Madison Medical Center

All Charges

Charge

Type

Setting

Price

GASTRIC FUNDOPLICATION

Facility

$12,878.55

Service Code	APR-DRG 2321
Min. Negotiated Rate	$12,878.55
Max. Negotiated Rate	$12,878.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,878.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,878.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,878.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,878.55

GASTRIC FUNDOPLICATION

Facility

$15,230.53

Service Code	APR-DRG 2322
Min. Negotiated Rate	$15,230.53
Max. Negotiated Rate	$15,230.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,230.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,230.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,230.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,230.53

GASTRIC FUNDOPLICATION

Facility

$24,718.86

Service Code	APR-DRG 2323
Min. Negotiated Rate	$24,718.86
Max. Negotiated Rate	$24,718.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$24,718.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24,718.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24,718.86
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24,718.86

GASTRIC INTUB & ASPIR-POISIONS

Professional

Both

$448.00

Service Code	CPT 43754
Hospital Charge Code	1891105
Hospital Revenue Code	981
Min. Negotiated Rate	$43.61
Max. Negotiated Rate	$193.72
Rate for Payer: Aetna Commercial/Medicare Advantage	$43.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$176.11
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cigna Commercial HMO & PPO	$43.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$176.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.72
Rate for Payer: Home State Health Plan Medicare Advantage	$43.61
Rate for Payer: Optum Medicare Advantage	$156.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$176.11

GASTRIC LAVAGE KIT (VACUUM)

Facility

$294.00

Hospital Charge Code	287393
Hospital Revenue Code	271
Rate for Payer: Cash Price	$264.60

GASTRIC LAVAGE KIT (VACUUM)

Facility

$294.00

Hospital Charge Code	287393
Hospital Revenue Code	271
Min. Negotiated Rate	$105.84
Max. Negotiated Rate	$209.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$174.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$209.92
Rate for Payer: Cash Price	$264.60
Rate for Payer: UnitedHealthcare Commercial	$196.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$105.84

GASTRIN

Facility

$147.00

Service Code	CPT 82941
Hospital Charge Code	227270
Hospital Revenue Code	301
Rate for Payer: Cash Price	$132.30

GASTRIN

Facility

$147.00

Service Code	CPT 82941
Hospital Charge Code	227270
Hospital Revenue Code	301
Min. Negotiated Rate	$15.87
Max. Negotiated Rate	$104.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.87
Rate for Payer: Aetna Medicare Advantage	$17.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$87.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$104.96
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cigna Commercial HMO & PPO	$17.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.98
Rate for Payer: Home State Health Plan Medicare Advantage	$17.63
Rate for Payer: Humana Commercial	$35.26
Rate for Payer: Humana Medicare Advantage	$17.63
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$52.92

GASTROINTESTINAL HEMORRHAGE WITH CC

Facility

$18,991.84

Service Code	MSDRG 378
Min. Negotiated Rate	$9,495.92
Max. Negotiated Rate	$18,991.84
Rate for Payer: Aetna Medicare Advantage	$9,495.92
Rate for Payer: Cigna Commercial HMO & PPO	$9,495.92
Rate for Payer: Home State Health Plan Medicare Advantage	$9,495.92
Rate for Payer: Humana Commercial	$18,991.84
Rate for Payer: Humana Medicare Advantage	$9,495.92

GASTROINTESTINAL HEMORRHAGE WITH MCC

Facility

$32,289.76

Service Code	MSDRG 377
Min. Negotiated Rate	$16,144.88
Max. Negotiated Rate	$32,289.76
Rate for Payer: Aetna Medicare Advantage	$16,144.88
Rate for Payer: Cigna Commercial HMO & PPO	$16,144.88
Rate for Payer: Home State Health Plan Medicare Advantage	$16,144.88
Rate for Payer: Humana Commercial	$32,289.76
Rate for Payer: Humana Medicare Advantage	$16,144.88

GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC

Facility

$13,517.40

Service Code	MSDRG 379
Min. Negotiated Rate	$6,758.70
Max. Negotiated Rate	$13,517.40
Rate for Payer: Aetna Medicare Advantage	$6,758.70
Rate for Payer: Cigna Commercial HMO & PPO	$6,758.70
Rate for Payer: Home State Health Plan Medicare Advantage	$6,758.70
Rate for Payer: Humana Commercial	$13,517.40
Rate for Payer: Humana Medicare Advantage	$6,758.70

GASTROINTESTINAL OBSTRUCTION WITH CC

Facility

$16,004.40

Service Code	MSDRG 389
Min. Negotiated Rate	$8,002.20
Max. Negotiated Rate	$16,004.40
Rate for Payer: Aetna Medicare Advantage	$8,002.20
Rate for Payer: Cigna Commercial HMO & PPO	$8,002.20
Rate for Payer: Home State Health Plan Medicare Advantage	$8,002.20
Rate for Payer: Humana Commercial	$16,004.40
Rate for Payer: Humana Medicare Advantage	$8,002.20

GASTROINTESTINAL OBSTRUCTION WITH MCC

Facility

$26,760.28

Service Code	MSDRG 388
Min. Negotiated Rate	$13,380.14
Max. Negotiated Rate	$26,760.28
Rate for Payer: Aetna Medicare Advantage	$13,380.14
Rate for Payer: Cigna Commercial HMO & PPO	$13,380.14
Rate for Payer: Home State Health Plan Medicare Advantage	$13,380.14
Rate for Payer: Humana Commercial	$26,760.28
Rate for Payer: Humana Medicare Advantage	$13,380.14

GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC

Facility

$12,181.80

Service Code	MSDRG 390
Min. Negotiated Rate	$6,090.90
Max. Negotiated Rate	$12,181.80
Rate for Payer: Aetna Medicare Advantage	$6,090.90
Rate for Payer: Cigna Commercial HMO & PPO	$6,090.90
Rate for Payer: Home State Health Plan Medicare Advantage	$6,090.90
Rate for Payer: Humana Commercial	$12,181.80
Rate for Payer: Humana Medicare Advantage	$6,090.90

GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$7,969.17

Service Code	APR-DRG 2461
Min. Negotiated Rate	$7,969.17
Max. Negotiated Rate	$7,969.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,969.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,969.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,969.17
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,969.17

GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$18,085.65

Service Code	APR-DRG 2464
Min. Negotiated Rate	$18,085.65
Max. Negotiated Rate	$18,085.65
Rate for Payer: Aetna Better Health Medicaid/QHP	$18,085.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18,085.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18,085.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18,085.65

GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$16,890.28

Service Code	APR-DRG 2463
Min. Negotiated Rate	$16,890.28
Max. Negotiated Rate	$16,890.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$16,890.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16,890.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16,890.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16,890.28

GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$10,269.09

Service Code	APR-DRG 2462
Min. Negotiated Rate	$10,269.09
Max. Negotiated Rate	$10,269.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,269.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,269.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,269.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,269.09

GASTRORHAPHY,SUTURE OF PERF DUOD G/ULCER

Professional

Both

$2,308.00

Service Code	CPT 43840
Hospital Charge Code	4143840
Hospital Revenue Code	975
Min. Negotiated Rate	$807.80
Max. Negotiated Rate	$1,221.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,221.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$1,028.87
Rate for Payer: Cash Price	$2,077.20
Rate for Payer: Cash Price	$2,077.20
Rate for Payer: Cigna Commercial HMO & PPO	$1,221.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,028.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,131.76
Rate for Payer: Home State Health Plan Medicare Advantage	$1,221.00
Rate for Payer: Optum Medicare Advantage	$807.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,028.87

GASTROSCOPE

Facility

$715.00

Hospital Charge Code	287390
Hospital Revenue Code	271
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$510.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$423.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$510.51
Rate for Payer: Cash Price	$643.50
Rate for Payer: UnitedHealthcare Commercial	$476.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$257.40

GASTROSCOPE

Facility

$715.00

Hospital Charge Code	287390
Hospital Revenue Code	271
Rate for Payer: Cash Price	$643.50

GASTROSTOMY,PERM,W/CONST OF GASTRIC TUBE

Professional

Both

$2,135.00

Service Code	CPT 43832
Hospital Charge Code	4143832
Hospital Revenue Code	975
Min. Negotiated Rate	$747.25
Max. Negotiated Rate	$944.26
Rate for Payer: Aetna Commercial/Medicare Advantage	$944.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$790.79
Rate for Payer: Cash Price	$1,921.50
Rate for Payer: Cash Price	$1,921.50
Rate for Payer: Cigna Commercial HMO & PPO	$944.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$790.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$869.87
Rate for Payer: Home State Health Plan Medicare Advantage	$944.26
Rate for Payer: Optum Medicare Advantage	$747.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$790.79

GASTROSTOMY TUBE CHANGE

Professional

Both

$951.00

Service Code	CPT 43760
Hospital Charge Code	1843760
Hospital Revenue Code	981
Min. Negotiated Rate	$332.85
Max. Negotiated Rate	$332.85
Rate for Payer: Cash Price	$855.90
Rate for Payer: Optum Medicare Advantage	$332.85

GATORADE

Facility

$13.00

Hospital Charge Code	2819480
Hospital Revenue Code	271
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

GATORADE

Facility

$13.00

Hospital Charge Code	2819480
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

Know your out-of-pocket cost for care.

All Charges