Madison Medical Center

All Charges

Charge

Type

Setting

Price

SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC

Facility

$18,968.36

Service Code	MSDRG 053
Min. Negotiated Rate	$9,484.18
Max. Negotiated Rate	$18,968.36
Rate for Payer: Aetna Medicare Advantage	$9,484.18
Rate for Payer: Cigna Commercial HMO & PPO	$9,484.18
Rate for Payer: Home State Health Plan Medicare Advantage	$9,484.18
Rate for Payer: Humana Commercial	$18,968.36
Rate for Payer: Humana Medicare Advantage	$9,484.18

SPINAL FLUID TAP

Professional

Both

$840.00

Service Code	CPT 62270
Hospital Charge Code	1862270
Hospital Revenue Code	981
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$294.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$57.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$97.45
Rate for Payer: Cash Price	$756.00
Rate for Payer: Cash Price	$756.00
Rate for Payer: Cigna Commercial HMO & PPO	$57.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$97.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$107.19
Rate for Payer: Home State Health Plan Medicare Advantage	$57.24
Rate for Payer: Optum Medicare Advantage	$294.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$97.45

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$70,651.74

Service Code	APR-DRG 3214
Min. Negotiated Rate	$70,651.74
Max. Negotiated Rate	$70,651.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$70,651.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$70,651.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$70,651.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$70,651.74

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$11,795.01

Service Code	APR-DRG 3211
Min. Negotiated Rate	$11,795.01
Max. Negotiated Rate	$11,795.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,795.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,795.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,795.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,795.01

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$40,423.67

Service Code	APR-DRG 3213
Min. Negotiated Rate	$40,423.67
Max. Negotiated Rate	$40,423.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$40,423.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$40,423.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$40,423.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$40,423.67

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$17,417.01

Service Code	APR-DRG 3212
Min. Negotiated Rate	$17,417.01
Max. Negotiated Rate	$17,417.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,417.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,417.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,417.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,417.01

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$97,796.62

Service Code	MSDRG 457
Min. Negotiated Rate	$48,898.31
Max. Negotiated Rate	$97,796.62
Rate for Payer: Aetna Medicare Advantage	$48,898.31
Rate for Payer: Cigna Commercial HMO & PPO	$48,898.31
Rate for Payer: Home State Health Plan Medicare Advantage	$48,898.31
Rate for Payer: Humana Commercial	$97,796.62
Rate for Payer: Humana Medicare Advantage	$48,898.31

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$136,535.60

Service Code	MSDRG 456
Min. Negotiated Rate	$68,267.80
Max. Negotiated Rate	$136,535.60
Rate for Payer: Aetna Medicare Advantage	$68,267.80
Rate for Payer: Cigna Commercial HMO & PPO	$68,267.80
Rate for Payer: Home State Health Plan Medicare Advantage	$68,267.80
Rate for Payer: Humana Commercial	$136,535.60
Rate for Payer: Humana Medicare Advantage	$68,267.80

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC

Facility

$69,373.04

Service Code	MSDRG 458
Min. Negotiated Rate	$34,686.52
Max. Negotiated Rate	$69,373.04
Rate for Payer: Aetna Medicare Advantage	$34,686.52
Rate for Payer: Cigna Commercial HMO & PPO	$34,686.52
Rate for Payer: Home State Health Plan Medicare Advantage	$34,686.52
Rate for Payer: Humana Commercial	$69,373.04
Rate for Payer: Humana Medicare Advantage	$34,686.52

SPINAL MANIPULATION 1 - 2

Facility

$95.00

Service Code	CPT 98925
Hospital Charge Code	9898925
Hospital Revenue Code	521
Rate for Payer: Cash Price	$85.50

SPINAL MANIPULATION 1 - 2

Facility

$95.00

Service Code	CPT 98925
Hospital Charge Code	9898925
Hospital Revenue Code	521
Min. Negotiated Rate	$17.51
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.46
Rate for Payer: Aetna Medicare Advantage	$22.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$67.83
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cigna Commercial HMO & PPO	$22.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.82
Rate for Payer: Home State Health Plan Medicare Advantage	$22.06
Rate for Payer: Humana Commercial	$44.12
Rate for Payer: Humana Medicare Advantage	$22.06
Rate for Payer: UnitedHealthcare Commercial	$63.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SPINAL MANIPULATION 3 - 4

Facility

$130.00

Service Code	CPT 98926
Hospital Charge Code	9898926
Hospital Revenue Code	521
Rate for Payer: Cash Price	$117.00

SPINAL MANIPULATION 3 - 4

Facility

$130.00

Service Code	CPT 98926
Hospital Charge Code	9898926
Hospital Revenue Code	521
Min. Negotiated Rate	$17.51
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.46
Rate for Payer: Aetna Medicare Advantage	$22.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.82
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial HMO & PPO	$22.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.82
Rate for Payer: Home State Health Plan Medicare Advantage	$22.06
Rate for Payer: Humana Commercial	$44.12
Rate for Payer: Humana Medicare Advantage	$22.06
Rate for Payer: UnitedHealthcare Commercial	$86.71
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SPINAL MANIPULATION 5 - 6

Facility

$170.00

Service Code	CPT 98927
Hospital Charge Code	9898927
Hospital Revenue Code	521
Min. Negotiated Rate	$17.51
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.46
Rate for Payer: Aetna Medicare Advantage	$22.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$121.38
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cigna Commercial HMO & PPO	$22.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.82
Rate for Payer: Home State Health Plan Medicare Advantage	$22.06
Rate for Payer: Humana Commercial	$44.12
Rate for Payer: Humana Medicare Advantage	$22.06
Rate for Payer: UnitedHealthcare Commercial	$113.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SPINAL MANIPULATION 5 - 6

Facility

$170.00

Service Code	CPT 98927
Hospital Charge Code	9898927
Hospital Revenue Code	521
Rate for Payer: Cash Price	$153.00

SPINAL MANIPULATION 7-8

Facility

$195.00

Service Code	CPT 98928
Hospital Charge Code	9898928
Hospital Revenue Code	521
Rate for Payer: Cash Price	$175.50

SPINAL MANIPULATION 7-8

Facility

$195.00

Service Code	CPT 98928
Hospital Charge Code	9898928
Hospital Revenue Code	521
Min. Negotiated Rate	$17.51
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.46
Rate for Payer: Aetna Medicare Advantage	$22.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$115.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$139.23
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cigna Commercial HMO & PPO	$22.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.82
Rate for Payer: Home State Health Plan Medicare Advantage	$22.06
Rate for Payer: Humana Commercial	$44.12
Rate for Payer: Humana Medicare Advantage	$22.06
Rate for Payer: UnitedHealthcare Commercial	$130.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SPINAL MANIPULATION 9-10

Facility

$221.00

Service Code	CPT 98929
Hospital Charge Code	9898929
Hospital Revenue Code	521
Rate for Payer: Cash Price	$198.90

SPINAL MANIPULATION 9-10

Facility

$221.00

Service Code	CPT 98929
Hospital Charge Code	9898929
Hospital Revenue Code	521
Min. Negotiated Rate	$17.51
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.46
Rate for Payer: Aetna Medicare Advantage	$22.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$130.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$157.79
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cigna Commercial HMO & PPO	$22.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.82
Rate for Payer: Home State Health Plan Medicare Advantage	$22.06
Rate for Payer: Humana Commercial	$44.12
Rate for Payer: Humana Medicare Advantage	$22.06
Rate for Payer: UnitedHealthcare Commercial	$147.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SPINAL NEEDLE

Facility

$121.00

Hospital Charge Code	2824468
Hospital Revenue Code	270
Min. Negotiated Rate	$43.56
Max. Negotiated Rate	$86.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$71.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$86.39
Rate for Payer: Cash Price	$108.90
Rate for Payer: UnitedHealthcare Commercial	$80.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$43.56

SPINAL NEEDLE

Facility

$121.00

Hospital Charge Code	2824468
Hospital Revenue Code	270
Rate for Payer: Cash Price	$108.90

SPINAL NEEDLE 25GX5IN

Facility

$44.00

Hospital Charge Code	2824469
Hospital Revenue Code	270
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

SPINAL NEEDLE 25GX5IN

Facility

$44.00

Hospital Charge Code	2824469
Hospital Revenue Code	270
Rate for Payer: Cash Price	$39.60

SPINAL PROCEDURES

Facility

$43,337.75

Service Code	APR-DRG 0233
Min. Negotiated Rate	$43,337.75
Max. Negotiated Rate	$43,337.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$43,337.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$43,337.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$43,337.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$43,337.75

SPINAL PROCEDURES

Facility

$64,574.88

Service Code	APR-DRG 0234
Min. Negotiated Rate	$64,574.88
Max. Negotiated Rate	$64,574.88
Rate for Payer: Aetna Better Health Medicaid/QHP	$64,574.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64,574.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$64,574.88
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64,574.88

Know your out-of-pocket cost for care.

All Charges