Madison Medical Center

All Charges

Charge

Type

Setting

Price

KNEE IMMOBILIZER STAT DEROYAL

Facility

$81.00

Hospital Charge Code	4070013
Hospital Revenue Code	271
Rate for Payer: Cash Price	$72.90

KNEE IMMOBILIZER STAT DEROYAL

Facility

$81.00

Hospital Charge Code	4070013
Hospital Revenue Code	271
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$57.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

KNEE INSTRUMENTATION SYSTEM

Facility

$811.00

Hospital Charge Code	1220848
Hospital Revenue Code	272
Min. Negotiated Rate	$291.96
Max. Negotiated Rate	$579.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$480.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$579.05
Rate for Payer: Cash Price	$729.90
Rate for Payer: UnitedHealthcare Commercial	$540.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$291.96

KNEE INSTRUMENTATION SYSTEM

Facility

$811.00

Hospital Charge Code	1220848
Hospital Revenue Code	272
Rate for Payer: Cash Price	$729.90

KNEE LT 3 VIEW

Facility

$548.00

Service Code	CPT 73562
Hospital Charge Code	3273563
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$391.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$324.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$391.27
Rate for Payer: Cash Price	$493.20
Rate for Payer: Cash Price	$493.20
Rate for Payer: Cash Price	$493.20
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$197.28

KNEE LT 3 VIEW

Facility

$548.00

Service Code	CPT 73562
Hospital Charge Code	3273563
Hospital Revenue Code	320
Rate for Payer: Cash Price	$493.20

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

$31,358.72

Service Code	MSDRG 488
Min. Negotiated Rate	$15,679.36
Max. Negotiated Rate	$31,358.72
Rate for Payer: Aetna Medicare Advantage	$15,679.36
Rate for Payer: Cigna Commercial HMO & PPO	$15,679.36
Rate for Payer: Home State Health Plan Medicare Advantage	$15,679.36
Rate for Payer: Humana Commercial	$31,358.72
Rate for Payer: Humana Medicare Advantage	$15,679.36

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$21,121.70

Service Code	MSDRG 489
Min. Negotiated Rate	$10,560.85
Max. Negotiated Rate	$21,121.70
Rate for Payer: Aetna Medicare Advantage	$10,560.85
Rate for Payer: Cigna Commercial HMO & PPO	$10,560.85
Rate for Payer: Home State Health Plan Medicare Advantage	$10,560.85
Rate for Payer: Humana Commercial	$21,121.70
Rate for Payer: Humana Medicare Advantage	$10,560.85

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC

Facility

$36,434.60

Service Code	MSDRG 486
Min. Negotiated Rate	$18,217.30
Max. Negotiated Rate	$36,434.60
Rate for Payer: Aetna Medicare Advantage	$18,217.30
Rate for Payer: Cigna Commercial HMO & PPO	$18,217.30
Rate for Payer: Home State Health Plan Medicare Advantage	$18,217.30
Rate for Payer: Humana Commercial	$36,434.60
Rate for Payer: Humana Medicare Advantage	$18,217.30

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC

Facility

$54,380.04

Service Code	MSDRG 485
Min. Negotiated Rate	$27,190.02
Max. Negotiated Rate	$54,380.04
Rate for Payer: Aetna Medicare Advantage	$27,190.02
Rate for Payer: Cigna Commercial HMO & PPO	$27,190.02
Rate for Payer: Home State Health Plan Medicare Advantage	$27,190.02
Rate for Payer: Humana Commercial	$54,380.04
Rate for Payer: Humana Medicare Advantage	$27,190.02

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$28,165.44

Service Code	MSDRG 487
Min. Negotiated Rate	$14,082.72
Max. Negotiated Rate	$28,165.44
Rate for Payer: Aetna Medicare Advantage	$14,082.72
Rate for Payer: Cigna Commercial HMO & PPO	$14,082.72
Rate for Payer: Home State Health Plan Medicare Advantage	$14,082.72
Rate for Payer: Humana Commercial	$28,165.44
Rate for Payer: Humana Medicare Advantage	$14,082.72

KNEE RT 3 VIEW

Facility

$548.00

Service Code	CPT 73562
Hospital Charge Code	3273562
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$391.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$324.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$391.27
Rate for Payer: Cash Price	$493.20
Rate for Payer: Cash Price	$493.20
Rate for Payer: Cash Price	$493.20
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$197.28

KNEE RT 3 VIEW

Facility

$548.00

Service Code	CPT 73562
Hospital Charge Code	3273562
Hospital Revenue Code	320
Rate for Payer: Cash Price	$493.20

KNEE STRAPPING

Professional

Both

$273.00

Service Code	CPT 29530
Hospital Charge Code	1829530
Hospital Revenue Code	981
Min. Negotiated Rate	$15.03
Max. Negotiated Rate	$95.55
Rate for Payer: Optum Medicare Advantage	$95.55
Rate for Payer: Aetna Commercial/Medicare Advantage	$15.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$30.40
Rate for Payer: Cash Price	$245.70
Rate for Payer: Cash Price	$245.70
Rate for Payer: Cigna Commercial HMO & PPO	$15.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33.44
Rate for Payer: Home State Health Plan Medicare Advantage	$15.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$30.40

KNEE SUPPORT ELASTIC

Facility

$155.00

Hospital Charge Code	2811813
Hospital Revenue Code	271
Rate for Payer: Cash Price	$139.50

KNEE SUPPORT ELASTIC

Facility

$155.00

Hospital Charge Code	2811813
Hospital Revenue Code	271
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$110.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$91.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$110.67
Rate for Payer: Cash Price	$139.50
Rate for Payer: UnitedHealthcare Commercial	$103.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.80

KNEE XRAY LT

Facility

$449.00

Service Code	CPT 73560
Hospital Charge Code	3211135
Hospital Revenue Code	320
Rate for Payer: Cash Price	$404.10

KNEE XRAY LT

Facility

$449.00

Service Code	CPT 73560
Hospital Charge Code	3211135
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$320.59
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$265.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$320.59
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$161.64

KNEE XRAY RT

Facility

$449.00

Service Code	CPT 73560
Hospital Charge Code	3211134
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$320.59
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$265.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$320.59
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$161.64

KNEE XRAY RT

Facility

$449.00

Service Code	CPT 73560
Hospital Charge Code	3211134
Hospital Revenue Code	320
Rate for Payer: Cash Price	$404.10

KOH PREP

Facility

$75.00

Service Code	CPT 87210
Hospital Charge Code	308040
Hospital Revenue Code	306
Rate for Payer: Cash Price	$67.50

KOH PREP

Facility

$75.00

Service Code	CPT 87210
Hospital Charge Code	308040
Hospital Revenue Code	306
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.24
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$5.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.61
Rate for Payer: Home State Health Plan Medicare Advantage	$5.82
Rate for Payer: Humana Commercial	$11.64
Rate for Payer: Humana Medicare Advantage	$5.82
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	9687210
Hospital Revenue Code	301
Rate for Payer: Cash Price	$36.00

KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	4287210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$36.00

KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	4187210
Hospital Revenue Code	301
Rate for Payer: Cash Price	$36.00

Know your out-of-pocket cost for care.

All Charges