Madison Medical Center

All Charges

Charge

Type

Setting

Price

MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC

Facility

$28,641.20

Service Code	MSDRG 142
Min. Negotiated Rate	$14,320.60
Max. Negotiated Rate	$28,641.20
Rate for Payer: Aetna Medicare Advantage	$14,320.60
Rate for Payer: Cigna Commercial HMO & PPO	$14,320.60
Rate for Payer: Home State Health Plan Medicare Advantage	$14,320.60
Rate for Payer: Humana Commercial	$28,641.20
Rate for Payer: Humana Medicare Advantage	$14,320.60

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC

Facility

$23,455.04

Service Code	MSDRG 809
Min. Negotiated Rate	$11,727.52
Max. Negotiated Rate	$23,455.04
Rate for Payer: Aetna Medicare Advantage	$11,727.52
Rate for Payer: Cigna Commercial HMO & PPO	$11,727.52
Rate for Payer: Home State Health Plan Medicare Advantage	$11,727.52
Rate for Payer: Humana Commercial	$23,455.04
Rate for Payer: Humana Medicare Advantage	$11,727.52

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC

Facility

$38,274.62

Service Code	MSDRG 808
Min. Negotiated Rate	$19,137.31
Max. Negotiated Rate	$38,274.62
Rate for Payer: Aetna Medicare Advantage	$19,137.31
Rate for Payer: Cigna Commercial HMO & PPO	$19,137.31
Rate for Payer: Home State Health Plan Medicare Advantage	$19,137.31
Rate for Payer: Humana Commercial	$38,274.62
Rate for Payer: Humana Medicare Advantage	$19,137.31

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC

Facility

$20,023.14

Service Code	MSDRG 810
Min. Negotiated Rate	$10,011.57
Max. Negotiated Rate	$20,023.14
Rate for Payer: Aetna Medicare Advantage	$10,011.57
Rate for Payer: Cigna Commercial HMO & PPO	$10,011.57
Rate for Payer: Home State Health Plan Medicare Advantage	$10,011.57
Rate for Payer: Humana Commercial	$20,023.14
Rate for Payer: Humana Medicare Advantage	$10,011.57

MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION

Facility

$58,929.46

Service Code	APR-DRG 6604
Min. Negotiated Rate	$58,929.46
Max. Negotiated Rate	$58,929.46
Rate for Payer: Aetna Better Health Medicaid/QHP	$58,929.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58,929.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$58,929.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$58,929.46

MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION

Facility

$11,423.28

Service Code	APR-DRG 6602
Min. Negotiated Rate	$11,423.28
Max. Negotiated Rate	$11,423.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,423.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,423.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,423.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,423.28

MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION

Facility

$18,522.87

Service Code	APR-DRG 6603
Min. Negotiated Rate	$18,522.87
Max. Negotiated Rate	$18,522.87
Rate for Payer: Aetna Better Health Medicaid/QHP	$18,522.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18,522.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18,522.87
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18,522.87

MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION

Facility

$7,257.03

Service Code	APR-DRG 6601
Min. Negotiated Rate	$7,257.03
Max. Negotiated Rate	$7,257.03
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,257.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,257.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,257.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,257.03

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT

Facility

$51,312.50

Service Code	MSDRG 469
Min. Negotiated Rate	$25,656.25
Max. Negotiated Rate	$51,312.50
Rate for Payer: Aetna Medicare Advantage	$25,656.25
Rate for Payer: Cigna Commercial HMO & PPO	$25,656.25
Rate for Payer: Home State Health Plan Medicare Advantage	$25,656.25
Rate for Payer: Humana Commercial	$51,312.50
Rate for Payer: Humana Medicare Advantage	$25,656.25

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility

$33,879.32

Service Code	MSDRG 470
Min. Negotiated Rate	$16,939.66
Max. Negotiated Rate	$33,879.32
Rate for Payer: Aetna Medicare Advantage	$16,939.66
Rate for Payer: Cigna Commercial HMO & PPO	$16,939.66
Rate for Payer: Home State Health Plan Medicare Advantage	$16,939.66
Rate for Payer: Humana Commercial	$33,879.32
Rate for Payer: Humana Medicare Advantage	$16,939.66

MAJOR JOINT INJECTION

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	5420610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

MAJOR JOINT INJECTION

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	5420610
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$190.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MAJOR JOINT INJECTION

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	4420610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

MAJOR JOINT INJECTION

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	4420610
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$190.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MAJOR JOINT INJ PERFORMED IN OR

Professional

Both

$285.00

Service Code	CPT 20610
Hospital Charge Code	41206100
Hospital Revenue Code	975
Min. Negotiated Rate	$38.30
Max. Negotiated Rate	$99.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$38.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$48.86
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cigna Commercial HMO & PPO	$38.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$48.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$53.75
Rate for Payer: Home State Health Plan Medicare Advantage	$38.30
Rate for Payer: Optum Medicare Advantage	$99.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$48.86

MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility

$47,178.72

Service Code	MSDRG 483
Min. Negotiated Rate	$23,589.36
Max. Negotiated Rate	$47,178.72
Rate for Payer: Aetna Medicare Advantage	$23,589.36
Rate for Payer: Cigna Commercial HMO & PPO	$23,589.36
Rate for Payer: Home State Health Plan Medicare Advantage	$23,589.36
Rate for Payer: Humana Commercial	$47,178.72
Rate for Payer: Humana Medicare Advantage	$23,589.36

MAJOR LARGE BOWEL PROCEDURES

Facility

$27,235.41

Service Code	APR-DRG 2313
Min. Negotiated Rate	$27,235.41
Max. Negotiated Rate	$27,235.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,235.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,235.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,235.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,235.41

MAJOR LARGE BOWEL PROCEDURES

Facility

$12,470.84

Service Code	APR-DRG 2311
Min. Negotiated Rate	$12,470.84
Max. Negotiated Rate	$12,470.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,470.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,470.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,470.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,470.84

MAJOR LARGE BOWEL PROCEDURES

Facility

$43,311.87

Service Code	APR-DRG 2314
Min. Negotiated Rate	$43,311.87
Max. Negotiated Rate	$43,311.87
Rate for Payer: Aetna Better Health Medicaid/QHP	$43,311.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$43,311.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$43,311.87
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$43,311.87

MAJOR LARGE BOWEL PROCEDURES

Facility

$15,832.39

Service Code	APR-DRG 2312
Min. Negotiated Rate	$15,832.39
Max. Negotiated Rate	$15,832.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,832.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,832.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,832.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,832.39

MAJOR MALE PELVIC PROCEDURES WITH CC/MCC

Facility

$35,004.14

Service Code	MSDRG 707
Min. Negotiated Rate	$17,502.07
Max. Negotiated Rate	$35,004.14
Rate for Payer: Aetna Medicare Advantage	$17,502.07
Rate for Payer: Cigna Commercial HMO & PPO	$17,502.07
Rate for Payer: Home State Health Plan Medicare Advantage	$17,502.07
Rate for Payer: Humana Commercial	$35,004.14
Rate for Payer: Humana Medicare Advantage	$17,502.07

MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC

Facility

$27,661.30

Service Code	MSDRG 708
Min. Negotiated Rate	$13,830.65
Max. Negotiated Rate	$27,661.30
Rate for Payer: Aetna Medicare Advantage	$13,830.65
Rate for Payer: Cigna Commercial HMO & PPO	$13,830.65
Rate for Payer: Home State Health Plan Medicare Advantage	$13,830.65
Rate for Payer: Humana Commercial	$27,661.30
Rate for Payer: Humana Medicare Advantage	$13,830.65

MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$19,647.88

Service Code	APR-DRG 6801
Min. Negotiated Rate	$19,647.88
Max. Negotiated Rate	$19,647.88
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,647.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,647.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,647.88
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,647.88

MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$36,995.55

Service Code	APR-DRG 6803
Min. Negotiated Rate	$36,995.55
Max. Negotiated Rate	$36,995.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$36,995.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$36,995.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$36,995.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$36,995.55

MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$80,903.73

Service Code	APR-DRG 6804
Min. Negotiated Rate	$80,903.73
Max. Negotiated Rate	$80,903.73
Rate for Payer: Aetna Better Health Medicaid/QHP	$80,903.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$80,903.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$80,903.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$80,903.73

Know your out-of-pocket cost for care.

All Charges