Madison Medical Center

All Charges

Charge

Type

Setting

Price

IMOVAX RABIES VAC 1ML IM INJ (EGG FREE)

Facility

$2,330.00

Service Code	HCPCS 90675
Hospital Charge Code	2625477
Hospital Revenue Code	250
Rate for Payer: Cash Price	$2,097.00

IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$152,185.07

Service Code	APR-DRG 1612
Min. Negotiated Rate	$152,185.07
Max. Negotiated Rate	$152,185.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$152,185.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$152,185.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$152,185.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$152,185.07

IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$152,185.07

Service Code	APR-DRG 1611
Min. Negotiated Rate	$152,185.07
Max. Negotiated Rate	$152,185.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$152,185.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$152,185.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$152,185.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$152,185.07

IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$243,374.08

Service Code	APR-DRG 1613
Min. Negotiated Rate	$243,374.08
Max. Negotiated Rate	$243,374.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$243,374.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$243,374.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$243,374.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$243,374.08

IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$279,823.24

Service Code	APR-DRG 1614
Min. Negotiated Rate	$279,823.24
Max. Negotiated Rate	$279,823.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$279,823.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$279,823.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$279,823.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$279,823.24

IMPLANTABLE NEUROSTIMULATOR ELECTRODE,

Facility

$1,435.00

Service Code	CPT L8680
Hospital Charge Code	1216041
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,291.50

IMPLANTABLE NEUROSTIMULATOR ELECTRODE,

Facility

$1,435.00

Service Code	CPT L8680
Hospital Charge Code	1216041
Hospital Revenue Code	360
Min. Negotiated Rate	$516.60
Max. Negotiated Rate	$957.14
Rate for Payer: Cash Price	$1,291.50
Rate for Payer: UnitedHealthcare Commercial	$957.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$516.60

INAPSINE 2.5MG/ML INJ DROPERIDOL

Facility

$87.00

Service Code	HCPCS J1790
Hospital Charge Code	260354
Hospital Revenue Code	250
Min. Negotiated Rate	$31.32
Max. Negotiated Rate	$62.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$51.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.12
Rate for Payer: Cash Price	$78.30
Rate for Payer: UnitedHealthcare Commercial	$58.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.32

INAPSINE 2.5MG/ML INJ DROPERIDOL

Facility

$87.00

Service Code	HCPCS J1790
Hospital Charge Code	260354
Hospital Revenue Code	250
Rate for Payer: Cash Price	$78.30

INBORN AND OTHER DISORDERS OF METABOLISM

Facility

$25,902.20

Service Code	MSDRG 642
Min. Negotiated Rate	$12,951.10
Max. Negotiated Rate	$25,902.20
Rate for Payer: Aetna Medicare Advantage	$12,951.10
Rate for Payer: Cigna Commercial HMO & PPO	$12,951.10
Rate for Payer: Home State Health Plan Medicare Advantage	$12,951.10
Rate for Payer: Humana Commercial	$25,902.20
Rate for Payer: Humana Medicare Advantage	$12,951.10

INBORN ERRORS OF METABOLISM

Facility

$28,882.81

Service Code	APR-DRG 4233
Min. Negotiated Rate	$28,882.81
Max. Negotiated Rate	$28,882.81
Rate for Payer: Aetna Better Health Medicaid/QHP	$28,882.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28,882.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28,882.81
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28,882.81

INBORN ERRORS OF METABOLISM

Facility

$13,901.53

Service Code	APR-DRG 4231
Min. Negotiated Rate	$13,901.53
Max. Negotiated Rate	$13,901.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,901.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,901.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,901.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,901.53

INBORN ERRORS OF METABOLISM

Facility

$17,431.53

Service Code	APR-DRG 4232
Min. Negotiated Rate	$17,431.53
Max. Negotiated Rate	$17,431.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,431.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,431.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,431.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,431.53

INBORN ERRORS OF METABOLISM

Facility

$57,748.32

Service Code	APR-DRG 4234
Min. Negotiated Rate	$57,748.32
Max. Negotiated Rate	$57,748.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$57,748.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$57,748.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$57,748.32
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$57,748.32

INC AND REM OF FB SUB TIS SIMPLE

Facility

$375.00

Service Code	CPT 10120
Hospital Charge Code	4210120
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$830.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$366.45
Rate for Payer: Aetna Medicare Advantage	$415.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$222.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$267.75
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cigna Commercial HMO & PPO	$415.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$329.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$392.10
Rate for Payer: Home State Health Plan Medicare Advantage	$415.32
Rate for Payer: Humana Commercial	$830.64
Rate for Payer: Humana Medicare Advantage	$415.32
Rate for Payer: UnitedHealthcare Commercial	$250.12
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INC AND REM OF FB SUB TIS SIMPLE

Facility

$375.00

Service Code	CPT 10120
Hospital Charge Code	4210120
Hospital Revenue Code	521
Rate for Payer: Cash Price	$337.50

INC & DRAINAGE SIMPLE

Facility

$101.00

Service Code	CPT 10080
Hospital Charge Code	5210080
Hospital Revenue Code	521
Min. Negotiated Rate	$59.79
Max. Negotiated Rate	$1,446.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$638.34
Rate for Payer: Aetna Medicare Advantage	$723.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cigna Commercial HMO & PPO	$723.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$574.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$683.02
Rate for Payer: Home State Health Plan Medicare Advantage	$723.47
Rate for Payer: Humana Commercial	$1,446.94
Rate for Payer: Humana Medicare Advantage	$723.47
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INC & DRAINAGE SIMPLE

Facility

$101.00

Service Code	CPT 10080
Hospital Charge Code	5210080
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.90

INCENTIVE SPIROMETER-SUPPLY

Facility

$438.00

Service Code	CPT A9284
Hospital Charge Code	4594013
Hospital Revenue Code	271
Rate for Payer: Cash Price	$394.20

INCENTIVE SPIROMETER-SUPPLY

Facility

$438.00

Service Code	CPT A9284
Hospital Charge Code	4594013
Hospital Revenue Code	271
Min. Negotiated Rate	$157.68
Max. Negotiated Rate	$312.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$259.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$312.73
Rate for Payer: Cash Price	$394.20
Rate for Payer: UnitedHealthcare Commercial	$292.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$157.68

INCISION AND DRAINAGE ABCESS/FINGER

Professional

Both

$663.00

Service Code	CPT 26010
Hospital Charge Code	1826010
Hospital Revenue Code	981
Min. Negotiated Rate	$133.15
Max. Negotiated Rate	$294.39
Rate for Payer: Aetna Commercial/Medicare Advantage	$133.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$267.63
Rate for Payer: Cash Price	$596.70
Rate for Payer: Cash Price	$596.70
Rate for Payer: Cigna Commercial HMO & PPO	$133.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$267.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$294.39
Rate for Payer: Home State Health Plan Medicare Advantage	$133.15
Rate for Payer: Optum Medicare Advantage	$232.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$267.63

INCISION AND DRAINAGE HEMOTOMA

Professional

Both

$448.00

Service Code	CPT 10140
Hospital Charge Code	1810070
Hospital Revenue Code	981
Min. Negotiated Rate	$107.50
Max. Negotiated Rate	$156.80
Rate for Payer: Aetna Commercial/Medicare Advantage	$107.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$128.94
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cigna Commercial HMO & PPO	$107.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$128.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$141.83
Rate for Payer: Home State Health Plan Medicare Advantage	$107.50
Rate for Payer: Optum Medicare Advantage	$156.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$128.94

INCISION AND DRAINAGE OF HEMATOMA SEROMA

Facility

$260.00

Service Code	CPT 10140
Hospital Charge Code	9110140
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.00

INCISION AND DRAINAGE OF HEMATOMA SEROMA

Facility

$260.00

Service Code	CPT 10140
Hospital Charge Code	9110140
Hospital Revenue Code	521
Min. Negotiated Rate	$153.92
Max. Negotiated Rate	$3,374.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,488.83
Rate for Payer: Aetna Medicare Advantage	$1,687.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cigna Commercial HMO & PPO	$1,687.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,339.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,593.05
Rate for Payer: Home State Health Plan Medicare Advantage	$1,687.37
Rate for Payer: Humana Commercial	$3,374.74
Rate for Payer: Humana Medicare Advantage	$1,687.37
Rate for Payer: UnitedHealthcare Commercial	$173.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INCISION AND DRAINAGE, PERIANAL ABSCESS,

Facility

$550.00

Service Code	CPT 46050
Hospital Charge Code	5446050
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,900.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$838.31
Rate for Payer: Aetna Medicare Advantage	$950.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$325.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$392.70
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cigna Commercial HMO & PPO	$950.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$754.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$896.99
Rate for Payer: Home State Health Plan Medicare Advantage	$950.10
Rate for Payer: Humana Commercial	$1,900.20
Rate for Payer: Humana Medicare Advantage	$950.10
Rate for Payer: UnitedHealthcare Commercial	$366.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$838.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges