Madison Medical Center

All Charges

Charge

Type

Setting

Price

PERCUSSION/VIBRATION (MECH) INITIAL

Facility

$107.00

Service Code	CPT 94667
Hospital Charge Code	4500485
Hospital Revenue Code	412
Min. Negotiated Rate	$38.52
Max. Negotiated Rate	$271.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$119.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$71.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

PERCUSSION/VIBRATION (MECH) INITIAL

Facility

$107.00

Service Code	CPT 94667
Hospital Charge Code	4500485
Hospital Revenue Code	412
Rate for Payer: Cash Price	$96.30

PERCUSSION/VIBRATION (MECH) SUBSEQUENT

Facility

$201.00

Service Code	CPT 94668
Hospital Charge Code	4594668
Hospital Revenue Code	412
Rate for Payer: Cash Price	$180.90

PERCUSSION/VIBRATION (MECH) SUBSEQUENT

Facility

$201.00

Service Code	CPT 94668
Hospital Charge Code	4594668
Hospital Revenue Code	412
Min. Negotiated Rate	$72.36
Max. Negotiated Rate	$271.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$118.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$143.51
Rate for Payer: Cash Price	$180.90
Rate for Payer: Cash Price	$180.90
Rate for Payer: Cash Price	$180.90
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$119.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$134.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$72.36

PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC

Facility

$68,626.00

Service Code	MSDRG 273
Min. Negotiated Rate	$34,313.00
Max. Negotiated Rate	$68,626.00
Rate for Payer: Aetna Medicare Advantage	$34,313.00
Rate for Payer: Cigna Commercial HMO & PPO	$34,313.00
Rate for Payer: Home State Health Plan Medicare Advantage	$34,313.00
Rate for Payer: Humana Commercial	$68,626.00
Rate for Payer: Humana Medicare Advantage	$34,313.00

PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC

Facility

$55,402.02

Service Code	MSDRG 274
Min. Negotiated Rate	$27,701.01
Max. Negotiated Rate	$55,402.02
Rate for Payer: Aetna Medicare Advantage	$27,701.01
Rate for Payer: Cigna Commercial HMO & PPO	$27,701.01
Rate for Payer: Home State Health Plan Medicare Advantage	$27,701.01
Rate for Payer: Humana Commercial	$55,402.02
Rate for Payer: Humana Medicare Advantage	$27,701.01

PERCUTANEOUS CARDIAC INTERVENTION WITH AMI

Facility

$17,730.43

Service Code	APR-DRG 1743
Min. Negotiated Rate	$17,730.43
Max. Negotiated Rate	$17,730.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,730.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,730.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,730.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,730.43

PERCUTANEOUS CARDIAC INTERVENTION WITH AMI

Facility

$36,731.14

Service Code	APR-DRG 1744
Min. Negotiated Rate	$36,731.14
Max. Negotiated Rate	$36,731.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$36,731.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$36,731.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$36,731.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$36,731.14

PERCUTANEOUS CARDIAC INTERVENTION WITH AMI

Facility

$14,050.84

Service Code	APR-DRG 1742
Min. Negotiated Rate	$14,050.84
Max. Negotiated Rate	$14,050.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,050.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,050.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,050.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,050.84

PERCUTANEOUS CARDIAC INTERVENTION WITH AMI

Facility

$12,129.69

Service Code	APR-DRG 1741
Min. Negotiated Rate	$12,129.69
Max. Negotiated Rate	$12,129.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,129.69
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,129.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,129.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,129.69

PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI

Facility

$34,075.00

Service Code	APR-DRG 1753
Min. Negotiated Rate	$34,075.00
Max. Negotiated Rate	$34,075.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$34,075.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$34,075.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$34,075.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$34,075.00

PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI

Facility

$48,871.92

Service Code	APR-DRG 1754
Min. Negotiated Rate	$48,871.92
Max. Negotiated Rate	$48,871.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$48,871.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$48,871.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$48,871.92
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$48,871.92

PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI

Facility

$22,415.89

Service Code	APR-DRG 1752
Min. Negotiated Rate	$22,415.89
Max. Negotiated Rate	$22,415.89
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,415.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,415.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,415.89
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,415.89

PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI

Facility

$15,040.08

Service Code	APR-DRG 1751
Min. Negotiated Rate	$15,040.08
Max. Negotiated Rate	$15,040.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,040.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,040.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,040.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,040.08

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES

Facility

$46,370.32

Service Code	MSDRG 321
Min. Negotiated Rate	$23,185.16
Max. Negotiated Rate	$46,370.32
Rate for Payer: Aetna Medicare Advantage	$23,185.16
Rate for Payer: Cigna Commercial HMO & PPO	$23,185.16
Rate for Payer: Home State Health Plan Medicare Advantage	$23,185.16
Rate for Payer: Humana Commercial	$46,370.32
Rate for Payer: Humana Medicare Advantage	$23,185.16

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$31,265.76

Service Code	MSDRG 322
Min. Negotiated Rate	$15,632.88
Max. Negotiated Rate	$31,265.76
Rate for Payer: Aetna Medicare Advantage	$15,632.88
Rate for Payer: Cigna Commercial HMO & PPO	$15,632.88
Rate for Payer: Home State Health Plan Medicare Advantage	$15,632.88
Rate for Payer: Humana Commercial	$31,265.76
Rate for Payer: Humana Medicare Advantage	$15,632.88

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC

Facility

$37,874.48

Service Code	MSDRG 250
Min. Negotiated Rate	$18,937.24
Max. Negotiated Rate	$37,874.48
Rate for Payer: Aetna Medicare Advantage	$18,937.24
Rate for Payer: Cigna Commercial HMO & PPO	$18,937.24
Rate for Payer: Home State Health Plan Medicare Advantage	$18,937.24
Rate for Payer: Humana Commercial	$37,874.48
Rate for Payer: Humana Medicare Advantage	$18,937.24

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC

Facility

$27,037.92

Service Code	MSDRG 251
Min. Negotiated Rate	$13,518.96
Max. Negotiated Rate	$27,037.92
Rate for Payer: Aetna Medicare Advantage	$13,518.96
Rate for Payer: Cigna Commercial HMO & PPO	$13,518.96
Rate for Payer: Home State Health Plan Medicare Advantage	$13,518.96
Rate for Payer: Humana Commercial	$27,037.92
Rate for Payer: Humana Medicare Advantage	$13,518.96

PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC

Facility

$57,731.38

Service Code	MSDRG 359
Min. Negotiated Rate	$28,865.69
Max. Negotiated Rate	$57,731.38
Rate for Payer: Aetna Medicare Advantage	$28,865.69
Rate for Payer: Cigna Commercial HMO & PPO	$28,865.69
Rate for Payer: Home State Health Plan Medicare Advantage	$28,865.69
Rate for Payer: Humana Commercial	$57,731.38
Rate for Payer: Humana Medicare Advantage	$28,865.69

PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$41,526.20

Service Code	MSDRG 360
Min. Negotiated Rate	$20,763.10
Max. Negotiated Rate	$41,526.20
Rate for Payer: Aetna Medicare Advantage	$20,763.10
Rate for Payer: Cigna Commercial HMO & PPO	$20,763.10
Rate for Payer: Home State Health Plan Medicare Advantage	$20,763.10
Rate for Payer: Humana Commercial	$41,526.20
Rate for Payer: Humana Medicare Advantage	$20,763.10

PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE

Facility

$41,650.80

Service Code	MSDRG 318
Min. Negotiated Rate	$20,825.40
Max. Negotiated Rate	$41,650.80
Rate for Payer: Aetna Medicare Advantage	$20,825.40
Rate for Payer: Cigna Commercial HMO & PPO	$20,825.40
Rate for Payer: Home State Health Plan Medicare Advantage	$20,825.40
Rate for Payer: Humana Commercial	$41,650.80
Rate for Payer: Humana Medicare Advantage	$20,825.40

PERCUTANEOUS ENDO GASTRO TUBE

Facility

$508.00

Hospital Charge Code	287392
Hospital Revenue Code	271
Min. Negotiated Rate	$182.88
Max. Negotiated Rate	$362.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$300.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$362.71
Rate for Payer: Cash Price	$457.20
Rate for Payer: UnitedHealthcare Commercial	$338.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$182.88

PERCUTANEOUS ENDO GASTRO TUBE

Facility

$508.00

Hospital Charge Code	287392
Hospital Revenue Code	271
Rate for Payer: Cash Price	$457.20

PERCUTANEOUS IMPLANTATION OF NEUROSTIMUL

Professional

Both

$4,400.00

Service Code	CPT 63650
Hospital Charge Code	4163650
Hospital Revenue Code	975
Min. Negotiated Rate	$358.70
Max. Negotiated Rate	$1,975.21
Rate for Payer: Aetna Commercial/Medicare Advantage	$358.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$1,795.65
Rate for Payer: Cash Price	$3,960.00
Rate for Payer: Cash Price	$3,960.00
Rate for Payer: Cigna Commercial HMO & PPO	$358.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,795.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,975.21
Rate for Payer: Home State Health Plan Medicare Advantage	$358.70
Rate for Payer: Optum Medicare Advantage	$1,540.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,795.65

PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$21,994.31

Service Code	APR-DRG 0302
Min. Negotiated Rate	$21,994.31
Max. Negotiated Rate	$21,994.31
Rate for Payer: Aetna Better Health Medicaid/QHP	$21,994.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21,994.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21,994.31
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21,994.31

Know your out-of-pocket cost for care.

All Charges