Madison Medical Center

All Charges

Charge

Type

Setting

Price

RESPIRATORY MALIGNANCY

Facility

$21,445.14

Service Code	APR-DRG 1364
Min. Negotiated Rate	$21,445.14
Max. Negotiated Rate	$21,445.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$21,445.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21,445.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21,445.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21,445.14

RESPIRATORY MALIGNANCY

Facility

$15,247.17

Service Code	APR-DRG 1363
Min. Negotiated Rate	$15,247.17
Max. Negotiated Rate	$15,247.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,247.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,247.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,247.17
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,247.17

RESPIRATORY MALIGNANCY

Facility

$8,457.50

Service Code	APR-DRG 1361
Min. Negotiated Rate	$8,457.50
Max. Negotiated Rate	$8,457.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,457.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,457.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,457.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,457.50

RESPIRATORY MALIGNANCY

Facility

$11,690.54

Service Code	APR-DRG 1362
Min. Negotiated Rate	$11,690.54
Max. Negotiated Rate	$11,690.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,690.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,690.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,690.54
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,690.54

RESPIRATORY NEOPLASMS WITH CC

Facility

$20,404.98

Service Code	MSDRG 181
Min. Negotiated Rate	$10,202.49
Max. Negotiated Rate	$20,404.98
Rate for Payer: Aetna Medicare Advantage	$10,202.49
Rate for Payer: Cigna Commercial HMO & PPO	$10,202.49
Rate for Payer: Home State Health Plan Medicare Advantage	$10,202.49
Rate for Payer: Humana Commercial	$20,404.98
Rate for Payer: Humana Medicare Advantage	$10,202.49

RESPIRATORY NEOPLASMS WITH MCC

Facility

$31,313.04

Service Code	MSDRG 180
Min. Negotiated Rate	$15,656.52
Max. Negotiated Rate	$31,313.04
Rate for Payer: Aetna Medicare Advantage	$15,656.52
Rate for Payer: Cigna Commercial HMO & PPO	$15,656.52
Rate for Payer: Home State Health Plan Medicare Advantage	$15,656.52
Rate for Payer: Humana Commercial	$31,313.04
Rate for Payer: Humana Medicare Advantage	$15,656.52

RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$15,441.02

Service Code	MSDRG 182
Min. Negotiated Rate	$7,720.51
Max. Negotiated Rate	$15,441.02
Rate for Payer: Aetna Medicare Advantage	$7,720.51
Rate for Payer: Cigna Commercial HMO & PPO	$7,720.51
Rate for Payer: Home State Health Plan Medicare Advantage	$7,720.51
Rate for Payer: Humana Commercial	$15,441.02
Rate for Payer: Humana Medicare Advantage	$7,720.51

RESPIRATORY SIGNS AND SYMPTOMS

Facility

$16,279.82

Service Code	MSDRG 204
Min. Negotiated Rate	$8,139.91
Max. Negotiated Rate	$16,279.82
Rate for Payer: Aetna Medicare Advantage	$8,139.91
Rate for Payer: Cigna Commercial HMO & PPO	$8,139.91
Rate for Payer: Home State Health Plan Medicare Advantage	$8,139.91
Rate for Payer: Humana Commercial	$16,279.82
Rate for Payer: Humana Medicare Advantage	$8,139.91

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$6,191.24

Service Code	APR-DRG 1441
Min. Negotiated Rate	$6,191.24
Max. Negotiated Rate	$6,191.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,191.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,191.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,191.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,191.24

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$10,392.62

Service Code	APR-DRG 1442
Min. Negotiated Rate	$10,392.62
Max. Negotiated Rate	$10,392.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,392.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,392.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,392.62
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,392.62

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$13,961.79

Service Code	APR-DRG 1443
Min. Negotiated Rate	$13,961.79
Max. Negotiated Rate	$13,961.79
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,961.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,961.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,961.79
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,961.79

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$26,619.20

Service Code	APR-DRG 1444
Min. Negotiated Rate	$26,619.20
Max. Negotiated Rate	$26,619.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$26,619.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26,619.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26,619.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26,619.20

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$46,811.70

Service Code	MSDRG 208
Min. Negotiated Rate	$23,405.85
Max. Negotiated Rate	$46,811.70
Rate for Payer: Aetna Medicare Advantage	$23,405.85
Rate for Payer: Cigna Commercial HMO & PPO	$23,405.85
Rate for Payer: Home State Health Plan Medicare Advantage	$23,405.85
Rate for Payer: Humana Commercial	$46,811.70
Rate for Payer: Humana Medicare Advantage	$23,405.85

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$65,025.03

Service Code	APR-DRG 1303
Min. Negotiated Rate	$65,025.03
Max. Negotiated Rate	$65,025.03
Rate for Payer: Aetna Better Health Medicaid/QHP	$65,025.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$65,025.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$65,025.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$65,025.03

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$55,330.01

Service Code	APR-DRG 1302
Min. Negotiated Rate	$55,330.01
Max. Negotiated Rate	$55,330.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$55,330.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55,330.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$55,330.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55,330.01

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$95,392.65

Service Code	APR-DRG 1304
Min. Negotiated Rate	$95,392.65
Max. Negotiated Rate	$95,392.65
Rate for Payer: Aetna Better Health Medicaid/QHP	$95,392.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$95,392.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$95,392.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$95,392.65

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$43,177.64

Service Code	APR-DRG 1301
Min. Negotiated Rate	$43,177.64
Max. Negotiated Rate	$43,177.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$43,177.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$43,177.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$43,177.64
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$43,177.64

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

Facility

$105,283.10

Service Code	MSDRG 207
Min. Negotiated Rate	$52,641.55
Max. Negotiated Rate	$105,283.10
Rate for Payer: Aetna Medicare Advantage	$52,641.55
Rate for Payer: Cigna Commercial HMO & PPO	$52,641.55
Rate for Payer: Home State Health Plan Medicare Advantage	$52,641.55
Rate for Payer: Humana Commercial	$105,283.10
Rate for Payer: Humana Medicare Advantage	$52,641.55

.RESPIRATORY VIRAL PANEL (DO NOT USE)

Facility

$414.00

Service Code	CPT 87633
Hospital Charge Code	2287633
Hospital Revenue Code	305
Rate for Payer: Cash Price	$372.60

.RESPIRATORY VIRAL PANEL (DO NOT USE)

Facility

$414.00

Service Code	CPT 87633
Hospital Charge Code	2287633
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$833.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$375.10
Rate for Payer: Aetna Medicare Advantage	$416.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$245.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$295.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: Cigna Commercial HMO & PPO	$416.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$375.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$401.36
Rate for Payer: Home State Health Plan Medicare Advantage	$416.78
Rate for Payer: Humana Commercial	$833.56
Rate for Payer: Humana Medicare Advantage	$416.78
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$375.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$149.04

RESP VIRAL PANEL (LC 139845)

Facility

$710.00

Service Code	CPT 87633QW
Hospital Charge Code	2287632
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$506.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$420.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$506.94
Rate for Payer: Cash Price	$639.00
Rate for Payer: Cash Price	$639.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$255.60

RESP VIRAL PANEL (LC 139845)

Facility

$710.00

Service Code	CPT 87633QW
Hospital Charge Code	2287632
Hospital Revenue Code	305
Rate for Payer: Cash Price	$639.00

REST HOME EST PT LEVEL 1

Facility

$105.00

Service Code	CPT 99347
Hospital Charge Code	4499334
Hospital Revenue Code	525
Rate for Payer: Cash Price	$94.50

REST HOME EST PT LEVEL 1

Facility

$105.00

Service Code	CPT 99347
Hospital Charge Code	4499334
Hospital Revenue Code	525
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: UnitedHealthcare Commercial	$70.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REST HOME EST PT LEVEL 2

Facility

$145.00

Service Code	CPT 99348
Hospital Charge Code	4499335
Hospital Revenue Code	525
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$85.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$103.53
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: UnitedHealthcare Commercial	$96.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges