Madison Medical Center

All Charges

Charge

Type

Setting

Price

HEADLIGHT

Facility

$474.00

Hospital Charge Code	124903
Hospital Revenue Code	360
Rate for Payer: Cash Price	$426.60

HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE

Facility

$6,479.03

Service Code	APR-DRG 0552
Min. Negotiated Rate	$6,479.03
Max. Negotiated Rate	$6,479.03
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,479.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,479.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,479.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,479.03

HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE

Facility

$3,263.55

Service Code	APR-DRG 0551
Min. Negotiated Rate	$3,263.55
Max. Negotiated Rate	$3,263.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$3,263.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3,263.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,263.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3,263.55

HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE

Facility

$29,179.67

Service Code	APR-DRG 0554
Min. Negotiated Rate	$29,179.67
Max. Negotiated Rate	$29,179.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$29,179.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29,179.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29,179.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29,179.67

HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE

Facility

$15,004.94

Service Code	APR-DRG 0553
Min. Negotiated Rate	$15,004.94
Max. Negotiated Rate	$15,004.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,004.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,004.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,004.94
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,004.94

HEALTH CHILD SCREENG

Facility

$70.00

Service Code	CPT W0025-XC
Hospital Charge Code	520025
Hospital Revenue Code	521
Min. Negotiated Rate	$41.44
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HEALTH CHILD SCREENG

Facility

$70.00

Service Code	CPT W0025-XC
Hospital Charge Code	520025
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

HEART FAILURE

Facility

$8,027.60

Service Code	APR-DRG 1942
Min. Negotiated Rate	$8,027.60
Max. Negotiated Rate	$8,027.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,027.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,027.60
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,027.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,027.60

HEART FAILURE

Facility

$13,306.60

Service Code	APR-DRG 1943
Min. Negotiated Rate	$13,306.60
Max. Negotiated Rate	$13,306.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,306.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,306.60
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,306.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,306.60

HEART FAILURE

Facility

$31,974.49

Service Code	APR-DRG 1944
Min. Negotiated Rate	$31,974.49
Max. Negotiated Rate	$31,974.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$31,974.49
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31,974.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$31,974.49
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31,974.49

HEART FAILURE

Facility

$5,163.44

Service Code	APR-DRG 1941
Min. Negotiated Rate	$5,163.44
Max. Negotiated Rate	$5,163.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,163.44
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,163.44
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,163.44
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,163.44

HEART FAILURE AND SHOCK WITH CC

Facility

$16,930.84

Service Code	MSDRG 292
Min. Negotiated Rate	$8,465.42
Max. Negotiated Rate	$16,930.84
Rate for Payer: Aetna Medicare Advantage	$8,465.42
Rate for Payer: Cigna Commercial HMO & PPO	$8,465.42
Rate for Payer: Home State Health Plan Medicare Advantage	$8,465.42
Rate for Payer: Humana Commercial	$16,930.84
Rate for Payer: Humana Medicare Advantage	$8,465.42

HEART FAILURE AND SHOCK WITH MCC

Facility

$23,735.18

Service Code	MSDRG 291
Min. Negotiated Rate	$11,867.59
Max. Negotiated Rate	$23,735.18
Rate for Payer: Aetna Medicare Advantage	$11,867.59
Rate for Payer: Cigna Commercial HMO & PPO	$11,867.59
Rate for Payer: Home State Health Plan Medicare Advantage	$11,867.59
Rate for Payer: Humana Commercial	$23,735.18
Rate for Payer: Humana Medicare Advantage	$11,867.59

HEART FAILURE AND SHOCK WITHOUT CC/MCC

Facility

$12,520.74

Service Code	MSDRG 293
Min. Negotiated Rate	$6,260.37
Max. Negotiated Rate	$12,520.74
Rate for Payer: Aetna Medicare Advantage	$6,260.37
Rate for Payer: Cigna Commercial HMO & PPO	$6,260.37
Rate for Payer: Home State Health Plan Medicare Advantage	$6,260.37
Rate for Payer: Humana Commercial	$12,520.74
Rate for Payer: Humana Medicare Advantage	$6,260.37

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC

Facility

$448,004.62

Service Code	MSDRG 001
Min. Negotiated Rate	$224,002.31
Max. Negotiated Rate	$448,004.62
Rate for Payer: Aetna Medicare Advantage	$224,002.31
Rate for Payer: Cigna Commercial HMO & PPO	$224,002.31
Rate for Payer: Home State Health Plan Medicare Advantage	$224,002.31
Rate for Payer: Humana Commercial	$448,004.62
Rate for Payer: Humana Medicare Advantage	$224,002.31

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC

Facility

$183,022.98

Service Code	MSDRG 002
Min. Negotiated Rate	$91,511.49
Max. Negotiated Rate	$183,022.98
Rate for Payer: Aetna Medicare Advantage	$91,511.49
Rate for Payer: Cigna Commercial HMO & PPO	$91,511.49
Rate for Payer: Home State Health Plan Medicare Advantage	$91,511.49
Rate for Payer: Humana Commercial	$183,022.98
Rate for Payer: Humana Medicare Advantage	$91,511.49

HEATED AEROSOL SETUP - INITIAL

Facility

$152.00

Service Code	CPT 94664
Hospital Charge Code	4500260
Hospital Revenue Code	271
Rate for Payer: Cash Price	$136.80

HEATED AEROSOL SETUP - INITIAL

Facility

$152.00

Service Code	CPT 94664
Hospital Charge Code	4500260
Hospital Revenue Code	271
Min. Negotiated Rate	$54.72
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
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	$89.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$108.53
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
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	$101.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.72

HEAVY DRAINAGE PACK

Facility

$39.00

Hospital Charge Code	287850
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

HEAVY DRAINAGE PACK

Facility

$39.00

Hospital Charge Code	287850
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

HEEL LIFT, INSIDE SHOE TAPERED TO 1/2

Facility

$5.00

Service Code	CPT L3332
Hospital Charge Code	9803332
Hospital Revenue Code	301
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$21.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3.57
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cash Price	$4.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.80

HEEL LIFT, INSIDE SHOE TAPERED TO 1/2

Facility

$5.00

Service Code	CPT L3332
Hospital Charge Code	9803332
Hospital Revenue Code	301
Rate for Payer: Cash Price	$4.50

HEEL, WALK, CHILD

Facility

$52.00

Hospital Charge Code	288713
Hospital Revenue Code	271
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$37.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.13
Rate for Payer: Cash Price	$46.80
Rate for Payer: UnitedHealthcare Commercial	$34.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.72

HEEL, WALK, CHILD

Facility

$52.00

Hospital Charge Code	288713
Hospital Revenue Code	271
Rate for Payer: Cash Price	$46.80

HEEL,WALK,DUALADULT

Facility

$60.00

Hospital Charge Code	288715
Hospital Revenue Code	271
Rate for Payer: Cash Price	$54.00

Know your out-of-pocket cost for care.

All Charges