Madison Medical Center

All Charges

Charge

Type

Setting

Price

CHOLSCTYSTECTOMY OPEN & IOC

Professional

Both

$2,543.00

Service Code	CPT 47605
Hospital Charge Code	4147605
Hospital Revenue Code	975
Min. Negotiated Rate	$854.87
Max. Negotiated Rate	$1,015.49
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,015.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$854.87
Rate for Payer: Cash Price	$2,288.70
Rate for Payer: Cash Price	$2,288.70
Rate for Payer: Cigna Commercial HMO & PPO	$1,015.49
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$854.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$940.36
Rate for Payer: Home State Health Plan Medicare Advantage	$1,015.49
Rate for Payer: Optum Medicare Advantage	$890.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$854.87

CHOLSCTYSTECTOMY W/XPLOR OF COMMON DUCT

Professional

Both

$3,017.00

Service Code	CPT 47610
Hospital Charge Code	4147610
Hospital Revenue Code	975
Min. Negotiated Rate	$950.77
Max. Negotiated Rate	$1,125.59
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,125.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$950.77
Rate for Payer: Cash Price	$2,715.30
Rate for Payer: Cash Price	$2,715.30
Rate for Payer: Cigna Commercial HMO & PPO	$1,125.59
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$950.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,045.85
Rate for Payer: Home State Health Plan Medicare Advantage	$1,125.59
Rate for Payer: Optum Medicare Advantage	$1,055.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$950.77

CHROMATIN ANTIBODY

Facility

$163.00

Service Code	CPT 86235
Hospital Charge Code	221234
Hospital Revenue Code	302
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$116.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.14
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$96.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$116.38
Rate for Payer: Cash Price	$146.70
Rate for Payer: Cash Price	$146.70
Rate for Payer: Cash Price	$146.70
Rate for Payer: Cigna Commercial HMO & PPO	$17.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.27
Rate for Payer: Home State Health Plan Medicare Advantage	$17.93
Rate for Payer: Humana Commercial	$35.86
Rate for Payer: Humana Medicare Advantage	$17.93
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$58.68

CHROMATIN ANTIBODY

Facility

$163.00

Service Code	CPT 86235
Hospital Charge Code	221234
Hospital Revenue Code	302
Rate for Payer: Cash Price	$146.70

CHROMIUM

Facility

$394.00

Service Code	CPT 82495
Hospital Charge Code	2282495
Hospital Revenue Code	301
Min. Negotiated Rate	$18.25
Max. Negotiated Rate	$281.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.25
Rate for Payer: Aetna Medicare Advantage	$20.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$233.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$281.32
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cigna Commercial HMO & PPO	$20.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19.53
Rate for Payer: Home State Health Plan Medicare Advantage	$20.28
Rate for Payer: Humana Commercial	$40.56
Rate for Payer: Humana Medicare Advantage	$20.28
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$141.84

CHROMIUM

Facility

$394.00

Service Code	CPT 82495
Hospital Charge Code	2282495
Hospital Revenue Code	301
Rate for Payer: Cash Price	$354.60

CHROMOGRANIN A

Facility

$265.00

Service Code	CPT 86316
Hospital Charge Code	228631
Hospital Revenue Code	301
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$189.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.73
Rate for Payer: Aetna Medicare Advantage	$20.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$156.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$189.21
Rate for Payer: Cash Price	$238.50
Rate for Payer: Cash Price	$238.50
Rate for Payer: Cash Price	$238.50
Rate for Payer: Cigna Commercial HMO & PPO	$20.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.04
Rate for Payer: Home State Health Plan Medicare Advantage	$20.81
Rate for Payer: Humana Commercial	$41.62
Rate for Payer: Humana Medicare Advantage	$20.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.40

CHROMOGRANIN A

Facility

$265.00

Service Code	CPT 86316
Hospital Charge Code	228631
Hospital Revenue Code	301
Rate for Payer: Cash Price	$238.50

CHRONIC KIDNEY DISEASE

Facility

$16,014.64

Service Code	APR-DRG 4703
Min. Negotiated Rate	$16,014.64
Max. Negotiated Rate	$16,014.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$16,014.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16,014.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16,014.64
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16,014.64

CHRONIC KIDNEY DISEASE

Facility

$34,438.19

Service Code	APR-DRG 4704
Min. Negotiated Rate	$34,438.19
Max. Negotiated Rate	$34,438.19
Rate for Payer: Aetna Better Health Medicaid/QHP	$34,438.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$34,438.19
Rate for Payer: Home State Health Plan Medicaid Managed Care	$34,438.19
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$34,438.19

CHRONIC KIDNEY DISEASE

Facility

$5,993.83

Service Code	APR-DRG 4701
Min. Negotiated Rate	$5,993.83
Max. Negotiated Rate	$5,993.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,993.83
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,993.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,993.83
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,993.83

CHRONIC KIDNEY DISEASE

Facility

$11,036.94

Service Code	APR-DRG 4702
Min. Negotiated Rate	$11,036.94
Max. Negotiated Rate	$11,036.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,036.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,036.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,036.94
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,036.94

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$12,401.87

Service Code	APR-DRG 1403
Min. Negotiated Rate	$12,401.87
Max. Negotiated Rate	$12,401.87
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,401.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,401.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,401.87
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,401.87

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$6,496.45

Service Code	APR-DRG 1401
Min. Negotiated Rate	$6,496.45
Max. Negotiated Rate	$6,496.45
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,496.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,496.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,496.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,496.45

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$8,247.73

Service Code	APR-DRG 1402
Min. Negotiated Rate	$8,247.73
Max. Negotiated Rate	$8,247.73
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,247.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,247.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,247.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,247.73

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$23,484.83

Service Code	APR-DRG 1404
Min. Negotiated Rate	$23,484.83
Max. Negotiated Rate	$23,484.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,484.83
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,484.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,484.83
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,484.83

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC

Facility

$16,836.94

Service Code	MSDRG 191
Min. Negotiated Rate	$8,418.47
Max. Negotiated Rate	$16,836.94
Rate for Payer: Aetna Medicare Advantage	$8,418.47
Rate for Payer: Cigna Commercial HMO & PPO	$8,418.47
Rate for Payer: Home State Health Plan Medicare Advantage	$8,418.47
Rate for Payer: Humana Commercial	$16,836.94
Rate for Payer: Humana Medicare Advantage	$8,418.47

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC

Facility

$20,979.32

Service Code	MSDRG 190
Min. Negotiated Rate	$10,489.66
Max. Negotiated Rate	$20,979.32
Rate for Payer: Aetna Medicare Advantage	$10,489.66
Rate for Payer: Cigna Commercial HMO & PPO	$10,489.66
Rate for Payer: Home State Health Plan Medicare Advantage	$10,489.66
Rate for Payer: Humana Commercial	$20,979.32
Rate for Payer: Humana Medicare Advantage	$10,489.66

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC

Facility

$13,698.12

Service Code	MSDRG 192
Min. Negotiated Rate	$6,849.06
Max. Negotiated Rate	$13,698.12
Rate for Payer: Aetna Medicare Advantage	$6,849.06
Rate for Payer: Cigna Commercial HMO & PPO	$6,849.06
Rate for Payer: Home State Health Plan Medicare Advantage	$6,849.06
Rate for Payer: Humana Commercial	$13,698.12
Rate for Payer: Humana Medicare Advantage	$6,849.06

CHRONIC URTICARIA INDEX

Facility

$415.00

Service Code	CPT 86849
Hospital Charge Code	2286849
Hospital Revenue Code	301
Rate for Payer: Cash Price	$373.50

CHRONIC URTICARIA INDEX

Facility

$415.00

Service Code	CPT 86849
Hospital Charge Code	2286849
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$296.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$245.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$296.31
Rate for Payer: Cash Price	$373.50
Rate for Payer: Cash Price	$373.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$149.40

CHRONIC UTICARIA PROFILE

Facility

$362.00

Service Code	CPT 86352
Hospital Charge Code	2286352
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$271.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$122.27
Rate for Payer: Aetna Medicare Advantage	$135.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$214.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$258.47
Rate for Payer: Cash Price	$325.80
Rate for Payer: Cash Price	$325.80
Rate for Payer: Cash Price	$325.80
Rate for Payer: Cigna Commercial HMO & PPO	$135.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$122.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$130.83
Rate for Payer: Home State Health Plan Medicare Advantage	$135.86
Rate for Payer: Humana Commercial	$271.72
Rate for Payer: Humana Medicare Advantage	$135.86
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$122.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$130.32

CHRONIC UTICARIA PROFILE

Facility

$362.00

Service Code	CPT 86352
Hospital Charge Code	2286352
Hospital Revenue Code	301
Rate for Payer: Cash Price	$325.80

CHULANGIOGRAM DRIP

Facility

$421.00

Hospital Charge Code	2800118
Hospital Revenue Code	271
Min. Negotiated Rate	$151.56
Max. Negotiated Rate	$300.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$249.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$300.59
Rate for Payer: Cash Price	$378.90
Rate for Payer: UnitedHealthcare Commercial	$280.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$151.56

CHULANGIOGRAM DRIP

Facility

$421.00

Hospital Charge Code	2800118
Hospital Revenue Code	271
Rate for Payer: Cash Price	$378.90

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