. Negotiated Rate	$23,477.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,477.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,477.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,477.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,477.24

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$16,172.61

Service Code	APR-DRG 8433
Min. Negotiated Rate	$16,172.61
Max. Negotiated Rate	$16,172.61
Rate for Payer: Aetna Better Health Medicaid/QHP	$16,172.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16,172.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16,172.61
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16,172.61

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$8,218.97

Service Code	APR-DRG 8432
Min. Negotiated Rate	$8,218.97
Max. Negotiated Rate	$8,218.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,218.97
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,218.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,218.97
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,218.97

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$37,788.79

Service Code	APR-DRG 8412
Min. Negotiated Rate	$37,788.79
Max. Negotiated Rate	$37,788.79
Rate for Payer: Aetna Better Health Medicaid/QHP	$37,788.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$37,788.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37,788.79
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$37,788.79

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$72,390.76

Service Code	APR-DRG 8413
Min. Negotiated Rate	$72,390.76
Max. Negotiated Rate	$72,390.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$72,390.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$72,390.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$72,390.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$72,390.76

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$20,785.04

Service Code	APR-DRG 8411
Min. Negotiated Rate	$20,785.04
Max. Negotiated Rate	$20,785.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,785.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,785.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,785.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,785.04

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$239,388.48

Service Code	APR-DRG 8414
Min. Negotiated Rate	$239,388.48
Max. Negotiated Rate	$239,388.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$239,388.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$239,388.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$239,388.48
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$239,388.48

EXTERNAL CATHETER

Facility

$39.00

Hospital Charge Code	285220
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

EXTERNAL CATHETER

Facility

$39.00

Hospital Charge Code	285220
Hospital Revenue Code	271
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

EXTERNAL DSUL

Facility

$151.00

Service Code	CPT 94669
Hospital Charge Code	4501000
Hospital Revenue Code	412
Min. Negotiated Rate	$54.36
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.81
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$100.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.36

Know your out-of-pocket cost for care.

All Charges