Madison Medical Center

All Charges

Charge

Type

Setting

Price

ONLINE TELEPHONE CONS 21 - 30 MIN

Facility

$230.00

Service Code	CPT 99448
Hospital Charge Code	9899448
Hospital Revenue Code	521
Rate for Payer: Cash Price	$207.00

ONLINE TELEPHONE CONS 21 - 30 MIN

Facility

$230.00

Service Code	CPT 99448
Hospital Charge Code	9899448
Hospital Revenue Code	521
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$136.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$164.22
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: UnitedHealthcare Commercial	$153.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ONLINE TELEPHONE CONS 31 OR MORE

Facility

$340.00

Service Code	CPT 99449
Hospital Charge Code	9899449
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$242.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$201.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$242.76
Rate for Payer: Cash Price	$306.00
Rate for Payer: Cash Price	$306.00
Rate for Payer: UnitedHealthcare Commercial	$226.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ONLINE TELEPHONE CONS 31 OR MORE

Facility

$340.00

Service Code	CPT 99449
Hospital Charge Code	9899449
Hospital Revenue Code	521
Rate for Payer: Cash Price	$306.00

ONLINE TELEPHONE CONS 5 - 10 MIN

Facility

$80.00

Service Code	CPT 99446
Hospital Charge Code	9899446
Hospital Revenue Code	521
Rate for Payer: Cash Price	$72.00

ONLINE TELEPHONE CONS 5 - 10 MIN

Facility

$80.00

Service Code	CPT 99446
Hospital Charge Code	9899446
Hospital Revenue Code	521
Min. Negotiated Rate	$47.36
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: UnitedHealthcare Commercial	$53.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OP BASIC

Facility

$215.00

Service Code	CPT 99211
Hospital Charge Code	1819007
Hospital Revenue Code	761
Rate for Payer: Cash Price	$193.50

OP BASIC

Facility

$215.00

Service Code	CPT 99211
Hospital Charge Code	1819007
Hospital Revenue Code	761
Min. Negotiated Rate	$77.40
Max. Negotiated Rate	$153.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$127.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$153.51
Rate for Payer: Cash Price	$193.50
Rate for Payer: UnitedHealthcare Commercial	$143.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$77.40

OP BASIC (ALLERGY)

Facility

$55.00

Hospital Charge Code	1819013
Hospital Revenue Code	510
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

OP BASIC (ALLERGY)

Facility

$55.00

Hospital Charge Code	1819013
Hospital Revenue Code	510
Rate for Payer: Cash Price	$49.50

OPEN CRANIOTOMY EXCEPT TRAUMA

Facility

$43,692.77

Service Code	APR-DRG 0213
Min. Negotiated Rate	$43,692.77
Max. Negotiated Rate	$43,692.77
Rate for Payer: Aetna Better Health Medicaid/QHP	$43,692.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$43,692.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$43,692.77
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$43,692.77

OPEN CRANIOTOMY EXCEPT TRAUMA

Facility

$109,493.56

Service Code	APR-DRG 0214
Min. Negotiated Rate	$109,493.56
Max. Negotiated Rate	$109,493.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$109,493.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$109,493.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$109,493.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$109,493.56

OPEN CRANIOTOMY EXCEPT TRAUMA

Facility

$27,906.61

Service Code	APR-DRG 0212
Min. Negotiated Rate	$27,906.61
Max. Negotiated Rate	$27,906.61
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,906.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,906.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,906.61
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,906.61

OPEN CRANIOTOMY EXCEPT TRAUMA

Facility

$18,276.82

Service Code	APR-DRG 0211
Min. Negotiated Rate	$18,276.82
Max. Negotiated Rate	$18,276.82
Rate for Payer: Aetna Better Health Medicaid/QHP	$18,276.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18,276.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18,276.82
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18,276.82

OPEN CRANIOTOMY FOR TRAUMA

Facility

$20,281.17

Service Code	APR-DRG 0201
Min. Negotiated Rate	$20,281.17
Max. Negotiated Rate	$20,281.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,281.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,281.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,281.17
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,281.17

OPEN CRANIOTOMY FOR TRAUMA

Facility

$55,215.05

Service Code	APR-DRG 0204
Min. Negotiated Rate	$55,215.05
Max. Negotiated Rate	$55,215.05
Rate for Payer: Aetna Better Health Medicaid/QHP	$55,215.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55,215.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$55,215.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55,215.05

OPEN CRANIOTOMY FOR TRAUMA

Facility

$25,270.80

Service Code	APR-DRG 0202
Min. Negotiated Rate	$25,270.80
Max. Negotiated Rate	$25,270.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$25,270.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25,270.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25,270.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25,270.80

OPEN CRANIOTOMY FOR TRAUMA

Facility

$36,340.07

Service Code	APR-DRG 0203
Min. Negotiated Rate	$36,340.07
Max. Negotiated Rate	$36,340.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$36,340.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$36,340.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$36,340.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$36,340.07

OPEN EXTRACRANIAL VASCULAR PROCEDURES

Facility

$11,703.49

Service Code	APR-DRG 0241
Min. Negotiated Rate	$11,703.49
Max. Negotiated Rate	$11,703.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,703.49
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,703.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,703.49
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,703.49

OPEN EXTRACRANIAL VASCULAR PROCEDURES

Facility

$14,273.65

Service Code	APR-DRG 0242
Min. Negotiated Rate	$14,273.65
Max. Negotiated Rate	$14,273.65
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,273.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,273.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,273.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,273.65

OPEN EXTRACRANIAL VASCULAR PROCEDURES

Facility

$25,666.50

Service Code	APR-DRG 0243
Min. Negotiated Rate	$25,666.50
Max. Negotiated Rate	$25,666.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$25,666.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25,666.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25,666.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25,666.50

OPEN EXTRACRANIAL VASCULAR PROCEDURES

Facility

$35,785.36

Service Code	APR-DRG 0244
Min. Negotiated Rate	$35,785.36
Max. Negotiated Rate	$35,785.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$35,785.36
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$35,785.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$35,785.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$35,785.36

OPERATION TO CORR ANGULATION-PENIS

Professional

Both

$1,674.00

Service Code	CPT 54360
Hospital Charge Code	4154360
Hospital Revenue Code	975
Min. Negotiated Rate	$539.28
Max. Negotiated Rate	$626.33
Rate for Payer: Aetna Commercial/Medicare Advantage	$626.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$539.28
Rate for Payer: Cash Price	$1,506.60
Rate for Payer: Cash Price	$1,506.60
Rate for Payer: Cigna Commercial HMO & PPO	$626.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$539.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$593.21
Rate for Payer: Home State Health Plan Medicare Advantage	$626.33
Rate for Payer: Optum Medicare Advantage	$585.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$539.28

OP EXTENSIVE

Facility

$418.00

Service Code	CPT 99211
Hospital Charge Code	1819009
Hospital Revenue Code	761
Min. Negotiated Rate	$150.48
Max. Negotiated Rate	$298.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$247.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$298.45
Rate for Payer: Cash Price	$376.20
Rate for Payer: UnitedHealthcare Commercial	$278.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$150.48

OP EXTENSIVE

Facility

$418.00

Service Code	CPT 99211
Hospital Charge Code	1819009
Hospital Revenue Code	761
Rate for Payer: Cash Price	$376.20

Know your out-of-pocket cost for care.

All Charges