Madison Medical Center

All Charges

Charge

Type

Setting

Price

KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$10,774.34

Service Code	APR-DRG 4421
Min. Negotiated Rate	$10,774.34
Max. Negotiated Rate	$10,774.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,774.34
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,774.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,774.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,774.34

KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY

Facility

$14,898.62

Service Code	APR-DRG 4432
Min. Negotiated Rate	$14,898.62
Max. Negotiated Rate	$14,898.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,898.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,898.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,898.62
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,898.62

KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY

Facility

$7,947.17

Service Code	APR-DRG 4431
Min. Negotiated Rate	$7,947.17
Max. Negotiated Rate	$7,947.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,947.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,947.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,947.17
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,947.17

KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY

Facility

$26,336.77

Service Code	APR-DRG 4433
Min. Negotiated Rate	$26,336.77
Max. Negotiated Rate	$26,336.77
Rate for Payer: Aetna Better Health Medicaid/QHP	$26,336.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26,336.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26,336.77
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26,336.77

KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY

Facility

$39,164.47

Service Code	APR-DRG 4434
Min. Negotiated Rate	$39,164.47
Max. Negotiated Rate	$39,164.47
Rate for Payer: Aetna Better Health Medicaid/QHP	$39,164.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$39,164.47
Rate for Payer: Home State Health Plan Medicaid Managed Care	$39,164.47
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$39,164.47

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC

Facility

$21,544.26

Service Code	MSDRG 695
Min. Negotiated Rate	$10,772.13
Max. Negotiated Rate	$21,544.26
Rate for Payer: Aetna Medicare Advantage	$10,772.13
Rate for Payer: Cigna Commercial HMO & PPO	$10,772.13
Rate for Payer: Home State Health Plan Medicare Advantage	$10,772.13
Rate for Payer: Humana Commercial	$21,544.26
Rate for Payer: Humana Medicare Advantage	$10,772.13

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$14,430.30

Service Code	MSDRG 696
Min. Negotiated Rate	$7,215.15
Max. Negotiated Rate	$14,430.30
Rate for Payer: Aetna Medicare Advantage	$7,215.15
Rate for Payer: Cigna Commercial HMO & PPO	$7,215.15
Rate for Payer: Home State Health Plan Medicare Advantage	$7,215.15
Rate for Payer: Humana Commercial	$14,430.30
Rate for Payer: Humana Medicare Advantage	$7,215.15

KIDNEY TRANSPLANT

Facility

$54,418.02

Service Code	MSDRG 652
Min. Negotiated Rate	$27,209.01
Max. Negotiated Rate	$54,418.02
Rate for Payer: Aetna Medicare Advantage	$27,209.01
Rate for Payer: Cigna Commercial HMO & PPO	$27,209.01
Rate for Payer: Home State Health Plan Medicare Advantage	$27,209.01
Rate for Payer: Humana Commercial	$54,418.02
Rate for Payer: Humana Medicare Advantage	$27,209.01

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC

Facility

$77,767.56

Service Code	MSDRG 650
Min. Negotiated Rate	$38,883.78
Max. Negotiated Rate	$77,767.56
Rate for Payer: Aetna Medicare Advantage	$38,883.78
Rate for Payer: Cigna Commercial HMO & PPO	$38,883.78
Rate for Payer: Home State Health Plan Medicare Advantage	$38,883.78
Rate for Payer: Humana Commercial	$77,767.56
Rate for Payer: Humana Medicare Advantage	$38,883.78

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC

Facility

$61,969.32

Service Code	MSDRG 651
Min. Negotiated Rate	$30,984.66
Max. Negotiated Rate	$61,969.32
Rate for Payer: Aetna Medicare Advantage	$30,984.66
Rate for Payer: Cigna Commercial HMO & PPO	$30,984.66
Rate for Payer: Home State Health Plan Medicare Advantage	$30,984.66
Rate for Payer: Humana Commercial	$61,969.32
Rate for Payer: Humana Medicare Advantage	$30,984.66

K LASER

Facility

$40.00

Service Code	CPT 97026
Hospital Charge Code	4197026
Hospital Revenue Code	521
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.23
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

K LASER

Facility

$40.00

Service Code	CPT 97026
Hospital Charge Code	4197026
Hospital Revenue Code	521
Rate for Payer: Cash Price	$36.00

KLEENEX LARGE #21400

Facility

$16.00

Hospital Charge Code	2811680
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

KLEENEX LARGE #21400

Facility

$16.00

Hospital Charge Code	2811680
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

KLING, 2 IN

Facility

$39.00

Hospital Charge Code	2811307
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

KLING, 2 IN

Facility

$39.00

Hospital Charge Code	2811307
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

KLING, 3 IN

Facility

$42.00

Hospital Charge Code	2811308
Hospital Revenue Code	271
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

KLING, 3 IN

Facility

$42.00

Hospital Charge Code	2811308
Hospital Revenue Code	271
Rate for Payer: Cash Price	$37.80

KLING, 4 IN

Facility

$52.00

Hospital Charge Code	2811309
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

KLING, 4 IN

Facility

$52.00

Hospital Charge Code	2811309
Hospital Revenue Code	271
Rate for Payer: Cash Price	$46.80

KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$11,035.98

Service Code	APR-DRG 3131
Min. Negotiated Rate	$11,035.98
Max. Negotiated Rate	$11,035.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,035.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,035.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,035.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,035.98

KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$53,810.70

Service Code	APR-DRG 3134
Min. Negotiated Rate	$53,810.70
Max. Negotiated Rate	$53,810.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$53,810.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$53,810.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$53,810.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53,810.70

KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$17,002.83

Service Code	APR-DRG 3132
Min. Negotiated Rate	$17,002.83
Max. Negotiated Rate	$17,002.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,002.83
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,002.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,002.83
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,002.83

KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$26,753.73

Service Code	APR-DRG 3133
Min. Negotiated Rate	$26,753.73
Max. Negotiated Rate	$26,753.73
Rate for Payer: Aetna Better Health Medicaid/QHP	$26,753.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26,753.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26,753.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26,753.73

KNEE DISLOCATION

Professional

Both

$1,672.00

Service Code	CPT 27560
Hospital Charge Code	1827560
Hospital Revenue Code	981
Min. Negotiated Rate	$281.89
Max. Negotiated Rate	$585.20
Rate for Payer: Aetna Commercial/Medicare Advantage	$364.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$281.89
Rate for Payer: Cash Price	$1,504.80
Rate for Payer: Cash Price	$1,504.80
Rate for Payer: Cigna Commercial HMO & PPO	$364.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$281.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$310.08
Rate for Payer: Home State Health Plan Medicare Advantage	$364.53
Rate for Payer: Optum Medicare Advantage	$585.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$281.89

Know your out-of-pocket cost for care.

All Charges