Madison Medical Center

All Charges

Charge

Type

Setting

Price

SHORT MEDIUM BLADE 18.5 X 9.0

Facility

$244.00

Hospital Charge Code	127780
Hospital Revenue Code	271
Rate for Payer: Cash Price	$219.60

SHOULDER-1 VIEW LT

Facility

$312.00

Service Code	CPT 73020
Hospital Charge Code	3273021
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$222.77
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$184.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$222.77
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$112.32

SHOULDER-1 VIEW LT

Facility

$312.00

Service Code	CPT 73020
Hospital Charge Code	3273021
Hospital Revenue Code	320
Rate for Payer: Cash Price	$280.80

SHOULDER-1 VIEW RT

Facility

$312.00

Service Code	CPT 73020
Hospital Charge Code	3273020
Hospital Revenue Code	320
Rate for Payer: Cash Price	$280.80

SHOULDER-1 VIEW RT

Facility

$312.00

Service Code	CPT 73020
Hospital Charge Code	3273020
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$222.77
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$184.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$222.77
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$112.32

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$17,162.77

Service Code	APR-DRG 3221
Min. Negotiated Rate	$17,162.77
Max. Negotiated Rate	$17,162.77
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,162.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,162.77
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,162.77

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$41,448.04

Service Code	APR-DRG 3224
Min. Negotiated Rate	$41,448.04
Max. Negotiated Rate	$41,448.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$41,448.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$41,448.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$41,448.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$41,448.04

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$26,193.47

Service Code	APR-DRG 3223
Min. Negotiated Rate	$26,193.47
Max. Negotiated Rate	$26,193.47
Rate for Payer: Aetna Better Health Medicaid/QHP	$26,193.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26,193.47
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26,193.47
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26,193.47

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$19,932.63

Service Code	APR-DRG 3222
Min. Negotiated Rate	$19,932.63
Max. Negotiated Rate	$19,932.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,932.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,932.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,932.63
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,932.63

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC

Facility

$36,250.26

Service Code	MSDRG 511
Min. Negotiated Rate	$18,125.13
Max. Negotiated Rate	$36,250.26
Rate for Payer: Aetna Medicare Advantage	$18,125.13
Rate for Payer: Cigna Commercial HMO & PPO	$18,125.13
Rate for Payer: Home State Health Plan Medicare Advantage	$18,125.13
Rate for Payer: Humana Commercial	$36,250.26
Rate for Payer: Humana Medicare Advantage	$18,125.13

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC

Facility

$51,111.58

Service Code	MSDRG 510
Min. Negotiated Rate	$25,555.79
Max. Negotiated Rate	$51,111.58
Rate for Payer: Aetna Medicare Advantage	$25,555.79
Rate for Payer: Cigna Commercial HMO & PPO	$25,555.79
Rate for Payer: Home State Health Plan Medicare Advantage	$25,555.79
Rate for Payer: Humana Commercial	$51,111.58
Rate for Payer: Humana Medicare Advantage	$25,555.79

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$29,570.66

Service Code	MSDRG 512
Min. Negotiated Rate	$14,785.33
Max. Negotiated Rate	$29,570.66
Rate for Payer: Aetna Medicare Advantage	$14,785.33
Rate for Payer: Cigna Commercial HMO & PPO	$14,785.33
Rate for Payer: Home State Health Plan Medicare Advantage	$14,785.33
Rate for Payer: Humana Commercial	$29,570.66
Rate for Payer: Humana Medicare Advantage	$14,785.33

SHOULDER IMMOB EX-LARGE

Facility

$489.00

Hospital Charge Code	2819235
Hospital Revenue Code	271
Rate for Payer: Cash Price	$440.10

SHOULDER IMMOB EX-LARGE

Facility

$489.00

Hospital Charge Code	2819235
Hospital Revenue Code	271
Min. Negotiated Rate	$176.04
Max. Negotiated Rate	$349.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$289.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$349.15
Rate for Payer: Cash Price	$440.10
Rate for Payer: UnitedHealthcare Commercial	$326.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$176.04

SHOULDER IMMOB LARGE

Facility

$489.00

Hospital Charge Code	2819234
Hospital Revenue Code	271
Min. Negotiated Rate	$176.04
Max. Negotiated Rate	$349.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$289.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$349.15
Rate for Payer: Cash Price	$440.10
Rate for Payer: UnitedHealthcare Commercial	$326.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$176.04

SHOULDER IMMOB LARGE

Facility

$489.00

Hospital Charge Code	2819234
Hospital Revenue Code	271
Rate for Payer: Cash Price	$440.10

SHOULDER IMMOB MEDIUM

Facility

$489.00

Hospital Charge Code	2819233
Hospital Revenue Code	271
Rate for Payer: Cash Price	$440.10

SHOULDER IMMOB MEDIUM

Facility

$489.00

Hospital Charge Code	2819233
Hospital Revenue Code	271
Min. Negotiated Rate	$176.04
Max. Negotiated Rate	$349.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$289.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$349.15
Rate for Payer: Cash Price	$440.10
Rate for Payer: UnitedHealthcare Commercial	$326.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$176.04

SHOULDER IMMOB SMALL

Facility

$489.00

Hospital Charge Code	2819232
Hospital Revenue Code	271
Rate for Payer: Cash Price	$440.10

SHOULDER IMMOB SMALL

Facility

$489.00

Hospital Charge Code	2819232
Hospital Revenue Code	271
Min. Negotiated Rate	$176.04
Max. Negotiated Rate	$349.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$289.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$349.15
Rate for Payer: Cash Price	$440.10
Rate for Payer: UnitedHealthcare Commercial	$326.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$176.04

SHOULDER STRAPPING

Professional

Both

$282.00

Service Code	CPT 29240
Hospital Charge Code	1829240
Hospital Revenue Code	981
Min. Negotiated Rate	$15.03
Max. Negotiated Rate	$98.70
Rate for Payer: Aetna Commercial/Medicare Advantage	$15.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$34.80
Rate for Payer: Cash Price	$253.80
Rate for Payer: Cash Price	$253.80
Rate for Payer: Cigna Commercial HMO & PPO	$15.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$34.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$38.28
Rate for Payer: Home State Health Plan Medicare Advantage	$15.03
Rate for Payer: Optum Medicare Advantage	$98.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$34.80

SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$12,590.10

Service Code	APR-DRG 3152
Min. Negotiated Rate	$12,590.10
Max. Negotiated Rate	$12,590.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,590.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,590.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,590.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,590.10

SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$43,047.45

Service Code	APR-DRG 3154
Min. Negotiated Rate	$43,047.45
Max. Negotiated Rate	$43,047.45
Rate for Payer: Aetna Better Health Medicaid/QHP	$43,047.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$43,047.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$43,047.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$43,047.45

SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$25,702.55

Service Code	APR-DRG 3153
Min. Negotiated Rate	$25,702.55
Max. Negotiated Rate	$25,702.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$25,702.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25,702.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25,702.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25,702.55

SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$8,395.56

Service Code	APR-DRG 3151
Min. Negotiated Rate	$8,395.56
Max. Negotiated Rate	$8,395.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,395.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,395.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,395.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,395.56

Know your out-of-pocket cost for care.

All Charges