Madison Medical Center

All Charges

Charge

Type

Setting

Price

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES

Facility

$15,780.89

Service Code	APR-DRG 8153
Min. Negotiated Rate	$15,780.89
Max. Negotiated Rate	$15,780.89
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,780.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,780.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,780.89
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,780.89

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES

Facility

$8,866.61

Service Code	APR-DRG 8152
Min. Negotiated Rate	$8,866.61
Max. Negotiated Rate	$8,866.61
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,866.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,866.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,866.61
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,866.61

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES

Facility

$7,696.67

Service Code	APR-DRG 8151
Min. Negotiated Rate	$7,696.67
Max. Negotiated Rate	$7,696.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,696.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,696.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,696.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,696.67

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC

Facility

$31,051.52

Service Code	MSDRG 922
Min. Negotiated Rate	$15,525.76
Max. Negotiated Rate	$31,051.52
Rate for Payer: Aetna Medicare Advantage	$15,525.76
Rate for Payer: Cigna Commercial HMO & PPO	$15,525.76
Rate for Payer: Home State Health Plan Medicare Advantage	$15,525.76
Rate for Payer: Humana Commercial	$31,051.52
Rate for Payer: Humana Medicare Advantage	$15,525.76

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC

Facility

$19,570.88

Service Code	MSDRG 923
Min. Negotiated Rate	$9,785.44
Max. Negotiated Rate	$19,570.88
Rate for Payer: Aetna Medicare Advantage	$9,785.44
Rate for Payer: Cigna Commercial HMO & PPO	$9,785.44
Rate for Payer: Home State Health Plan Medicare Advantage	$9,785.44
Rate for Payer: Humana Commercial	$19,570.88
Rate for Payer: Humana Medicare Advantage	$9,785.44

OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS

Facility

$6,765.32

Service Code	APR-DRG 4681
Min. Negotiated Rate	$6,765.32
Max. Negotiated Rate	$6,765.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,765.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,765.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,765.32
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,765.32

OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS

Facility

$11,933.16

Service Code	APR-DRG 4683
Min. Negotiated Rate	$11,933.16
Max. Negotiated Rate	$11,933.16
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,933.16
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,933.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,933.16
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,933.16

OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS

Facility

$8,968.34

Service Code	APR-DRG 4682
Min. Negotiated Rate	$8,968.34
Max. Negotiated Rate	$8,968.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,968.34
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,968.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,968.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,968.34

OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS

Facility

$22,824.77

Service Code	APR-DRG 4684
Min. Negotiated Rate	$22,824.77
Max. Negotiated Rate	$22,824.77
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,824.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,824.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,824.77
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,824.77

OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC

Facility

$19,528.62

Service Code	MSDRG 699
Min. Negotiated Rate	$9,764.31
Max. Negotiated Rate	$19,528.62
Rate for Payer: Aetna Medicare Advantage	$9,764.31
Rate for Payer: Cigna Commercial HMO & PPO	$9,764.31
Rate for Payer: Home State Health Plan Medicare Advantage	$9,764.31
Rate for Payer: Humana Commercial	$19,528.62
Rate for Payer: Humana Medicare Advantage	$9,764.31

OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC

Facility

$29,554.92

Service Code	MSDRG 698
Min. Negotiated Rate	$14,777.46
Max. Negotiated Rate	$29,554.92
Rate for Payer: Aetna Medicare Advantage	$14,777.46
Rate for Payer: Cigna Commercial HMO & PPO	$14,777.46
Rate for Payer: Home State Health Plan Medicare Advantage	$14,777.46
Rate for Payer: Humana Commercial	$29,554.92
Rate for Payer: Humana Medicare Advantage	$14,777.46

OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC

Facility

$14,444.34

Service Code	MSDRG 700
Min. Negotiated Rate	$7,222.17
Max. Negotiated Rate	$14,444.34
Rate for Payer: Aetna Medicare Advantage	$7,222.17
Rate for Payer: Cigna Commercial HMO & PPO	$7,222.17
Rate for Payer: Home State Health Plan Medicare Advantage	$7,222.17
Rate for Payer: Humana Commercial	$14,444.34
Rate for Payer: Humana Medicare Advantage	$7,222.17

OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC

Facility

$40,333.64

Service Code	MSDRG 674
Min. Negotiated Rate	$20,166.82
Max. Negotiated Rate	$40,333.64
Rate for Payer: Aetna Medicare Advantage	$20,166.82
Rate for Payer: Cigna Commercial HMO & PPO	$20,166.82
Rate for Payer: Home State Health Plan Medicare Advantage	$20,166.82
Rate for Payer: Humana Commercial	$40,333.64
Rate for Payer: Humana Medicare Advantage	$20,166.82

OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC

Facility

$69,833.40

Service Code	MSDRG 673
Min. Negotiated Rate	$34,916.70
Max. Negotiated Rate	$69,833.40
Rate for Payer: Aetna Medicare Advantage	$34,916.70
Rate for Payer: Cigna Commercial HMO & PPO	$34,916.70
Rate for Payer: Home State Health Plan Medicare Advantage	$34,916.70
Rate for Payer: Humana Commercial	$69,833.40
Rate for Payer: Humana Medicare Advantage	$34,916.70

OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC

Facility

$29,350.12

Service Code	MSDRG 675
Min. Negotiated Rate	$14,675.06
Max. Negotiated Rate	$29,350.12
Rate for Payer: Aetna Medicare Advantage	$14,675.06
Rate for Payer: Cigna Commercial HMO & PPO	$14,675.06
Rate for Payer: Home State Health Plan Medicare Advantage	$14,675.06
Rate for Payer: Humana Commercial	$29,350.12
Rate for Payer: Humana Medicare Advantage	$14,675.06

OTHER KIDNEY, URINARY TRACT AND RELATED NON-PERCUTANEOUS PROCEDURES

Facility

$48,184.08

Service Code	APR-DRG 4474
Min. Negotiated Rate	$48,184.08
Max. Negotiated Rate	$48,184.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$48,184.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$48,184.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$48,184.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$48,184.08

OTHER KIDNEY, URINARY TRACT AND RELATED NON-PERCUTANEOUS PROCEDURES

Facility

$14,157.16

Service Code	APR-DRG 4471
Min. Negotiated Rate	$14,157.16
Max. Negotiated Rate	$14,157.16
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,157.16
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,157.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,157.16
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,157.16

OTHER KIDNEY, URINARY TRACT AND RELATED NON-PERCUTANEOUS PROCEDURES

Facility

$20,393.04

Service Code	APR-DRG 4472
Min. Negotiated Rate	$20,393.04
Max. Negotiated Rate	$20,393.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,393.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,393.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,393.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,393.04

OTHER KIDNEY, URINARY TRACT AND RELATED NON-PERCUTANEOUS PROCEDURES

Facility

$27,547.89

Service Code	APR-DRG 4473
Min. Negotiated Rate	$27,547.89
Max. Negotiated Rate	$27,547.89
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,547.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,547.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,547.89
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,547.89

OTHER KIDNEY, URINARY TRACT AND RELATED PERCUTANEOUS PROCEDURES

Facility

$28,061.93

Service Code	APR-DRG 4483
Min. Negotiated Rate	$28,061.93
Max. Negotiated Rate	$28,061.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$28,061.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28,061.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28,061.93
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28,061.93

OTHER KIDNEY, URINARY TRACT AND RELATED PERCUTANEOUS PROCEDURES

Facility

$46,786.21

Service Code	APR-DRG 4484
Min. Negotiated Rate	$46,786.21
Max. Negotiated Rate	$46,786.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$46,786.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$46,786.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$46,786.21
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$46,786.21

OTHER KIDNEY, URINARY TRACT AND RELATED PERCUTANEOUS PROCEDURES

Facility

$22,050.70

Service Code	APR-DRG 4482
Min. Negotiated Rate	$22,050.70
Max. Negotiated Rate	$22,050.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,050.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,050.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,050.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,050.70

OTHER KIDNEY, URINARY TRACT AND RELATED PERCUTANEOUS PROCEDURES

Facility

$15,189.85

Service Code	APR-DRG 4481
Min. Negotiated Rate	$15,189.85
Max. Negotiated Rate	$15,189.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,189.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,189.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,189.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,189.85

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC

Facility

$59,598.18

Service Code	MSDRG 271
Min. Negotiated Rate	$29,799.09
Max. Negotiated Rate	$59,598.18
Rate for Payer: Aetna Medicare Advantage	$29,799.09
Rate for Payer: Cigna Commercial HMO & PPO	$29,799.09
Rate for Payer: Home State Health Plan Medicare Advantage	$29,799.09
Rate for Payer: Humana Commercial	$59,598.18
Rate for Payer: Humana Medicare Advantage	$29,799.09

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC

Facility

$86,893.92

Service Code	MSDRG 270
Min. Negotiated Rate	$43,446.96
Max. Negotiated Rate	$86,893.92
Rate for Payer: Aetna Medicare Advantage	$43,446.96
Rate for Payer: Cigna Commercial HMO & PPO	$43,446.96
Rate for Payer: Home State Health Plan Medicare Advantage	$43,446.96
Rate for Payer: Humana Commercial	$86,893.92
Rate for Payer: Humana Medicare Advantage	$43,446.96

Know your out-of-pocket cost for care.

All Charges