Madison Medical Center

All Charges

Charge

Type

Setting

Price

EXTERNAL DSUL

Facility

$151.00

Service Code	CPT 94669
Hospital Charge Code	4501000
Hospital Revenue Code	412
Rate for Payer: Cash Price	$135.90

EXTERNAL HEART ASSIST DEVICES

Facility

$61,741.23

Service Code	APR-DRG 1782
Min. Negotiated Rate	$61,741.23
Max. Negotiated Rate	$61,741.23
Rate for Payer: Aetna Better Health Medicaid/QHP	$61,741.23
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$61,741.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$61,741.23
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$61,741.23

EXTERNAL HEART ASSIST DEVICES

Facility

$90,546.47

Service Code	APR-DRG 1784
Min. Negotiated Rate	$90,546.47
Max. Negotiated Rate	$90,546.47
Rate for Payer: Aetna Better Health Medicaid/QHP	$90,546.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$90,546.47
Rate for Payer: Home State Health Plan Medicaid Managed Care	$90,546.47
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$90,546.47

EXTERNAL HEART ASSIST DEVICES

Facility

$71,796.30

Service Code	APR-DRG 1783
Min. Negotiated Rate	$71,796.30
Max. Negotiated Rate	$71,796.30
Rate for Payer: Aetna Better Health Medicaid/QHP	$71,796.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$71,796.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$71,796.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$71,796.30

EXTERNAL HEART ASSIST DEVICES

Facility

$55,202.10

Service Code	APR-DRG 1781
Min. Negotiated Rate	$55,202.10
Max. Negotiated Rate	$55,202.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$55,202.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55,202.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$55,202.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55,202.10

EXTERNAL MOBILE CARDIO TELEMETRY W/ECG R

Facility

$170.00

Service Code	CPT 93228
Hospital Charge Code	4293228
Hospital Revenue Code	521
Min. Negotiated Rate	$100.64
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$121.38
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: UnitedHealthcare Commercial	$113.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXTERNAL MOBILE CARDIO TELEMETRY W/ECG R

Facility

$170.00

Service Code	CPT 93228
Hospital Charge Code	4293228
Hospital Revenue Code	521
Rate for Payer: Cash Price	$153.00

EXTERNAL PACEMAKER

Facility

$255.00

Service Code	CPT 71090
Hospital Charge Code	3216195
Hospital Revenue Code	320
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$182.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.07
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$91.80

EXTERNAL PACEMAKER

Facility

$255.00

Service Code	CPT 71090
Hospital Charge Code	3216195
Hospital Revenue Code	320
Rate for Payer: Cash Price	$229.50

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$67,641.51

Service Code	APR-DRG 0091
Min. Negotiated Rate	$67,641.51
Max. Negotiated Rate	$67,641.51
Rate for Payer: Aetna Better Health Medicaid/QHP	$67,641.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$67,641.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$67,641.51
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$67,641.51

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$83,602.40

Service Code	APR-DRG 0092
Min. Negotiated Rate	$83,602.40
Max. Negotiated Rate	$83,602.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$83,602.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$83,602.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83,602.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$83,602.40

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$255,718.26

Service Code	APR-DRG 0094
Min. Negotiated Rate	$255,718.26
Max. Negotiated Rate	$255,718.26
Rate for Payer: Aetna Better Health Medicaid/QHP	$255,718.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$255,718.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$255,718.26
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$255,718.26

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$145,682.93

Service Code	APR-DRG 0093
Min. Negotiated Rate	$145,682.93
Max. Negotiated Rate	$145,682.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$145,682.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$145,682.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$145,682.93
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$145,682.93

EXTRACRANIAL PROCEDURES WITH CC

Facility

$29,053.96

Service Code	MSDRG 038
Min. Negotiated Rate	$14,526.98
Max. Negotiated Rate	$29,053.96
Rate for Payer: Aetna Medicare Advantage	$14,526.98
Rate for Payer: Cigna Commercial HMO & PPO	$14,526.98
Rate for Payer: Home State Health Plan Medicare Advantage	$14,526.98
Rate for Payer: Humana Commercial	$29,053.96
Rate for Payer: Humana Medicare Advantage	$14,526.98

EXTRACRANIAL PROCEDURES WITH MCC

Facility

$55,408.34

Service Code	MSDRG 037
Min. Negotiated Rate	$27,704.17
Max. Negotiated Rate	$55,408.34
Rate for Payer: Aetna Medicare Advantage	$27,704.17
Rate for Payer: Cigna Commercial HMO & PPO	$27,704.17
Rate for Payer: Home State Health Plan Medicare Advantage	$27,704.17
Rate for Payer: Humana Commercial	$55,408.34
Rate for Payer: Humana Medicare Advantage	$27,704.17

EXTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$22,040.34

Service Code	MSDRG 039
Min. Negotiated Rate	$11,020.17
Max. Negotiated Rate	$22,040.34
Rate for Payer: Aetna Medicare Advantage	$11,020.17
Rate for Payer: Cigna Commercial HMO & PPO	$11,020.17
Rate for Payer: Home State Health Plan Medicare Advantage	$11,020.17
Rate for Payer: Humana Commercial	$22,040.34
Rate for Payer: Humana Medicare Advantage	$11,020.17

EXTRAOCULAR PROCEDURES EXCEPT ORBIT

Facility

$27,672.34

Service Code	MSDRG 115
Min. Negotiated Rate	$13,836.17
Max. Negotiated Rate	$27,672.34
Rate for Payer: Aetna Medicare Advantage	$13,836.17
Rate for Payer: Cigna Commercial HMO & PPO	$13,836.17
Rate for Payer: Home State Health Plan Medicare Advantage	$13,836.17
Rate for Payer: Humana Commercial	$27,672.34
Rate for Payer: Humana Medicare Advantage	$13,836.17

EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE

Facility

$97,485.48

Service Code	MSDRG 790
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$97,485.48
Rate for Payer: Aetna Medicare Advantage	$48,742.74
Rate for Payer: Cigna Commercial HMO & PPO	$48,742.74
Rate for Payer: Home State Health Plan Medicare Advantage	$48,742.74
Rate for Payer: Humana Commercial	$97,485.48
Rate for Payer: Humana Medicare Advantage	$48,742.74
Rate for Payer: UnitedHealthcare Commercial	$351.00

EXTREMITY SHEET/ UPPER #89271

Facility

$125.00

Hospital Charge Code	1269113
Hospital Revenue Code	271
Rate for Payer: Cash Price	$112.50

EXTREMITY SHEET/ UPPER #89271

Facility

$125.00

Hospital Charge Code	1269113
Hospital Revenue Code	271
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$89.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: UnitedHealthcare Commercial	$83.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

EYE DRAPE #8441

Facility

$28.00

Hospital Charge Code	285365
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

EYE DRAPE #8441

Facility

$28.00

Hospital Charge Code	285365
Hospital Revenue Code	271
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

EYE INFECTIONS AND OTHER EYE DISORDERS

Facility

$6,222.94

Service Code	APR-DRG 0822
Min. Negotiated Rate	$6,222.94
Max. Negotiated Rate	$6,222.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,222.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,222.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,222.94
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,222.94

EYE INFECTIONS AND OTHER EYE DISORDERS

Facility

$19,413.05

Service Code	APR-DRG 0824
Min. Negotiated Rate	$19,413.05
Max. Negotiated Rate	$19,413.05
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,413.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,413.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,413.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,413.05

EYE INFECTIONS AND OTHER EYE DISORDERS

Facility

$11,630.45

Service Code	APR-DRG 0823
Min. Negotiated Rate	$11,630.45
Max. Negotiated Rate	$11,630.45
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,630.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,630.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,630.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,630.45

Know your out-of-pocket cost for care.

All Charges