Madison Medical Center

All Charges

Charge

Type

Setting

Price

SPINAL PROCEDURES

Facility

$22,066.42

Service Code	APR-DRG 0232
Min. Negotiated Rate	$22,066.42
Max. Negotiated Rate	$22,066.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,066.42
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,066.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,066.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,066.42

SPINAL PROCEDURES

Facility

$19,475.92

Service Code	APR-DRG 0231
Min. Negotiated Rate	$19,475.92
Max. Negotiated Rate	$19,475.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,475.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,475.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,475.92
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,475.92

SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS

Facility

$57,303.16

Service Code	MSDRG 029
Min. Negotiated Rate	$28,651.58
Max. Negotiated Rate	$57,303.16
Rate for Payer: Aetna Medicare Advantage	$28,651.58
Rate for Payer: Cigna Commercial HMO & PPO	$28,651.58
Rate for Payer: Home State Health Plan Medicare Advantage	$28,651.58
Rate for Payer: Humana Commercial	$57,303.16
Rate for Payer: Humana Medicare Advantage	$28,651.58

SPINAL PROCEDURES WITH MCC

Facility

$98,514.16

Service Code	MSDRG 028
Min. Negotiated Rate	$49,257.08
Max. Negotiated Rate	$98,514.16
Rate for Payer: Aetna Medicare Advantage	$49,257.08
Rate for Payer: Cigna Commercial HMO & PPO	$49,257.08
Rate for Payer: Home State Health Plan Medicare Advantage	$49,257.08
Rate for Payer: Humana Commercial	$98,514.16
Rate for Payer: Humana Medicare Advantage	$49,257.08

SPINAL PROCEDURES WITHOUT CC/MCC

Facility

$38,074.54

Service Code	MSDRG 030
Min. Negotiated Rate	$19,037.27
Max. Negotiated Rate	$38,074.54
Rate for Payer: Aetna Medicare Advantage	$19,037.27
Rate for Payer: Cigna Commercial HMO & PPO	$19,037.27
Rate for Payer: Home State Health Plan Medicare Advantage	$19,037.27
Rate for Payer: Humana Commercial	$38,074.54
Rate for Payer: Humana Medicare Advantage	$19,037.27

SPINAL PUNCTURE, LUMBAR

Professional

Both

$1,164.00

Service Code	CPT 62272
Hospital Charge Code	1862272
Hospital Revenue Code	981
Min. Negotiated Rate	$81.99
Max. Negotiated Rate	$407.40
Rate for Payer: Aetna Commercial/Medicare Advantage	$81.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$130.31
Rate for Payer: Cash Price	$1,047.60
Rate for Payer: Cash Price	$1,047.60
Rate for Payer: Cigna Commercial HMO & PPO	$81.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$130.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$143.34
Rate for Payer: Home State Health Plan Medicare Advantage	$81.99
Rate for Payer: Optum Medicare Advantage	$407.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$130.31

SPINE (BACK) BOARD

Facility

$65.00

Hospital Charge Code	1886665
Hospital Revenue Code	271
Rate for Payer: Cash Price	$58.50

SPINE (BACK) BOARD

Facility

$65.00

Hospital Charge Code	1886665
Hospital Revenue Code	271
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

SPINE SINGLE VIEW

Facility

$385.00

Service Code	CPT 72020
Hospital Charge Code	3272020
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$274.89
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	$227.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$274.89
Rate for Payer: Cash Price	$346.50
Rate for Payer: Cash Price	$346.50
Rate for Payer: Cash Price	$346.50
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	$138.60

SPINE SINGLE VIEW

Facility

$385.00

Service Code	CPT 72020
Hospital Charge Code	3272020
Hospital Revenue Code	320
Rate for Payer: Cash Price	$346.50

SPIROMETRY

Facility

$384.00

Service Code	CPT 94010
Hospital Charge Code	4594010
Hospital Revenue Code	460
Min. Negotiated Rate	$138.24
Max. Negotiated Rate	$441.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$194.65
Rate for Payer: Aetna Medicare Advantage	$220.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$227.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$274.18
Rate for Payer: Cash Price	$345.60
Rate for Payer: Cash Price	$345.60
Rate for Payer: Cash Price	$345.60
Rate for Payer: Cigna Commercial HMO & PPO	$220.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$194.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$208.28
Rate for Payer: Home State Health Plan Medicare Advantage	$220.60
Rate for Payer: Humana Commercial	$441.20
Rate for Payer: Humana Medicare Advantage	$220.60
Rate for Payer: UnitedHealthcare Commercial	$256.13
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$194.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$138.24

SPIROMETRY

Facility

$384.00

Service Code	CPT 94010
Hospital Charge Code	4594010
Hospital Revenue Code	460
Rate for Payer: Cash Price	$345.60

SPIRONOLACTONE 100MG TAB EMP

Facility

$9.00

Service Code	NDC 5.3746E+10
Hospital Charge Code	2622722
Hospital Revenue Code	250
Rate for Payer: Cash Price	$8.10

SPIRONOLACTONE 100MG TAB EMP

Facility

$9.00

Service Code	NDC 5.3746E+10
Hospital Charge Code	2622722
Hospital Revenue Code	250
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$6.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$6.43
Rate for Payer: Cash Price	$8.10
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.24

SPIRONOLACTONE 25MG TAB EMP

Facility

$18.00

Service Code	NDC 5.3746E+10
Hospital Charge Code	2620884
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

SPIRONOLACTONE 25MG TAB EMP

Facility

$18.00

Service Code	NDC 5.3746E+10
Hospital Charge Code	2620884
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

SPIRONOLACTONE 50MG TAB EMP

Facility

$9.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2622479
Hospital Revenue Code	250
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$6.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$6.43
Rate for Payer: Cash Price	$8.10
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.24

SPIRONOLACTONE 50MG TAB EMP

Facility

$9.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2622479
Hospital Revenue Code	250
Rate for Payer: Cash Price	$8.10

SPIRONOLACTONE (ALDACTONE) 25MG TAB UD

Facility

$18.00

Service Code	NDC 6.0687E+10
Hospital Charge Code	2656210
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

SPIRONOLACTONE (ALDACTONE) 25MG TAB UD

Facility

$18.00

Service Code	NDC 6.0687E+10
Hospital Charge Code	2656210
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

SPIRONOLACTONE/HCTZ 25/25MG TAB EMP

Facility

$18.00

Service Code	NDC 378040301
Hospital Charge Code	2625271
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

SPIRONOLACTONE/HCTZ 25/25MG TAB EMP

Facility

$18.00

Service Code	NDC 378040301
Hospital Charge Code	2625271
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

SPLENIC PROCEDURES

Facility

$23,960.76

Service Code	APR-DRG 6502
Min. Negotiated Rate	$23,960.76
Max. Negotiated Rate	$23,960.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,960.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,960.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,960.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,960.76

SPLENIC PROCEDURES

Facility

$17,151.68

Service Code	APR-DRG 6501
Min. Negotiated Rate	$17,151.68
Max. Negotiated Rate	$17,151.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,151.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,151.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,151.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,151.68

SPLENIC PROCEDURES

Facility

$30,757.82

Service Code	APR-DRG 6503
Min. Negotiated Rate	$30,757.82
Max. Negotiated Rate	$30,757.82
Rate for Payer: Aetna Better Health Medicaid/QHP	$30,757.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30,757.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$30,757.82
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$30,757.82

Know your out-of-pocket cost for care.

All Charges