Madison Medical Center

All Charges

Charge

Type

Setting

Price

REST HOME EST PT LEVEL 2

Facility

$145.00

Service Code	CPT 99348
Hospital Charge Code	4499335
Hospital Revenue Code	525
Rate for Payer: Cash Price	$130.50

REST HOME EST PT LEVEL 3

Facility

$215.00

Service Code	CPT 99349
Hospital Charge Code	4499336
Hospital Revenue Code	525
Rate for Payer: Cash Price	$193.50

REST HOME EST PT LEVEL 3

Facility

$215.00

Service Code	CPT 99349
Hospital Charge Code	4499336
Hospital Revenue Code	525
Min. Negotiated Rate	$127.28
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$127.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$153.51
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: UnitedHealthcare Commercial	$143.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REST HOME EST PT LEVEL 4

Facility

$310.00

Service Code	CPT 99350
Hospital Charge Code	4499337
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$221.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$183.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$221.34
Rate for Payer: Cash Price	$279.00
Rate for Payer: Cash Price	$279.00
Rate for Payer: UnitedHealthcare Commercial	$206.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REST HOME EST PT LEVEL 4

Facility

$310.00

Service Code	CPT 99350
Hospital Charge Code	4499337
Hospital Revenue Code	525
Rate for Payer: Cash Price	$279.00

REST HOME NEW PT LEVEL 3

Facility

$245.00

Service Code	CPT 99344
Hospital Charge Code	4499326
Hospital Revenue Code	525
Min. Negotiated Rate	$145.04
Max. Negotiated Rate	$174.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$145.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.93
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: UnitedHealthcare Commercial	$163.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REST HOME NEW PT LEVEL 3

Facility

$245.00

Service Code	CPT 99344
Hospital Charge Code	4499326
Hospital Revenue Code	525
Rate for Payer: Cash Price	$220.50

REST HOME NEW PT LEVEL 4

Facility

$330.00

Service Code	CPT 99345
Hospital Charge Code	4499327
Hospital Revenue Code	525
Rate for Payer: Cash Price	$297.00

REST HOME NEW PT LEVEL 4

Facility

$330.00

Service Code	CPT 99345
Hospital Charge Code	4499327
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$235.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$195.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$235.62
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: UnitedHealthcare Commercial	$220.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REST HOME NEW PT LEVEL 5

Facility

$415.00

Service Code	CPT 99345
Hospital Charge Code	4499328
Hospital Revenue Code	525
Rate for Payer: Cash Price	$373.50

REST HOME NEW PT LEVEL 5

Facility

$415.00

Service Code	CPT 99345
Hospital Charge Code	4499328
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$296.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$245.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$296.31
Rate for Payer: Cash Price	$373.50
Rate for Payer: Cash Price	$373.50
Rate for Payer: UnitedHealthcare Commercial	$276.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

RESTRAINT, WRIST

Facility

$52.00

Hospital Charge Code	2818640
Hospital Revenue Code	271
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$37.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.13
Rate for Payer: Cash Price	$46.80
Rate for Payer: UnitedHealthcare Commercial	$34.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.72

RESTRAINT, WRIST

Facility

$52.00

Hospital Charge Code	2818640
Hospital Revenue Code	271
Rate for Payer: Cash Price	$46.80

RETICULOCYTE COUNT AUTOMATED

Facility

$70.00

Service Code	CPT 85045
Hospital Charge Code	2285045
Hospital Revenue Code	305
Rate for Payer: Cash Price	$63.00

RETICULOCYTE COUNT AUTOMATED

Facility

$70.00

Service Code	CPT 85045
Hospital Charge Code	2285045
Hospital Revenue Code	305
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$49.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.59
Rate for Payer: Aetna Medicare Advantage	$3.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$3.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.84
Rate for Payer: Home State Health Plan Medicare Advantage	$3.99
Rate for Payer: Humana Commercial	$7.98
Rate for Payer: Humana Medicare Advantage	$3.99
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC

Facility

$19,512.98

Service Code	MSDRG 815
Min. Negotiated Rate	$9,756.49
Max. Negotiated Rate	$19,512.98
Rate for Payer: Aetna Medicare Advantage	$9,756.49
Rate for Payer: Cigna Commercial HMO & PPO	$9,756.49
Rate for Payer: Home State Health Plan Medicare Advantage	$9,756.49
Rate for Payer: Humana Commercial	$19,512.98
Rate for Payer: Humana Medicare Advantage	$9,756.49

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC

Facility

$36,995.44

Service Code	MSDRG 814
Min. Negotiated Rate	$18,497.72
Max. Negotiated Rate	$36,995.44
Rate for Payer: Aetna Medicare Advantage	$18,497.72
Rate for Payer: Cigna Commercial HMO & PPO	$18,497.72
Rate for Payer: Home State Health Plan Medicare Advantage	$18,497.72
Rate for Payer: Humana Commercial	$36,995.44
Rate for Payer: Humana Medicare Advantage	$18,497.72

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC

Facility

$13,542.34

Service Code	MSDRG 816
Min. Negotiated Rate	$6,771.17
Max. Negotiated Rate	$13,542.34
Rate for Payer: Aetna Medicare Advantage	$6,771.17
Rate for Payer: Cigna Commercial HMO & PPO	$6,771.17
Rate for Payer: Home State Health Plan Medicare Advantage	$6,771.17
Rate for Payer: Humana Commercial	$13,542.34
Rate for Payer: Humana Medicare Advantage	$6,771.17

REVISION OF HIP OR KNEE REPLACEMENT WITH CC

Facility

$59,127.12

Service Code	MSDRG 467
Min. Negotiated Rate	$29,563.56
Max. Negotiated Rate	$59,127.12
Rate for Payer: Aetna Medicare Advantage	$29,563.56
Rate for Payer: Cigna Commercial HMO & PPO	$29,563.56
Rate for Payer: Home State Health Plan Medicare Advantage	$29,563.56
Rate for Payer: Humana Commercial	$59,127.12
Rate for Payer: Humana Medicare Advantage	$29,563.56

REVISION OF HIP OR KNEE REPLACEMENT WITH MCC

Facility

$85,768.38

Service Code	MSDRG 466
Min. Negotiated Rate	$42,884.19
Max. Negotiated Rate	$85,768.38
Rate for Payer: Aetna Medicare Advantage	$42,884.19
Rate for Payer: Cigna Commercial HMO & PPO	$42,884.19
Rate for Payer: Home State Health Plan Medicare Advantage	$42,884.19
Rate for Payer: Humana Commercial	$85,768.38
Rate for Payer: Humana Medicare Advantage	$42,884.19

REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC

Facility

$46,800.62

Service Code	MSDRG 468
Min. Negotiated Rate	$23,400.31
Max. Negotiated Rate	$46,800.62
Rate for Payer: Aetna Medicare Advantage	$23,400.31
Rate for Payer: Cigna Commercial HMO & PPO	$23,400.31
Rate for Payer: Home State Health Plan Medicare Advantage	$23,400.31
Rate for Payer: Humana Commercial	$46,800.62
Rate for Payer: Humana Medicare Advantage	$23,400.31

REVISION OF PACEMAKER

Professional

Both

$1,439.00

Service Code	CPT 33216
Hospital Charge Code	4133216
Hospital Revenue Code	975
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$503.65
Rate for Payer: Aetna Commercial/Medicare Advantage	$315.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$280.00
Rate for Payer: Cash Price	$1,295.10
Rate for Payer: Cash Price	$1,295.10
Rate for Payer: Cigna Commercial HMO & PPO	$315.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$280.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$308.00
Rate for Payer: Home State Health Plan Medicare Advantage	$315.70
Rate for Payer: Optum Medicare Advantage	$503.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$280.00

REV OF GASTRO ANASTOMOSIS-ROUX-EN-Y

Professional

Both

$3,418.00

Service Code	CPT 43860
Hospital Charge Code	4143860
Hospital Revenue Code	975
Min. Negotiated Rate	$1,196.30
Max. Negotiated Rate	$1,458.03
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,458.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$1,237.91
Rate for Payer: Cash Price	$3,076.20
Rate for Payer: Cash Price	$3,076.20
Rate for Payer: Cigna Commercial HMO & PPO	$1,458.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,237.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,361.70
Rate for Payer: Home State Health Plan Medicare Advantage	$1,458.03
Rate for Payer: Optum Medicare Advantage	$1,196.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,237.91

RFA GROUNDING PAD

Facility

$93.00

Hospital Charge Code	127773
Hospital Revenue Code	271
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$66.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: UnitedHealthcare Commercial	$62.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

RFA GROUNDING PAD

Facility

$93.00

Hospital Charge Code	127773
Hospital Revenue Code	271
Rate for Payer: Cash Price	$83.70

Know your out-of-pocket cost for care.

All Charges