Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$35,554.23

Service Code	APR-DRG 0303
Min. Negotiated Rate	$35,554.23
Max. Negotiated Rate	$35,554.23
Rate for Payer: Aetna Better Health Medicaid/QHP	$35,554.23
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$35,554.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$35,554.23
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$35,554.23

PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$50,046.99

Service Code	APR-DRG 0304
Min. Negotiated Rate	$50,046.99
Max. Negotiated Rate	$50,046.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$50,046.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$50,046.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$50,046.99
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$50,046.99

PERCUTANEOUS SHEATH INTRODUCER KIT

Facility

$156.00

Hospital Charge Code	287391
Hospital Revenue Code	271
Min. Negotiated Rate	$56.16
Max. Negotiated Rate	$111.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: UnitedHealthcare Commercial	$104.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.16

PERCUTANEOUS SHEATH INTRODUCER KIT

Facility

$156.00

Hospital Charge Code	287391
Hospital Revenue Code	271
Rate for Payer: Cash Price	$140.40

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$55,456.35

Service Code	APR-DRG 1833
Min. Negotiated Rate	$55,456.35
Max. Negotiated Rate	$55,456.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$55,456.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55,456.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$55,456.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55,456.35

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$42,175.63

Service Code	APR-DRG 1831
Min. Negotiated Rate	$42,175.63
Max. Negotiated Rate	$42,175.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$42,175.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$42,175.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$42,175.63
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$42,175.63

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$81,970.63

Service Code	APR-DRG 1834
Min. Negotiated Rate	$81,970.63
Max. Negotiated Rate	$81,970.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$81,970.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$81,970.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$81,970.63
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$81,970.63

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$44,951.04

Service Code	APR-DRG 1832
Min. Negotiated Rate	$44,951.04
Max. Negotiated Rate	$44,951.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$44,951.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$44,951.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$44,951.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$44,951.04

PERCUTANIOUS PRECUT T TUBE

Facility

$214.00

Hospital Charge Code	1269047
Hospital Revenue Code	271
Rate for Payer: Cash Price	$192.60

PERCUTANIOUS PRECUT T TUBE

Facility

$214.00

Hospital Charge Code	1269047
Hospital Revenue Code	271
Min. Negotiated Rate	$77.04
Max. Negotiated Rate	$152.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$126.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$152.80
Rate for Payer: Cash Price	$192.60
Rate for Payer: UnitedHealthcare Commercial	$142.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$77.04

PERI AIRE

Facility

$45.00

Hospital Charge Code	2816100
Hospital Revenue Code	271
Rate for Payer: Cash Price	$40.50

PERI AIRE

Facility

$45.00

Hospital Charge Code	2816100
Hospital Revenue Code	271
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

PERIBULBAR

Facility

$48.00

Hospital Charge Code	1269045
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

PERIBULBAR

Facility

$48.00

Hospital Charge Code	1269045
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

PERICARDIALCENTESIS

Professional

Both

$1,213.00

Service Code	CPT 33010
Hospital Charge Code	1832001
Hospital Revenue Code	981
Min. Negotiated Rate	$424.55
Max. Negotiated Rate	$424.55
Rate for Payer: Cash Price	$1,091.70
Rate for Payer: Optum Medicare Advantage	$424.55

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$31,320.77

Service Code	APR-DRG 1974
Min. Negotiated Rate	$31,320.77
Max. Negotiated Rate	$31,320.77
Rate for Payer: Aetna Better Health Medicaid/QHP	$31,320.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31,320.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$31,320.77
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31,320.77

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$17,975.44

Service Code	APR-DRG 1973
Min. Negotiated Rate	$17,975.44
Max. Negotiated Rate	$17,975.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,975.44
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,975.44
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,975.44
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,975.44

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$11,561.35

Service Code	APR-DRG 1971
Min. Negotiated Rate	$11,561.35
Max. Negotiated Rate	$11,561.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,561.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,561.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,561.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,561.35

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$12,945.66

Service Code	APR-DRG 1972
Min. Negotiated Rate	$12,945.66
Max. Negotiated Rate	$12,945.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,945.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,945.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,945.66
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,945.66

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$19,049.71

Service Code	APR-DRG 0484
Min. Negotiated Rate	$19,049.71
Max. Negotiated Rate	$19,049.71
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,049.71
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,049.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,049.71
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,049.71

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$5,771.77

Service Code	APR-DRG 0482
Min. Negotiated Rate	$5,771.77
Max. Negotiated Rate	$5,771.77
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,771.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,771.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,771.77
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,771.77

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$11,035.06

Service Code	APR-DRG 0483
Min. Negotiated Rate	$11,035.06
Max. Negotiated Rate	$11,035.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,035.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,035.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,035.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,035.06

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$5,091.33

Service Code	APR-DRG 0481
Min. Negotiated Rate	$5,091.33
Max. Negotiated Rate	$5,091.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,091.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,091.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,091.33
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,091.33

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR

Facility

$38,129.70

Service Code	MSDRG 041
Min. Negotiated Rate	$19,064.85
Max. Negotiated Rate	$38,129.70
Rate for Payer: Aetna Medicare Advantage	$19,064.85
Rate for Payer: Cigna Commercial HMO & PPO	$19,064.85
Rate for Payer: Home State Health Plan Medicare Advantage	$19,064.85
Rate for Payer: Humana Commercial	$38,129.70
Rate for Payer: Humana Medicare Advantage	$19,064.85

Know your out-of-pocket cost for care.

All Charges