Madison Medical Center

All Charges

Charge

Type

Setting

Price

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$9,555.83

Service Code	APR-DRG 3091
Min. Negotiated Rate	$9,555.83
Max. Negotiated Rate	$9,555.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,555.83
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,555.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,555.83
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,555.83

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$51,213.73

Service Code	APR-DRG 3094
Min. Negotiated Rate	$51,213.73
Max. Negotiated Rate	$51,213.73
Rate for Payer: Aetna Better Health Medicaid/QHP	$51,213.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$51,213.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$51,213.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$51,213.73

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$18,539.38

Service Code	APR-DRG 3854
Min. Negotiated Rate	$18,539.38
Max. Negotiated Rate	$18,539.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$18,539.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18,539.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18,539.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18,539.38

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$11,183.91

Service Code	APR-DRG 3853
Min. Negotiated Rate	$11,183.91
Max. Negotiated Rate	$11,183.91
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,183.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,183.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,183.91
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,183.91

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$6,962.55

Service Code	APR-DRG 3852
Min. Negotiated Rate	$6,962.55
Max. Negotiated Rate	$6,962.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,962.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,962.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,962.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,962.55

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$5,045.10

Service Code	APR-DRG 3851
Min. Negotiated Rate	$5,045.10
Max. Negotiated Rate	$5,045.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,045.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,045.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,045.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,045.10

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$30,714.38

Service Code	MSDRG 580
Min. Negotiated Rate	$15,357.19
Max. Negotiated Rate	$30,714.38
Rate for Payer: Aetna Medicare Advantage	$15,357.19
Rate for Payer: Cigna Commercial HMO & PPO	$15,357.19
Rate for Payer: Home State Health Plan Medicare Advantage	$15,357.19
Rate for Payer: Humana Commercial	$30,714.38
Rate for Payer: Humana Medicare Advantage	$15,357.19

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$54,560.40

Service Code	MSDRG 579
Min. Negotiated Rate	$27,280.20
Max. Negotiated Rate	$54,560.40
Rate for Payer: Aetna Medicare Advantage	$27,280.20
Rate for Payer: Cigna Commercial HMO & PPO	$27,280.20
Rate for Payer: Home State Health Plan Medicare Advantage	$27,280.20
Rate for Payer: Humana Commercial	$54,560.40
Rate for Payer: Humana Medicare Advantage	$27,280.20

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility

$26,231.64

Service Code	MSDRG 581
Min. Negotiated Rate	$13,115.82
Max. Negotiated Rate	$26,231.64
Rate for Payer: Aetna Medicare Advantage	$13,115.82
Rate for Payer: Cigna Commercial HMO & PPO	$13,115.82
Rate for Payer: Home State Health Plan Medicare Advantage	$13,115.82
Rate for Payer: Humana Commercial	$26,231.64
Rate for Payer: Humana Medicare Advantage	$13,115.82

OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$32,624.43

Service Code	APR-DRG 3644
Min. Negotiated Rate	$32,624.43
Max. Negotiated Rate	$32,624.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$32,624.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$32,624.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32,624.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$32,624.43

OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$18,916.58

Service Code	APR-DRG 3643
Min. Negotiated Rate	$18,916.58
Max. Negotiated Rate	$18,916.58
Rate for Payer: Aetna Better Health Medicaid/QHP	$18,916.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18,916.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18,916.58
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18,916.58

OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$9,489.26

Service Code	APR-DRG 3642
Min. Negotiated Rate	$9,489.26
Max. Negotiated Rate	$9,489.26
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,489.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,489.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,489.26
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,489.26

OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$6,655.61

Service Code	APR-DRG 3641
Min. Negotiated Rate	$6,655.61
Max. Negotiated Rate	$6,655.61
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,655.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,655.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,655.61
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,655.61

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$22,889.24

Service Code	APR-DRG 2233
Min. Negotiated Rate	$22,889.24
Max. Negotiated Rate	$22,889.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,889.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,889.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,889.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,889.24

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$11,453.87

Service Code	APR-DRG 2231
Min. Negotiated Rate	$11,453.87
Max. Negotiated Rate	$11,453.87
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,453.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,453.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,453.87
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,453.87

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$42,643.44

Service Code	APR-DRG 2234
Min. Negotiated Rate	$42,643.44
Max. Negotiated Rate	$42,643.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$42,643.44
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$42,643.44
Rate for Payer: Home State Health Plan Medicaid Managed Care	$42,643.44
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$42,643.44

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$16,341.80

Service Code	APR-DRG 2232
Min. Negotiated Rate	$16,341.80
Max. Negotiated Rate	$16,341.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$16,341.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16,341.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16,341.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16,341.80

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$14,048.99

Service Code	APR-DRG 2221
Min. Negotiated Rate	$14,048.99
Max. Negotiated Rate	$14,048.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,048.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,048.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,048.99
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,048.99

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$15,219.43

Service Code	APR-DRG 2222
Min. Negotiated Rate	$15,219.43
Max. Negotiated Rate	$15,219.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,219.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,219.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,219.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,219.43

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$44,155.95

Service Code	APR-DRG 2224
Min. Negotiated Rate	$44,155.95
Max. Negotiated Rate	$44,155.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$44,155.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$44,155.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$44,155.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$44,155.95

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$25,950.32

Service Code	APR-DRG 2223
Min. Negotiated Rate	$25,950.32
Max. Negotiated Rate	$25,950.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$25,950.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25,950.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25,950.32
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25,950.32

OTHER VASCULAR PROCEDURES WITH CC

Facility

$44,389.62

Service Code	MSDRG 253
Min. Negotiated Rate	$22,194.81
Max. Negotiated Rate	$44,389.62
Rate for Payer: Aetna Medicare Advantage	$22,194.81
Rate for Payer: Cigna Commercial HMO & PPO	$22,194.81
Rate for Payer: Home State Health Plan Medicare Advantage	$22,194.81
Rate for Payer: Humana Commercial	$44,389.62
Rate for Payer: Humana Medicare Advantage	$22,194.81

OTHER VASCULAR PROCEDURES WITH MCC

Facility

$58,519.66

Service Code	MSDRG 252
Min. Negotiated Rate	$29,259.83
Max. Negotiated Rate	$58,519.66
Rate for Payer: Aetna Medicare Advantage	$29,259.83
Rate for Payer: Cigna Commercial HMO & PPO	$29,259.83
Rate for Payer: Home State Health Plan Medicare Advantage	$29,259.83
Rate for Payer: Humana Commercial	$58,519.66
Rate for Payer: Humana Medicare Advantage	$29,259.83

OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$31,560.38

Service Code	MSDRG 254
Min. Negotiated Rate	$15,780.19
Max. Negotiated Rate	$31,560.38
Rate for Payer: Aetna Medicare Advantage	$15,780.19
Rate for Payer: Cigna Commercial HMO & PPO	$15,780.19
Rate for Payer: Home State Health Plan Medicare Advantage	$15,780.19
Rate for Payer: Humana Commercial	$31,560.38
Rate for Payer: Humana Medicare Advantage	$15,780.19

OT HIGH EVALUATION

Facility

$264.00

Service Code	CPT 97167GO
Hospital Charge Code	5397167
Hospital Revenue Code	434
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.04

Know your out-of-pocket cost for care.

All Charges