Madison Medical Center

All Charges

Charge

Type

Setting

Price

MAGNESIUM URINE 24 HOUR

Facility

$44.00

Service Code	CPT 83735
Hospital Charge Code	2203735
Hospital Revenue Code	307
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$31.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.03
Rate for Payer: Aetna Medicare Advantage	$6.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cigna Commercial HMO & PPO	$6.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.45
Rate for Payer: Home State Health Plan Medicare Advantage	$6.70
Rate for Payer: Humana Commercial	$13.40
Rate for Payer: Humana Medicare Advantage	$6.70
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$28,679.50

Service Code	APR-DRG 1691
Min. Negotiated Rate	$28,679.50
Max. Negotiated Rate	$28,679.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$28,679.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28,679.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28,679.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28,679.50

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$69,740.17

Service Code	APR-DRG 1694
Min. Negotiated Rate	$69,740.17
Max. Negotiated Rate	$69,740.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$69,740.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$69,740.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69,740.17
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$69,740.17

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$46,078.95

Service Code	APR-DRG 1693
Min. Negotiated Rate	$46,078.95
Max. Negotiated Rate	$46,078.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$46,078.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$46,078.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$46,078.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$46,078.95

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$36,127.43

Service Code	APR-DRG 1692
Min. Negotiated Rate	$36,127.43
Max. Negotiated Rate	$36,127.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$36,127.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$36,127.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$36,127.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$36,127.43

MAJOR BILIARY TRACT PROCEDURES

Facility

$25,274.50

Service Code	APR-DRG 2612
Min. Negotiated Rate	$25,274.50
Max. Negotiated Rate	$25,274.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$25,274.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25,274.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25,274.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25,274.50

MAJOR BILIARY TRACT PROCEDURES

Facility

$20,209.99

Service Code	APR-DRG 2611
Min. Negotiated Rate	$20,209.99
Max. Negotiated Rate	$20,209.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,209.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,209.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,209.99
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,209.99

MAJOR BILIARY TRACT PROCEDURES

Facility

$57,554.08

Service Code	APR-DRG 2614
Min. Negotiated Rate	$57,554.08
Max. Negotiated Rate	$57,554.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$57,554.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$57,554.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$57,554.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$57,554.08

MAJOR BILIARY TRACT PROCEDURES

Facility

$27,964.85

Service Code	APR-DRG 2613
Min. Negotiated Rate	$27,964.85
Max. Negotiated Rate	$27,964.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,964.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,964.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,964.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,964.85

MAJOR BLADDER PROCEDURES

Facility

$31,904.23

Service Code	APR-DRG 4412
Min. Negotiated Rate	$31,904.23
Max. Negotiated Rate	$31,904.23
Rate for Payer: Aetna Better Health Medicaid/QHP	$31,904.23
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31,904.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$31,904.23
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31,904.23

MAJOR BLADDER PROCEDURES

Facility

$64,193.05

Service Code	APR-DRG 4414
Min. Negotiated Rate	$64,193.05
Max. Negotiated Rate	$64,193.05
Rate for Payer: Aetna Better Health Medicaid/QHP	$64,193.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64,193.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$64,193.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64,193.05

MAJOR BLADDER PROCEDURES

Facility

$26,605.81

Service Code	APR-DRG 4411
Min. Negotiated Rate	$26,605.81
Max. Negotiated Rate	$26,605.81
Rate for Payer: Aetna Better Health Medicaid/QHP	$26,605.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26,605.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26,605.81
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26,605.81

MAJOR BLADDER PROCEDURES

Facility

$31,904.23

Service Code	APR-DRG 4413
Min. Negotiated Rate	$31,904.23
Max. Negotiated Rate	$31,904.23
Rate for Payer: Aetna Better Health Medicaid/QHP	$31,904.23
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31,904.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$31,904.23
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31,904.23

MAJOR BLADDER PROCEDURES WITH CC

Facility

$47,612.20

Service Code	MSDRG 654
Min. Negotiated Rate	$23,806.10
Max. Negotiated Rate	$47,612.20
Rate for Payer: Aetna Medicare Advantage	$23,806.10
Rate for Payer: Cigna Commercial HMO & PPO	$23,806.10
Rate for Payer: Home State Health Plan Medicare Advantage	$23,806.10
Rate for Payer: Humana Commercial	$47,612.20
Rate for Payer: Humana Medicare Advantage	$23,806.10

MAJOR BLADDER PROCEDURES WITH MCC

Facility

$85,625.52

Service Code	MSDRG 653
Min. Negotiated Rate	$42,812.76
Max. Negotiated Rate	$85,625.52
Rate for Payer: Aetna Medicare Advantage	$42,812.76
Rate for Payer: Cigna Commercial HMO & PPO	$42,812.76
Rate for Payer: Home State Health Plan Medicare Advantage	$42,812.76
Rate for Payer: Humana Commercial	$85,625.52
Rate for Payer: Humana Medicare Advantage	$42,812.76

MAJOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$36,836.32

Service Code	MSDRG 655
Min. Negotiated Rate	$18,418.16
Max. Negotiated Rate	$36,836.32
Rate for Payer: Aetna Medicare Advantage	$18,418.16
Rate for Payer: Cigna Commercial HMO & PPO	$18,418.16
Rate for Payer: Home State Health Plan Medicare Advantage	$18,418.16
Rate for Payer: Humana Commercial	$36,836.32
Rate for Payer: Humana Medicare Advantage	$18,418.16

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$147,943.38

Service Code	APR-DRG 1604
Min. Negotiated Rate	$147,943.38
Max. Negotiated Rate	$147,943.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$147,943.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$147,943.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$147,943.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$147,943.38

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$58,281.68

Service Code	APR-DRG 1602
Min. Negotiated Rate	$58,281.68
Max. Negotiated Rate	$58,281.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$58,281.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58,281.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$58,281.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$58,281.68

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$68,069.56

Service Code	APR-DRG 1603
Min. Negotiated Rate	$68,069.56
Max. Negotiated Rate	$68,069.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$68,069.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$68,069.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$68,069.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$68,069.56

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$34,590.88

Service Code	APR-DRG 1601
Min. Negotiated Rate	$34,590.88
Max. Negotiated Rate	$34,590.88
Rate for Payer: Aetna Better Health Medicaid/QHP	$34,590.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$34,590.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$34,590.88
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$34,590.88

MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$23,368.14

Service Code	APR-DRG 1354
Min. Negotiated Rate	$23,368.14
Max. Negotiated Rate	$23,368.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,368.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,368.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,368.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,368.14

MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$10,967.57

Service Code	APR-DRG 1353
Min. Negotiated Rate	$10,967.57
Max. Negotiated Rate	$10,967.57
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,967.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,967.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,967.57
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,967.57

MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$3,931.98

Service Code	APR-DRG 1351
Min. Negotiated Rate	$3,931.98
Max. Negotiated Rate	$3,931.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$3,931.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3,931.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,931.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3,931.98

MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$5,968.69

Service Code	APR-DRG 1352
Min. Negotiated Rate	$5,968.69
Max. Negotiated Rate	$5,968.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,968.69
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,968.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,968.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,968.69

MAJOR CHEST PROCEDURES WITH CC

Facility

$43,257.20

Service Code	MSDRG 164
Min. Negotiated Rate	$21,628.60
Max. Negotiated Rate	$43,257.20
Rate for Payer: Aetna Medicare Advantage	$21,628.60
Rate for Payer: Cigna Commercial HMO & PPO	$21,628.60
Rate for Payer: Home State Health Plan Medicare Advantage	$21,628.60
Rate for Payer: Humana Commercial	$43,257.20
Rate for Payer: Humana Medicare Advantage	$21,628.60

Know your out-of-pocket cost for care.

All Charges