Madison Medical Center

All Charges

Charge

Type

Setting

Price

ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$5,413.96

Service Code	APR-DRG 5642
Min. Negotiated Rate	$5,413.96
Max. Negotiated Rate	$5,413.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,413.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,413.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,413.96
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,413.96

ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$21,988.10

Service Code	APR-DRG 5644
Min. Negotiated Rate	$21,988.10
Max. Negotiated Rate	$21,988.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$21,988.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21,988.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21,988.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21,988.10

ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$4,059.00

Service Code	APR-DRG 5641
Min. Negotiated Rate	$4,059.00
Max. Negotiated Rate	$4,059.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,059.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,059.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,059.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,059.00

.AB PANEL COMPONENT

Facility

$36.00

Service Code	CPT 86235
Hospital Charge Code	2229841
Hospital Revenue Code	302
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$35.86
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	$21.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$25.70
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
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	$12.96

.AB PANEL COMPONENT

Facility

$36.00

Service Code	CPT 86235
Hospital Charge Code	2229841
Hospital Revenue Code	302
Rate for Payer: Cash Price	$32.40

ABRASION SINGLE LESION

Facility

$95.00

Service Code	CPT 15786
Hospital Charge Code	9815786
Hospital Revenue Code	521
Min. Negotiated Rate	$56.24
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$67.83
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$63.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ABRASION SINGLE LESION

Facility

$95.00

Service Code	CPT 15786
Hospital Charge Code	9815786
Hospital Revenue Code	521
Rate for Payer: Cash Price	$85.50

ACAPELLA PEP

Facility

$235.00

Service Code	CPT E0484
Hospital Charge Code	4500331
Hospital Revenue Code	271
Min. Negotiated Rate	$84.60
Max. Negotiated Rate	$167.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.79
Rate for Payer: Cash Price	$211.50
Rate for Payer: UnitedHealthcare Commercial	$156.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.60

ACAPELLA PEP

Facility

$235.00

Service Code	CPT E0484
Hospital Charge Code	4500331
Hospital Revenue Code	271
Rate for Payer: Cash Price	$211.50

ACAPPELA DEMO HOURLY

Facility

$139.00

Service Code	CPT 94664
Hospital Charge Code	4594016
Hospital Revenue Code	460
Min. Negotiated Rate	$50.04
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$82.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$99.25
Rate for Payer: Cash Price	$125.10
Rate for Payer: Cash Price	$125.10
Rate for Payer: Cash Price	$125.10
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$92.71
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$50.04

ACAPPELA DEMO HOURLY

Facility

$139.00

Service Code	CPT 94664
Hospital Charge Code	4594016
Hospital Revenue Code	460
Rate for Payer: Cash Price	$125.10

A/C BE-BAG

Facility

$65.00

Hospital Charge Code	2800131
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

A/C BE-BAG

Facility

$65.00

Hospital Charge Code	2800131
Hospital Revenue Code	271
Rate for Payer: Cash Price	$58.50

AC BE-BAG

Facility

$63.00

Hospital Charge Code	3200131
Hospital Revenue Code	271
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

AC BE-BAG

Facility

$63.00

Hospital Charge Code	3200131
Hospital Revenue Code	271
Rate for Payer: Cash Price	$56.70

AC B.E. KIT

Facility

$199.00

Hospital Charge Code	3200130
Hospital Revenue Code	271
Min. Negotiated Rate	$71.64
Max. Negotiated Rate	$142.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$117.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.09
Rate for Payer: Cash Price	$179.10
Rate for Payer: UnitedHealthcare Commercial	$132.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.64

AC B.E. KIT

Facility

$199.00

Hospital Charge Code	3200130
Hospital Revenue Code	271
Rate for Payer: Cash Price	$179.10

ACCUTYPE IL28

Facility

$427.00

Service Code	CPT 81400
Hospital Charge Code	2203898
Hospital Revenue Code	305
Rate for Payer: Cash Price	$384.30

ACCUTYPE IL28

Facility

$427.00

Service Code	CPT 81400
Hospital Charge Code	2203898
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$304.88
Rate for Payer: Aetna Better Health Medicaid/QHP	$57.56
Rate for Payer: Aetna Medicare Advantage	$63.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$252.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$304.88
Rate for Payer: Cash Price	$384.30
Rate for Payer: Cash Price	$384.30
Rate for Payer: Cash Price	$384.30
Rate for Payer: Cigna Commercial HMO & PPO	$63.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$57.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$61.59
Rate for Payer: Home State Health Plan Medicare Advantage	$63.96
Rate for Payer: Humana Commercial	$127.92
Rate for Payer: Humana Medicare Advantage	$63.96
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$57.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$153.72

ACEBUTOLOL (SECTRAL) 200MG TAB EMP

Facility

$24.00

Service Code	NDC 5.3746E+10
Hospital Charge Code	2627161
Hospital Revenue Code	250
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

ACEBUTOLOL (SECTRAL) 200MG TAB EMP

Facility

$24.00

Service Code	NDC 5.3746E+10
Hospital Charge Code	2627161
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

ACEF 500 MG

Facility

$11.00

Service Code	HCPCS J0690
Hospital Charge Code	4400690
Hospital Revenue Code	636
Min. Negotiated Rate	$7.34
Max. Negotiated Rate	$7.34
Rate for Payer: Cash Price	$9.90
Rate for Payer: UnitedHealthcare Commercial	$7.34

ACEF 500 MG

Facility

$11.00

Service Code	HCPCS J0690
Hospital Charge Code	4400690
Hospital Revenue Code	636
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$7.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$6.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.85
Rate for Payer: Cash Price	$9.90
Rate for Payer: UnitedHealthcare Commercial	$7.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.96

ACETAMIN/COD(TYL#3)120/12.5/5ML SOL C5

Facility

$19.00

Service Code	NDC 121050404
Hospital Charge Code	2654011
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$13.57
Rate for Payer: Cash Price	$17.10
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.84

ACETAMIN/COD(TYL#3)120/12.5/5ML SOL C5

Facility

$19.00

Service Code	NDC 121050404
Hospital Charge Code	2654011
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

Know your out-of-pocket cost for care.

All Charges