Madison Medical Center

All Charges

Charge

Type

Setting

Price

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$18,149.84

Service Code	APR-DRG 1423
Min. Negotiated Rate	$18,149.84
Max. Negotiated Rate	$18,149.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$18,149.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18,149.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18,149.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18,149.84

INTERSTITIAL LUNG DISEASE WITH CC

Facility

$18,497.34

Service Code	MSDRG 197
Min. Negotiated Rate	$9,248.67
Max. Negotiated Rate	$18,497.34
Rate for Payer: Aetna Medicare Advantage	$9,248.67
Rate for Payer: Cigna Commercial HMO & PPO	$9,248.67
Rate for Payer: Home State Health Plan Medicare Advantage	$9,248.67
Rate for Payer: Humana Commercial	$18,497.34
Rate for Payer: Humana Medicare Advantage	$9,248.67

INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$33,222.40

Service Code	MSDRG 196
Min. Negotiated Rate	$16,611.20
Max. Negotiated Rate	$33,222.40
Rate for Payer: Aetna Medicare Advantage	$16,611.20
Rate for Payer: Cigna Commercial HMO & PPO	$16,611.20
Rate for Payer: Home State Health Plan Medicare Advantage	$16,611.20
Rate for Payer: Humana Commercial	$33,222.40
Rate for Payer: Humana Medicare Advantage	$16,611.20

INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$14,854.04

Service Code	MSDRG 198
Min. Negotiated Rate	$7,427.02
Max. Negotiated Rate	$14,854.04
Rate for Payer: Aetna Medicare Advantage	$7,427.02
Rate for Payer: Cigna Commercial HMO & PPO	$7,427.02
Rate for Payer: Home State Health Plan Medicare Advantage	$7,427.02
Rate for Payer: Humana Commercial	$14,854.04
Rate for Payer: Humana Medicare Advantage	$7,427.02

INTESTINAL OBSTRUCTION

Facility

$7,805.67

Service Code	APR-DRG 2472
Min. Negotiated Rate	$7,805.67
Max. Negotiated Rate	$7,805.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,805.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,805.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,805.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,805.67

INTESTINAL OBSTRUCTION

Facility

$17,178.52

Service Code	APR-DRG 2473
Min. Negotiated Rate	$17,178.52
Max. Negotiated Rate	$17,178.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,178.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,178.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,178.52
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,178.52

INTESTINAL OBSTRUCTION

Facility

$6,308.72

Service Code	APR-DRG 2471
Min. Negotiated Rate	$6,308.72
Max. Negotiated Rate	$6,308.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,308.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,308.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,308.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,308.72

INTESTINAL OBSTRUCTION

Facility

$23,727.05

Service Code	APR-DRG 2474
Min. Negotiated Rate	$23,727.05
Max. Negotiated Rate	$23,727.05
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,727.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,727.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,727.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,727.05

INT PACEMAKER INSERT

Facility

$1,328.00

Hospital Charge Code	289107
Hospital Revenue Code	271
Rate for Payer: Cash Price	$1,195.20

INT PACEMAKER INSERT

Facility

$1,328.00

Hospital Charge Code	289107
Hospital Revenue Code	271
Min. Negotiated Rate	$478.08
Max. Negotiated Rate	$948.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$786.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$948.19
Rate for Payer: Cash Price	$1,195.20
Rate for Payer: UnitedHealthcare Commercial	$885.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$478.08

INTRACATHETER

Professional

Both

$500.00

Service Code	CPT 36140
Hospital Charge Code	4136140
Hospital Revenue Code	975
Min. Negotiated Rate	$77.26
Max. Negotiated Rate	$443.11
Rate for Payer: Aetna Commercial/Medicare Advantage	$77.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$402.83
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cigna Commercial HMO & PPO	$77.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$402.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$443.11
Rate for Payer: Home State Health Plan Medicare Advantage	$77.26
Rate for Payer: Optum Medicare Advantage	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$402.83

INTRACRANIAL HEMORRHAGE

Facility

$20,034.33

Service Code	APR-DRG 0443
Min. Negotiated Rate	$20,034.33
Max. Negotiated Rate	$20,034.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,034.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,034.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,034.33
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,034.33

INTRACRANIAL HEMORRHAGE

Facility

$10,735.51

Service Code	APR-DRG 0442
Min. Negotiated Rate	$10,735.51
Max. Negotiated Rate	$10,735.51
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,735.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,735.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,735.51
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,735.51

INTRACRANIAL HEMORRHAGE

Facility

$8,299.41

Service Code	APR-DRG 0441
Min. Negotiated Rate	$8,299.41
Max. Negotiated Rate	$8,299.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,299.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,299.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,299.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,299.41

INTRACRANIAL HEMORRHAGE

Facility

$65,092.61

Service Code	APR-DRG 0444
Min. Negotiated Rate	$65,092.61
Max. Negotiated Rate	$65,092.61
Rate for Payer: Aetna Better Health Medicaid/QHP	$65,092.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$65,092.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$65,092.61
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$65,092.61

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS

Facility

$19,455.08

Service Code	MSDRG 065
Min. Negotiated Rate	$9,727.54
Max. Negotiated Rate	$19,455.08
Rate for Payer: Aetna Medicare Advantage	$9,727.54
Rate for Payer: Cigna Commercial HMO & PPO	$9,727.54
Rate for Payer: Home State Health Plan Medicare Advantage	$9,727.54
Rate for Payer: Humana Commercial	$19,455.08
Rate for Payer: Humana Medicare Advantage	$9,727.54

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC

Facility

$35,172.72

Service Code	MSDRG 064
Min. Negotiated Rate	$17,586.36
Max. Negotiated Rate	$35,172.72
Rate for Payer: Aetna Medicare Advantage	$17,586.36
Rate for Payer: Cigna Commercial HMO & PPO	$17,586.36
Rate for Payer: Home State Health Plan Medicare Advantage	$17,586.36
Rate for Payer: Humana Commercial	$35,172.72
Rate for Payer: Humana Medicare Advantage	$17,586.36

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC

Facility

$14,358.64

Service Code	MSDRG 066
Min. Negotiated Rate	$7,179.32
Max. Negotiated Rate	$14,358.64
Rate for Payer: Aetna Medicare Advantage	$7,179.32
Rate for Payer: Cigna Commercial HMO & PPO	$7,179.32
Rate for Payer: Home State Health Plan Medicare Advantage	$7,179.32
Rate for Payer: Humana Commercial	$14,358.64
Rate for Payer: Humana Medicare Advantage	$7,179.32

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC

Facility

$87,171.70

Service Code	MSDRG 021
Min. Negotiated Rate	$43,585.85
Max. Negotiated Rate	$87,171.70
Rate for Payer: Aetna Medicare Advantage	$43,585.85
Rate for Payer: Cigna Commercial HMO & PPO	$43,585.85
Rate for Payer: Home State Health Plan Medicare Advantage	$43,585.85
Rate for Payer: Humana Commercial	$87,171.70
Rate for Payer: Humana Medicare Advantage	$43,585.85

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC

Facility

$128,049.00

Service Code	MSDRG 020
Min. Negotiated Rate	$64,024.50
Max. Negotiated Rate	$128,049.00
Rate for Payer: Aetna Medicare Advantage	$64,024.50
Rate for Payer: Cigna Commercial HMO & PPO	$64,024.50
Rate for Payer: Home State Health Plan Medicare Advantage	$64,024.50
Rate for Payer: Humana Commercial	$128,049.00
Rate for Payer: Humana Medicare Advantage	$64,024.50

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC

Facility

$53,593.76

Service Code	MSDRG 022
Min. Negotiated Rate	$26,796.88
Max. Negotiated Rate	$53,593.76
Rate for Payer: Aetna Medicare Advantage	$26,796.88
Rate for Payer: Cigna Commercial HMO & PPO	$26,796.88
Rate for Payer: Home State Health Plan Medicare Advantage	$26,796.88
Rate for Payer: Humana Commercial	$53,593.76
Rate for Payer: Humana Medicare Advantage	$26,796.88

INTRAOCULAR PROCEDURES WITH CC/MCC

Facility

$31,976.26

Service Code	MSDRG 116
Min. Negotiated Rate	$15,988.13
Max. Negotiated Rate	$31,976.26
Rate for Payer: Aetna Medicare Advantage	$15,988.13
Rate for Payer: Cigna Commercial HMO & PPO	$15,988.13
Rate for Payer: Home State Health Plan Medicare Advantage	$15,988.13
Rate for Payer: Humana Commercial	$31,976.26
Rate for Payer: Humana Medicare Advantage	$15,988.13

INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility

$20,622.50

Service Code	MSDRG 117
Min. Negotiated Rate	$10,311.25
Max. Negotiated Rate	$20,622.50
Rate for Payer: Aetna Medicare Advantage	$10,311.25
Rate for Payer: Cigna Commercial HMO & PPO	$10,311.25
Rate for Payer: Home State Health Plan Medicare Advantage	$10,311.25
Rate for Payer: Humana Commercial	$20,622.50
Rate for Payer: Humana Medicare Advantage	$10,311.25

INTRINSIC FACTOR AB

Facility

$399.00

Service Code	CPT 86340
Hospital Charge Code	2286340
Hospital Revenue Code	305
Rate for Payer: Cash Price	$359.10

INTRINSIC FACTOR AB

Facility

$399.00

Service Code	CPT 86340
Hospital Charge Code	2286340
Hospital Revenue Code	305
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$284.89
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.57
Rate for Payer: Aetna Medicare Advantage	$15.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$236.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$284.89
Rate for Payer: Cash Price	$359.10
Rate for Payer: Cash Price	$359.10
Rate for Payer: Cash Price	$359.10
Rate for Payer: Cigna Commercial HMO & PPO	$15.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.52
Rate for Payer: Home State Health Plan Medicare Advantage	$15.08
Rate for Payer: Humana Commercial	$30.16
Rate for Payer: Humana Medicare Advantage	$15.08
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$143.64

Know your out-of-pocket cost for care.

All Charges