Madison Medical Center

All Charges

Charge

Type

Setting

Price

CHOLECYSTECTOMY

Facility

$7,148.38

Service Code	APR-DRG 2631
Min. Negotiated Rate	$7,148.38
Max. Negotiated Rate	$7,148.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,148.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,148.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,148.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,148.38

CHOLECYSTECTOMY

Facility

$19,066.36

Service Code	APR-DRG 2633
Min. Negotiated Rate	$19,066.36
Max. Negotiated Rate	$19,066.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,066.36
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,066.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,066.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,066.36

CHOLECYSTECTOMY

Facility

$31,957.85

Service Code	APR-DRG 2634
Min. Negotiated Rate	$31,957.85
Max. Negotiated Rate	$31,957.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$31,957.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31,957.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$31,957.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31,957.85

CHOLECYSTECTOMY

Facility

$9,545.66

Service Code	APR-DRG 2632
Min. Negotiated Rate	$9,545.66
Max. Negotiated Rate	$9,545.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,545.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,545.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,545.66
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,545.66

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC

Facility

$36,050.18

Service Code	MSDRG 415
Min. Negotiated Rate	$18,025.09
Max. Negotiated Rate	$36,050.18
Rate for Payer: Aetna Medicare Advantage	$18,025.09
Rate for Payer: Cigna Commercial HMO & PPO	$18,025.09
Rate for Payer: Home State Health Plan Medicare Advantage	$18,025.09
Rate for Payer: Humana Commercial	$36,050.18
Rate for Payer: Humana Medicare Advantage	$18,025.09

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC

Facility

$59,698.10

Service Code	MSDRG 414
Min. Negotiated Rate	$29,849.05
Max. Negotiated Rate	$59,698.10
Rate for Payer: Aetna Medicare Advantage	$29,849.05
Rate for Payer: Cigna Commercial HMO & PPO	$29,849.05
Rate for Payer: Home State Health Plan Medicare Advantage	$29,849.05
Rate for Payer: Humana Commercial	$59,698.10
Rate for Payer: Humana Medicare Advantage	$29,849.05

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$24,979.80

Service Code	MSDRG 416
Min. Negotiated Rate	$12,489.90
Max. Negotiated Rate	$24,979.80
Rate for Payer: Aetna Medicare Advantage	$12,489.90
Rate for Payer: Cigna Commercial HMO & PPO	$12,489.90
Rate for Payer: Home State Health Plan Medicare Advantage	$12,489.90
Rate for Payer: Humana Commercial	$24,979.80
Rate for Payer: Humana Medicare Advantage	$12,489.90

CHOLECYSTECTOMY WITH C.D.E. WITH CC

Facility

$36,614.20

Service Code	MSDRG 412
Min. Negotiated Rate	$18,307.10
Max. Negotiated Rate	$36,614.20
Rate for Payer: Aetna Medicare Advantage	$18,307.10
Rate for Payer: Cigna Commercial HMO & PPO	$18,307.10
Rate for Payer: Home State Health Plan Medicare Advantage	$18,307.10
Rate for Payer: Humana Commercial	$36,614.20
Rate for Payer: Humana Medicare Advantage	$18,307.10

CHOLECYSTECTOMY WITH C.D.E. WITH MCC

Facility

$55,585.54

Service Code	MSDRG 411
Min. Negotiated Rate	$27,792.77
Max. Negotiated Rate	$55,585.54
Rate for Payer: Aetna Medicare Advantage	$27,792.77
Rate for Payer: Cigna Commercial HMO & PPO	$27,792.77
Rate for Payer: Home State Health Plan Medicare Advantage	$27,792.77
Rate for Payer: Humana Commercial	$55,585.54
Rate for Payer: Humana Medicare Advantage	$27,792.77

CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC

Facility

$29,651.00

Service Code	MSDRG 413
Min. Negotiated Rate	$14,825.50
Max. Negotiated Rate	$29,651.00
Rate for Payer: Aetna Medicare Advantage	$14,825.50
Rate for Payer: Cigna Commercial HMO & PPO	$14,825.50
Rate for Payer: Home State Health Plan Medicare Advantage	$14,825.50
Rate for Payer: Humana Commercial	$29,651.00
Rate for Payer: Humana Medicare Advantage	$14,825.50

CHOLECYSTOENTEROSTOMY; DIRECT

Professional

Both

$2,617.00

Service Code	CPT 47720
Hospital Charge Code	4147720
Hospital Revenue Code	975
Min. Negotiated Rate	$877.98
Max. Negotiated Rate	$1,045.24
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,045.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$877.98
Rate for Payer: Cash Price	$2,355.30
Rate for Payer: Cash Price	$2,355.30
Rate for Payer: Cigna Commercial HMO & PPO	$1,045.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$877.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$965.78
Rate for Payer: Home State Health Plan Medicare Advantage	$1,045.24
Rate for Payer: Optum Medicare Advantage	$915.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$877.98

CHOLEDOCHOTOMY W/REMOVAL OF CALCIUM

Professional

Both

$2,987.00

Service Code	CPT 47420 51
Hospital Charge Code	4147420
Hospital Revenue Code	975
Min. Negotiated Rate	$1,045.45
Max. Negotiated Rate	$1,045.45
Rate for Payer: Cash Price	$2,688.30
Rate for Payer: Optum Medicare Advantage	$1,045.45

CHOLEDOCHOTOMY W/TRANSDUO PLASTY/ROTOMYI

Professional

Both

$3,710.00

Service Code	CPT 47425
Hospital Charge Code	4147425
Hospital Revenue Code	975
Min. Negotiated Rate	$1,037.53
Max. Negotiated Rate	$1,298.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,229.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$1,037.53
Rate for Payer: Cash Price	$3,339.00
Rate for Payer: Cash Price	$3,339.00
Rate for Payer: Cigna Commercial HMO & PPO	$1,229.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,037.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,141.28
Rate for Payer: Home State Health Plan Medicare Advantage	$1,229.35
Rate for Payer: Optum Medicare Advantage	$1,298.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,037.53

CHOLEDOCHOTOMY W/XPLOR DRAIN/REMOVE CALC

Professional

Both

$2,149.00

Service Code	CPT 47480
Hospital Charge Code	4147480
Hospital Revenue Code	975
Min. Negotiated Rate	$663.63
Max. Negotiated Rate	$793.54
Rate for Payer: Aetna Commercial/Medicare Advantage	$793.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$663.63
Rate for Payer: Cash Price	$1,934.10
Rate for Payer: Cash Price	$1,934.10
Rate for Payer: Cigna Commercial HMO & PPO	$793.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$663.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$729.99
Rate for Payer: Home State Health Plan Medicare Advantage	$793.54
Rate for Payer: Optum Medicare Advantage	$752.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$663.63

CHOLESTEROL

Facility

$112.00

Service Code	CPT 82465
Hospital Charge Code	223115
Hospital Revenue Code	301
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.92
Rate for Payer: Aetna Medicare Advantage	$4.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$4.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.19
Rate for Payer: Home State Health Plan Medicare Advantage	$4.35
Rate for Payer: Humana Commercial	$8.70
Rate for Payer: Humana Medicare Advantage	$4.35
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

CHOLESTEROL

Facility

$112.00

Service Code	CPT 82465
Hospital Charge Code	223115
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

.CHOLESTEROL, TOTAL CPT 82465

Facility

$55.00

Service Code	CPT 82465
Hospital Charge Code	22282465
Hospital Revenue Code	307
Rate for Payer: Cash Price	$49.50

.CHOLESTEROL, TOTAL CPT 82465

Facility

$55.00

Service Code	CPT 82465
Hospital Charge Code	22282465
Hospital Revenue Code	307
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.92
Rate for Payer: Aetna Medicare Advantage	$4.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$4.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.19
Rate for Payer: Home State Health Plan Medicare Advantage	$4.35
Rate for Payer: Humana Commercial	$8.70
Rate for Payer: Humana Medicare Advantage	$4.35
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

CHOLESTYRAMINE 4GM PWDR PKT EMP

Facility

$119.00

Service Code	NDC 4.9884E+10
Hospital Charge Code	2623844
Hospital Revenue Code	250
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$84.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$70.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$84.97
Rate for Payer: Cash Price	$107.10
Rate for Payer: UnitedHealthcare Commercial	$79.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84

CHOLESTYRAMINE 4GM PWDR PKT EMP

Facility

$119.00

Service Code	NDC 4.9884E+10
Hospital Charge Code	2623844
Hospital Revenue Code	250
Rate for Payer: Cash Price	$107.10

CHOLESTYRAMINE (QUESTRAN) 4GM PWDR PKT

Facility

$119.00

Service Code	NDC 4.9884E+10
Hospital Charge Code	2626276
Hospital Revenue Code	250
Rate for Payer: Cash Price	$107.10

CHOLESTYRAMINE (QUESTRAN) 4GM PWDR PKT

Facility

$119.00

Service Code	NDC 4.9884E+10
Hospital Charge Code	2626276
Hospital Revenue Code	250
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$84.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$70.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$84.97
Rate for Payer: Cash Price	$107.10
Rate for Payer: UnitedHealthcare Commercial	$79.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84

CHOLINESTERASE

Facility

$107.00

Service Code	CPT 82480
Hospital Charge Code	223400
Hospital Revenue Code	301
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$76.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.08
Rate for Payer: Aetna Medicare Advantage	$7.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cigna Commercial HMO & PPO	$7.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.58
Rate for Payer: Home State Health Plan Medicare Advantage	$7.87
Rate for Payer: Humana Commercial	$15.74
Rate for Payer: Humana Medicare Advantage	$7.87
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

CHOLINESTERASE

Facility

$107.00

Service Code	CPT 82480
Hospital Charge Code	223400
Hospital Revenue Code	301
Rate for Payer: Cash Price	$96.30

CHOLSCTYSTECTOMY

Professional

Both

$2,340.00

Service Code	CPT 47600
Hospital Charge Code	4147600
Hospital Revenue Code	975
Min. Negotiated Rate	$810.11
Max. Negotiated Rate	$965.76
Rate for Payer: Aetna Commercial/Medicare Advantage	$965.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$810.11
Rate for Payer: Cash Price	$2,106.00
Rate for Payer: Cash Price	$2,106.00
Rate for Payer: Cigna Commercial HMO & PPO	$965.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$810.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$891.12
Rate for Payer: Home State Health Plan Medicare Advantage	$965.76
Rate for Payer: Optum Medicare Advantage	$819.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$810.11

Know your out-of-pocket cost for care.

All Charges