Madison Medical Center

All Charges

Charge

Type

Setting

Price

APOLIPOPROTEIN B

Facility

$44.00

Service Code	CPT 82172
Hospital Charge Code	222172
Hospital Revenue Code	301
Rate for Payer: Cash Price	$39.60

APOLIPOPROTEIN B

Facility

$44.00

Service Code	CPT 82172
Hospital Charge Code	222172
Hospital Revenue Code	301
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$42.18
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.98
Rate for Payer: Aetna Medicare Advantage	$21.09
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	$21.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.31
Rate for Payer: Home State Health Plan Medicare Advantage	$21.09
Rate for Payer: Humana Commercial	$42.18
Rate for Payer: Humana Medicare Advantage	$21.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

APPENDECTOMY

Professional

Both

$2,100.00

Service Code	CPT 44950
Hospital Charge Code	5444950
Hospital Revenue Code	975
Min. Negotiated Rate	$486.66
Max. Negotiated Rate	$735.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$579.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$486.66
Rate for Payer: Cash Price	$1,890.00
Rate for Payer: Cash Price	$1,890.00
Rate for Payer: Cigna Commercial HMO & PPO	$579.42
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$486.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$535.33
Rate for Payer: Home State Health Plan Medicare Advantage	$579.42
Rate for Payer: Optum Medicare Advantage	$735.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$486.66

APPENDECTOMY, EXCISION

Professional

Both

$1,532.00

Service Code	CPT 44950
Hospital Charge Code	4144950
Hospital Revenue Code	975
Min. Negotiated Rate	$486.66
Max. Negotiated Rate	$579.42
Rate for Payer: Aetna Commercial/Medicare Advantage	$579.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$486.66
Rate for Payer: Cash Price	$1,378.80
Rate for Payer: Cash Price	$1,378.80
Rate for Payer: Cigna Commercial HMO & PPO	$579.42
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$486.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$535.33
Rate for Payer: Home State Health Plan Medicare Advantage	$579.42
Rate for Payer: Optum Medicare Advantage	$536.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$486.66

APPENDECTOMY, EXCISION FOR INDICATED PUR

Professional

Both

$772.00

Service Code	CPT 44955
Hospital Charge Code	4144955
Hospital Revenue Code	975
Min. Negotiated Rate	$72.71
Max. Negotiated Rate	$270.20
Rate for Payer: Aetna Commercial/Medicare Advantage	$72.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$75.47
Rate for Payer: Cash Price	$694.80
Rate for Payer: Cash Price	$694.80
Rate for Payer: Cigna Commercial HMO & PPO	$72.71
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$75.47
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.02
Rate for Payer: Home State Health Plan Medicare Advantage	$72.71
Rate for Payer: Optum Medicare Advantage	$270.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$75.47

APPENDECTOMY, RUPTURED APPENDIX

Professional

Both

$1,886.00

Service Code	CPT 44960
Hospital Charge Code	4144960
Hospital Revenue Code	975
Min. Negotiated Rate	$660.10
Max. Negotiated Rate	$790.09
Rate for Payer: Aetna Commercial/Medicare Advantage	$790.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$665.68
Rate for Payer: Cash Price	$1,697.40
Rate for Payer: Cash Price	$1,697.40
Rate for Payer: Cigna Commercial HMO & PPO	$790.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$665.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$732.25
Rate for Payer: Home State Health Plan Medicare Advantage	$790.09
Rate for Payer: Optum Medicare Advantage	$660.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$665.68

APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$33,368.66

Service Code	APR-DRG 2334
Min. Negotiated Rate	$33,368.66
Max. Negotiated Rate	$33,368.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$33,368.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33,368.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33,368.66
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33,368.66

APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$12,144.48

Service Code	APR-DRG 2332
Min. Negotiated Rate	$12,144.48
Max. Negotiated Rate	$12,144.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,144.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,144.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,144.48
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,144.48

APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$8,622.06

Service Code	APR-DRG 2331
Min. Negotiated Rate	$8,622.06
Max. Negotiated Rate	$8,622.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,622.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,622.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,622.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,622.06

APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$20,388.42

Service Code	APR-DRG 2333
Min. Negotiated Rate	$20,388.42
Max. Negotiated Rate	$20,388.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,388.42
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,388.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,388.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,388.42

APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$29,898.02

Service Code	APR-DRG 2344
Min. Negotiated Rate	$29,898.02
Max. Negotiated Rate	$29,898.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$29,898.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29,898.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29,898.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29,898.02

APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$20,732.34

Service Code	APR-DRG 2343
Min. Negotiated Rate	$20,732.34
Max. Negotiated Rate	$20,732.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,732.34
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,732.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,732.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,732.34

APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$12,836.95

Service Code	APR-DRG 2342
Min. Negotiated Rate	$12,836.95
Max. Negotiated Rate	$12,836.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,836.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,836.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,836.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,836.95

APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$3,942.15

Service Code	APR-DRG 2341
Min. Negotiated Rate	$3,942.15
Max. Negotiated Rate	$3,942.15
Rate for Payer: Aetna Better Health Medicaid/QHP	$3,942.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3,942.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,942.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3,942.15

APPENDIX PROCEDURES WITH CC

Facility

$27,337.56

Service Code	MSDRG 398
Min. Negotiated Rate	$13,668.78
Max. Negotiated Rate	$27,337.56
Rate for Payer: Aetna Medicare Advantage	$13,668.78
Rate for Payer: Cigna Commercial HMO & PPO	$13,668.78
Rate for Payer: Home State Health Plan Medicare Advantage	$13,668.78
Rate for Payer: Humana Commercial	$27,337.56
Rate for Payer: Humana Medicare Advantage	$13,668.78

APPENDIX PROCEDURES WITH MCC

Facility

$41,220.58

Service Code	MSDRG 397
Min. Negotiated Rate	$20,610.29
Max. Negotiated Rate	$41,220.58
Rate for Payer: Aetna Medicare Advantage	$20,610.29
Rate for Payer: Cigna Commercial HMO & PPO	$20,610.29
Rate for Payer: Home State Health Plan Medicare Advantage	$20,610.29
Rate for Payer: Humana Commercial	$41,220.58
Rate for Payer: Humana Medicare Advantage	$20,610.29

APPENDIX PROCEDURES WITHOUT CC/MCC

Facility

$21,558.34

Service Code	MSDRG 399
Min. Negotiated Rate	$10,779.17
Max. Negotiated Rate	$21,558.34
Rate for Payer: Aetna Medicare Advantage	$10,779.17
Rate for Payer: Cigna Commercial HMO & PPO	$10,779.17
Rate for Payer: Home State Health Plan Medicare Advantage	$10,779.17
Rate for Payer: Humana Commercial	$21,558.34
Rate for Payer: Humana Medicare Advantage	$10,779.17

APPLICATION OF LONG ARM CAST

Facility

$330.00

Service Code	CPT 29065
Hospital Charge Code	9129065
Hospital Revenue Code	521
Rate for Payer: Cash Price	$297.00

APPLICATION OF LONG ARM CAST

Facility

$330.00

Service Code	CPT 29065
Hospital Charge Code	9129065
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$571.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$252.13
Rate for Payer: Aetna Medicare Advantage	$285.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$195.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$235.62
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cigna Commercial HMO & PPO	$285.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$226.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$269.78
Rate for Payer: Home State Health Plan Medicare Advantage	$285.75
Rate for Payer: Humana Commercial	$571.50
Rate for Payer: Humana Medicare Advantage	$285.75
Rate for Payer: UnitedHealthcare Commercial	$220.11
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$252.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

APPLICATION OF SHORT ARM CAST

Facility

$320.00

Service Code	CPT 29075
Hospital Charge Code	9129075
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$571.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$252.13
Rate for Payer: Aetna Medicare Advantage	$285.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$189.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$228.48
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cigna Commercial HMO & PPO	$285.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$226.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$269.78
Rate for Payer: Home State Health Plan Medicare Advantage	$285.75
Rate for Payer: Humana Commercial	$571.50
Rate for Payer: Humana Medicare Advantage	$285.75
Rate for Payer: UnitedHealthcare Commercial	$213.44
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$252.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

APPLICATION OF SHORT ARM CAST

Facility

$320.00

Service Code	CPT 29075
Hospital Charge Code	9129075
Hospital Revenue Code	521
Rate for Payer: Cash Price	$288.00

APPLICATION OF SHORT LEG CAST

Facility

$250.00

Service Code	CPT 29405
Hospital Charge Code	4429405
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

APPLICATION OF SHORT LEG CAST

Facility

$320.00

Service Code	CPT 29405
Hospital Charge Code	9129405
Hospital Revenue Code	521
Rate for Payer: Cash Price	$288.00

APPLICATION OF SHORT LEG CAST

Facility

$250.00

Service Code	CPT 29405
Hospital Charge Code	4429405
Hospital Revenue Code	521
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$571.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$252.13
Rate for Payer: Aetna Medicare Advantage	$285.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial HMO & PPO	$285.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$226.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$269.78
Rate for Payer: Home State Health Plan Medicare Advantage	$285.75
Rate for Payer: Humana Commercial	$571.50
Rate for Payer: Humana Medicare Advantage	$285.75
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$252.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

APPLICATION OF SHORT LEG CAST

Facility

$320.00

Service Code	CPT 29405
Hospital Charge Code	9129405
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$571.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$252.13
Rate for Payer: Aetna Medicare Advantage	$285.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$189.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$228.48
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cigna Commercial HMO & PPO	$285.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$226.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$269.78
Rate for Payer: Home State Health Plan Medicare Advantage	$285.75
Rate for Payer: Humana Commercial	$571.50
Rate for Payer: Humana Medicare Advantage	$285.75
Rate for Payer: UnitedHealthcare Commercial	$213.44
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$252.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges