Madison Medical Center

All Charges

Charge

Type

Setting

Price

CERUMEN REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	9369210
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CERUMEN REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	9369210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

CERVICAL COLLAR FIRM EX-LARGE

Facility

$153.00

Hospital Charge Code	283246
Hospital Revenue Code	271
Rate for Payer: Cash Price	$137.70

CERVICAL COLLAR FIRM EX-LARGE

Facility

$153.00

Hospital Charge Code	283246
Hospital Revenue Code	271
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$109.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: UnitedHealthcare Commercial	$102.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

CERVICAL COLLAR FIRM LARGE

Facility

$153.00

Hospital Charge Code	283244
Hospital Revenue Code	271
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$109.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: UnitedHealthcare Commercial	$102.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

CERVICAL COLLAR FIRM LARGE

Facility

$153.00

Hospital Charge Code	283244
Hospital Revenue Code	271
Rate for Payer: Cash Price	$137.70

CERVICAL COLLAR FIRM MEDIUM

Facility

$153.00

Hospital Charge Code	283245
Hospital Revenue Code	271
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$109.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: UnitedHealthcare Commercial	$102.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

CERVICAL COLLAR FIRM MEDIUM

Facility

$153.00

Hospital Charge Code	283245
Hospital Revenue Code	271
Rate for Payer: Cash Price	$137.70

CERVICAL COLLAR FIRM SMALL

Facility

$153.00

Hospital Charge Code	283243
Hospital Revenue Code	271
Rate for Payer: Cash Price	$137.70

CERVICAL COLLAR FIRM SMALL

Facility

$153.00

Hospital Charge Code	283243
Hospital Revenue Code	271
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$109.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: UnitedHealthcare Commercial	$102.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

CERVICAL DILATION EXAM W/ANESTHESIA

Facility

$100.00

Service Code	CPT 57800
Hospital Charge Code	4257800
Hospital Revenue Code	521
Min. Negotiated Rate	$59.20
Max. Negotiated Rate	$6,614.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,918.10
Rate for Payer: Aetna Medicare Advantage	$3,307.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cigna Commercial HMO & PPO	$3,307.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,626.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,122.37
Rate for Payer: Home State Health Plan Medicare Advantage	$3,307.24
Rate for Payer: Humana Commercial	$6,614.48
Rate for Payer: Humana Medicare Advantage	$3,307.24
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,918.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CERVICAL DILATION EXAM W/ANESTHESIA

Facility

$100.00

Service Code	CPT 57800
Hospital Charge Code	4257800
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.00

CERVICAL EXAMINATION

Facility

$66.00

Service Code	CPT G0101
Hospital Charge Code	410101
Hospital Revenue Code	521
Rate for Payer: Cash Price	$59.40

CERVICAL EXAMINATION

Facility

$66.00

Service Code	CPT G0101
Hospital Charge Code	410101
Hospital Revenue Code	521
Min. Negotiated Rate	$39.07
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$59.40
Rate for Payer: Aetna Medicare Advantage	$103.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.12
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cigna Commercial HMO & PPO	$103.79
Rate for Payer: Home State Health Plan Medicare Advantage	$103.79
Rate for Payer: Humana Commercial	$207.58
Rate for Payer: Humana Medicare Advantage	$103.79
Rate for Payer: UnitedHealthcare Commercial	$44.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CERVICAL SPINAL FUSION WITH CC

Facility

$49,934.58

Service Code	MSDRG 472
Min. Negotiated Rate	$24,967.29
Max. Negotiated Rate	$49,934.58
Rate for Payer: Aetna Medicare Advantage	$24,967.29
Rate for Payer: Cigna Commercial HMO & PPO	$24,967.29
Rate for Payer: Home State Health Plan Medicare Advantage	$24,967.29
Rate for Payer: Humana Commercial	$49,934.58
Rate for Payer: Humana Medicare Advantage	$24,967.29

CERVICAL SPINAL FUSION WITH MCC

Facility

$79,788.40

Service Code	MSDRG 471
Min. Negotiated Rate	$39,894.20
Max. Negotiated Rate	$79,788.40
Rate for Payer: Aetna Medicare Advantage	$39,894.20
Rate for Payer: Cigna Commercial HMO & PPO	$39,894.20
Rate for Payer: Home State Health Plan Medicare Advantage	$39,894.20
Rate for Payer: Humana Commercial	$79,788.40
Rate for Payer: Humana Medicare Advantage	$39,894.20

CERVICAL SPINAL FUSION WITHOUT CC/MCC

Facility

$41,952.18

Service Code	MSDRG 473
Min. Negotiated Rate	$20,976.09
Max. Negotiated Rate	$41,952.18
Rate for Payer: Aetna Medicare Advantage	$20,976.09
Rate for Payer: Cigna Commercial HMO & PPO	$20,976.09
Rate for Payer: Home State Health Plan Medicare Advantage	$20,976.09
Rate for Payer: Humana Commercial	$41,952.18
Rate for Payer: Humana Medicare Advantage	$20,976.09

CESAREAN SECTION

Facility

$1,668.00

Service Code	CPT 59515
Hospital Charge Code	4259515
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,501.20

CESAREAN SECTION

Facility

$1,668.00

Service Code	CPT 59515
Hospital Charge Code	4259515
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,190.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$987.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,190.95
Rate for Payer: Cash Price	$1,501.20
Rate for Payer: Cash Price	$1,501.20
Rate for Payer: UnitedHealthcare Commercial	$1,112.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CESAREAN SECTION WITHOUT STERILIZATION

Facility

$9,228.73

Service Code	APR-DRG 5402
Min. Negotiated Rate	$9,228.73
Max. Negotiated Rate	$9,228.73
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,228.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,228.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,228.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,228.73

CESAREAN SECTION WITHOUT STERILIZATION

Facility

$6,934.47

Service Code	APR-DRG 5401
Min. Negotiated Rate	$6,934.47
Max. Negotiated Rate	$6,934.47
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,934.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,934.47
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,934.47
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,934.47

CESAREAN SECTION WITHOUT STERILIZATION

Facility

$13,771.48

Service Code	APR-DRG 5403
Min. Negotiated Rate	$13,771.48
Max. Negotiated Rate	$13,771.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,771.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,771.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,771.48
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,771.48

CESAREAN SECTION WITHOUT STERILIZATION

Facility

$40,310.54

Service Code	APR-DRG 5404
Min. Negotiated Rate	$40,310.54
Max. Negotiated Rate	$40,310.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$40,310.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$40,310.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$40,310.54
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$40,310.54

CESAREAN SECTION WITHOUT STERILIZATION WITH CC

Facility

$21,121.70

Service Code	MSDRG 787
Min. Negotiated Rate	$10,560.85
Max. Negotiated Rate	$21,121.70
Rate for Payer: Aetna Medicare Advantage	$10,560.85
Rate for Payer: Cigna Commercial HMO & PPO	$10,560.85
Rate for Payer: Home State Health Plan Medicare Advantage	$10,560.85
Rate for Payer: Humana Commercial	$21,121.70
Rate for Payer: Humana Medicare Advantage	$10,560.85

CESAREAN SECTION WITHOUT STERILIZATION WITH MCC

Facility

$29,477.72

Service Code	MSDRG 786
Min. Negotiated Rate	$14,738.86
Max. Negotiated Rate	$29,477.72
Rate for Payer: Aetna Medicare Advantage	$14,738.86
Rate for Payer: Cigna Commercial HMO & PPO	$14,738.86
Rate for Payer: Home State Health Plan Medicare Advantage	$14,738.86
Rate for Payer: Humana Commercial	$29,477.72
Rate for Payer: Humana Medicare Advantage	$14,738.86

Know your out-of-pocket cost for care.

All Charges