Madison Medical Center

All Charges

Charge

Type

Setting

Price

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 WITH CC

Facility

$47,771.96

Service Code	MSDRG 800
Min. Negotiated Rate	$23,885.98
Max. Negotiated Rate	$47,771.96
Rate for Payer: Aetna Medicare Advantage	$23,885.98
Rate for Payer: Cigna Commercial HMO & PPO	$23,885.98
Rate for Payer: Home State Health Plan Medicare Advantage	$23,885.98
Rate for Payer: Humana Commercial	$47,771.96
Rate for Payer: Humana Medicare Advantage	$23,885.98

SPLENIC PROCEDURES WITH MCC

Facility

$75,029.18

Service Code	MSDRG 799
Min. Negotiated Rate	$37,514.59
Max. Negotiated Rate	$75,029.18
Rate for Payer: Aetna Medicare Advantage	$37,514.59
Rate for Payer: Cigna Commercial HMO & PPO	$37,514.59
Rate for Payer: Home State Health Plan Medicare Advantage	$37,514.59
Rate for Payer: Humana Commercial	$75,029.18
Rate for Payer: Humana Medicare Advantage	$37,514.59

SPLENIC PROCEDURES WITHOUT CC/MCC

Facility

$33,564.22

Service Code	MSDRG 801
Min. Negotiated Rate	$16,782.11
Max. Negotiated Rate	$33,564.22
Rate for Payer: Aetna Medicare Advantage	$16,782.11
Rate for Payer: Cigna Commercial HMO & PPO	$16,782.11
Rate for Payer: Home State Health Plan Medicare Advantage	$16,782.11
Rate for Payer: Humana Commercial	$33,564.22
Rate for Payer: Humana Medicare Advantage	$16,782.11

SPLINT FINGER 1-1/2

Facility

$24.00

Hospital Charge Code	2819846
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

SPLINT FINGER 1-1/2

Facility

$24.00

Hospital Charge Code	2819846
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

SPLINT FINGER 3

Facility

$91.00

Hospital Charge Code	2819847
Hospital Revenue Code	271
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$64.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: UnitedHealthcare Commercial	$60.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

SPLINT FINGER 3

Facility

$91.00

Hospital Charge Code	2819847
Hospital Revenue Code	271
Rate for Payer: Cash Price	$81.90

SPLINT FINGER 5-1/2

Facility

$91.00

Hospital Charge Code	2819848
Hospital Revenue Code	271
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$64.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: UnitedHealthcare Commercial	$60.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

SPLINT FINGER 5-1/2

Facility

$91.00

Hospital Charge Code	2819848
Hospital Revenue Code	271
Rate for Payer: Cash Price	$81.90

SPLINT FINGER ONLY

Professional

Both

$250.00

Service Code	CPT 29130
Hospital Charge Code	1829130
Hospital Revenue Code	981
Min. Negotiated Rate	$24.73
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$24.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$30.76
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial HMO & PPO	$24.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33.84
Rate for Payer: Home State Health Plan Medicare Advantage	$24.73
Rate for Payer: Optum Medicare Advantage	$87.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$30.76

SPLINT, FINGER STRIP

Facility

$91.00

Hospital Charge Code	2819850
Hospital Revenue Code	271
Rate for Payer: Cash Price	$81.90

SPLINT, FINGER STRIP

Facility

$91.00

Hospital Charge Code	2819850
Hospital Revenue Code	271
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$64.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: UnitedHealthcare Commercial	$60.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

SPLINT FINGER TOAD--LG

Facility

$24.00

Hospital Charge Code	2819856
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

SPLINT FINGER TOAD--LG

Facility

$24.00

Hospital Charge Code	2819856
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

SPLINT FINGER TOAD--MED

Facility

$24.00

Hospital Charge Code	2819855
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

SPLINT FINGER TOAD--MED

Facility

$24.00

Hospital Charge Code	2819855
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

SPLINT FINGER TOAD--SM

Facility

$24.00

Hospital Charge Code	2819854
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

SPLINT FINGER TOAD--SM

Facility

$24.00

Hospital Charge Code	2819854
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

SPLINT FOUR PRONG FINGER 2

Facility

$24.00

Hospital Charge Code	2819851
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

SPLINT FOUR PRONG FINGER 2

Facility

$24.00

Hospital Charge Code	2819851
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

SPLINT FOUR PRONG FINGER 3

Facility

$24.00

Hospital Charge Code	2819852
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

SPLINT FOUR PRONG FINGER 3

Facility

$24.00

Hospital Charge Code	2819852
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

SPLINT FOUR PRONG FINGER 3-1/2

Facility

$24.00

Hospital Charge Code	2819853
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

SPLINT FOUR PRONG FINGER 3-1/2

Facility

$24.00

Hospital Charge Code	2819853
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

Know your out-of-pocket cost for care.

All Charges