Madison Medical Center

All Charges

Charge

Type

Setting

Price

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC

Facility

$64,434.06

Service Code	MSDRG 040
Min. Negotiated Rate	$32,217.03
Max. Negotiated Rate	$64,434.06
Rate for Payer: Aetna Medicare Advantage	$32,217.03
Rate for Payer: Cigna Commercial HMO & PPO	$32,217.03
Rate for Payer: Home State Health Plan Medicare Advantage	$32,217.03
Rate for Payer: Humana Commercial	$64,434.06
Rate for Payer: Humana Medicare Advantage	$32,217.03

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC

Facility

$30,709.66

Service Code	MSDRG 042
Min. Negotiated Rate	$15,354.83
Max. Negotiated Rate	$30,709.66
Rate for Payer: Aetna Medicare Advantage	$15,354.83
Rate for Payer: Cigna Commercial HMO & PPO	$15,354.83
Rate for Payer: Home State Health Plan Medicare Advantage	$15,354.83
Rate for Payer: Humana Commercial	$30,709.66
Rate for Payer: Humana Medicare Advantage	$15,354.83

PERIPHERAL VASCULAR DISORDERS WITH CC

Facility

$20,350.20

Service Code	MSDRG 300
Min. Negotiated Rate	$10,175.10
Max. Negotiated Rate	$20,350.20
Rate for Payer: Aetna Medicare Advantage	$10,175.10
Rate for Payer: Cigna Commercial HMO & PPO	$10,175.10
Rate for Payer: Home State Health Plan Medicare Advantage	$10,175.10
Rate for Payer: Humana Commercial	$20,350.20
Rate for Payer: Humana Medicare Advantage	$10,175.10

PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility

$29,213.06

Service Code	MSDRG 299
Min. Negotiated Rate	$14,606.53
Max. Negotiated Rate	$29,213.06
Rate for Payer: Aetna Medicare Advantage	$14,606.53
Rate for Payer: Cigna Commercial HMO & PPO	$14,606.53
Rate for Payer: Home State Health Plan Medicare Advantage	$14,606.53
Rate for Payer: Humana Commercial	$29,213.06
Rate for Payer: Humana Medicare Advantage	$14,606.53

PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility

$14,908.56

Service Code	MSDRG 301
Min. Negotiated Rate	$7,454.28
Max. Negotiated Rate	$14,908.56
Rate for Payer: Aetna Medicare Advantage	$7,454.28
Rate for Payer: Cigna Commercial HMO & PPO	$7,454.28
Rate for Payer: Home State Health Plan Medicare Advantage	$7,454.28
Rate for Payer: Humana Commercial	$14,908.56
Rate for Payer: Humana Medicare Advantage	$7,454.28

PERITONEAL ADHESIOLYSIS

Facility

$10,737.36

Service Code	APR-DRG 2241
Min. Negotiated Rate	$10,737.36
Max. Negotiated Rate	$10,737.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,737.36
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,737.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,737.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,737.36

PERITONEAL ADHESIOLYSIS

Facility

$26,727.84

Service Code	APR-DRG 2243
Min. Negotiated Rate	$26,727.84
Max. Negotiated Rate	$26,727.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$26,727.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26,727.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26,727.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26,727.84

PERITONEAL ADHESIOLYSIS

Facility

$49,559.77

Service Code	APR-DRG 2244
Min. Negotiated Rate	$49,559.77
Max. Negotiated Rate	$49,559.77
Rate for Payer: Aetna Better Health Medicaid/QHP	$49,559.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$49,559.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$49,559.77
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$49,559.77

PERITONEAL ADHESIOLYSIS

Facility

$13,023.70

Service Code	APR-DRG 2242
Min. Negotiated Rate	$13,023.70
Max. Negotiated Rate	$13,023.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,023.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,023.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,023.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,023.70

PERITONEAL ADHESIOLYSIS WITH CC

Facility

$36,711.84

Service Code	MSDRG 336
Min. Negotiated Rate	$18,355.92
Max. Negotiated Rate	$36,711.84
Rate for Payer: Aetna Medicare Advantage	$18,355.92
Rate for Payer: Cigna Commercial HMO & PPO	$18,355.92
Rate for Payer: Home State Health Plan Medicare Advantage	$18,355.92
Rate for Payer: Humana Commercial	$36,711.84
Rate for Payer: Humana Medicare Advantage	$18,355.92

PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$59,829.76

Service Code	MSDRG 335
Min. Negotiated Rate	$29,914.88
Max. Negotiated Rate	$59,829.76
Rate for Payer: Aetna Medicare Advantage	$29,914.88
Rate for Payer: Cigna Commercial HMO & PPO	$29,914.88
Rate for Payer: Home State Health Plan Medicare Advantage	$29,914.88
Rate for Payer: Humana Commercial	$59,829.76
Rate for Payer: Humana Medicare Advantage	$29,914.88

PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$27,673.90

Service Code	MSDRG 337
Min. Negotiated Rate	$13,836.95
Max. Negotiated Rate	$27,673.90
Rate for Payer: Aetna Medicare Advantage	$13,836.95
Rate for Payer: Cigna Commercial HMO & PPO	$13,836.95
Rate for Payer: Home State Health Plan Medicare Advantage	$13,836.95
Rate for Payer: Humana Commercial	$27,673.90
Rate for Payer: Humana Medicare Advantage	$13,836.95

PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK

Facility

$24,974.96

Service Code	APR-DRG 1702
Min. Negotiated Rate	$24,974.96
Max. Negotiated Rate	$24,974.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$24,974.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24,974.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24,974.96
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24,974.96

PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK

Facility

$24,974.96

Service Code	APR-DRG 1701
Min. Negotiated Rate	$24,974.96
Max. Negotiated Rate	$24,974.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$24,974.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24,974.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24,974.96
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24,974.96

PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK

Facility

$50,465.79

Service Code	APR-DRG 1704
Min. Negotiated Rate	$50,465.79
Max. Negotiated Rate	$50,465.79
Rate for Payer: Aetna Better Health Medicaid/QHP	$50,465.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$50,465.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$50,465.79
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$50,465.79

PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK

Facility

$33,840.17

Service Code	APR-DRG 1703
Min. Negotiated Rate	$33,840.17
Max. Negotiated Rate	$33,840.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$33,840.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33,840.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33,840.17
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33,840.17

PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC

Facility

$37,061.58

Service Code	MSDRG 243
Min. Negotiated Rate	$18,530.79
Max. Negotiated Rate	$37,061.58
Rate for Payer: Aetna Medicare Advantage	$18,530.79
Rate for Payer: Cigna Commercial HMO & PPO	$18,530.79
Rate for Payer: Home State Health Plan Medicare Advantage	$18,530.79
Rate for Payer: Humana Commercial	$37,061.58
Rate for Payer: Humana Medicare Advantage	$18,530.79

PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility

$53,837.40

Service Code	MSDRG 242
Min. Negotiated Rate	$26,918.70
Max. Negotiated Rate	$53,837.40
Rate for Payer: Aetna Medicare Advantage	$26,918.70
Rate for Payer: Cigna Commercial HMO & PPO	$26,918.70
Rate for Payer: Home State Health Plan Medicare Advantage	$26,918.70
Rate for Payer: Humana Commercial	$53,837.40
Rate for Payer: Humana Medicare Advantage	$26,918.70

PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK

Facility

$41,578.39

Service Code	APR-DRG 1714
Min. Negotiated Rate	$41,578.39
Max. Negotiated Rate	$41,578.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$41,578.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$41,578.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$41,578.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$41,578.39

PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK

Facility

$20,245.12

Service Code	APR-DRG 1712
Min. Negotiated Rate	$20,245.12
Max. Negotiated Rate	$20,245.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,245.12
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,245.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,245.12
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,245.12

PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK

Facility

$25,080.35

Service Code	APR-DRG 1713
Min. Negotiated Rate	$25,080.35
Max. Negotiated Rate	$25,080.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$25,080.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25,080.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25,080.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25,080.35

PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK

Facility

$12,038.16

Service Code	APR-DRG 1711
Min. Negotiated Rate	$12,038.16
Max. Negotiated Rate	$12,038.16
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,038.16
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,038.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,038.16
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,038.16

PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

$31,966.80

Service Code	MSDRG 244
Min. Negotiated Rate	$15,983.40
Max. Negotiated Rate	$31,966.80
Rate for Payer: Aetna Medicare Advantage	$15,983.40
Rate for Payer: Cigna Commercial HMO & PPO	$15,983.40
Rate for Payer: Home State Health Plan Medicare Advantage	$15,983.40
Rate for Payer: Humana Commercial	$31,966.80
Rate for Payer: Humana Medicare Advantage	$15,983.40

PERMETHRIN 5% 60GM CRM EMP

Facility

$373.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2626893
Hospital Revenue Code	250
Min. Negotiated Rate	$134.28
Max. Negotiated Rate	$266.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$220.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$266.32
Rate for Payer: Cash Price	$335.70
Rate for Payer: UnitedHealthcare Commercial	$248.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$134.28

PERMETHRIN 5% 60GM CRM EMP

Facility

$373.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2626893
Hospital Revenue Code	250
Rate for Payer: Cash Price	$335.70

Know your out-of-pocket cost for care.

All Charges