Madison Medical Center

All Charges

Charge

Type

Setting

Price

ACHR BLOCKING ANTIBODY

Facility

$126.00

Service Code	CPT 83519
Hospital Charge Code	2283536
Hospital Revenue Code	301
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$89.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.56
Rate for Payer: Aetna Medicare Advantage	$18.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cigna Commercial HMO & PPO	$18.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.72
Rate for Payer: Home State Health Plan Medicare Advantage	$18.40
Rate for Payer: Humana Commercial	$36.80
Rate for Payer: Humana Medicare Advantage	$18.40
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

ACHR BLOCKING ANTIBODY

Facility

$126.00

Service Code	CPT 83519
Hospital Charge Code	2283536
Hospital Revenue Code	301
Rate for Payer: Cash Price	$113.40

ACH RECEPTOR BINDING ANTIBODY

Facility

$563.00

Service Code	CPT 83519
Hospital Charge Code	2283535
Hospital Revenue Code	301
Rate for Payer: Cash Price	$506.70

ACH RECEPTOR BINDING ANTIBODY

Facility

$563.00

Service Code	CPT 83519
Hospital Charge Code	2283535
Hospital Revenue Code	301
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$401.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.56
Rate for Payer: Aetna Medicare Advantage	$18.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$333.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$401.98
Rate for Payer: Cash Price	$506.70
Rate for Payer: Cash Price	$506.70
Rate for Payer: Cash Price	$506.70
Rate for Payer: Cigna Commercial HMO & PPO	$18.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.72
Rate for Payer: Home State Health Plan Medicare Advantage	$18.40
Rate for Payer: Humana Commercial	$36.80
Rate for Payer: Humana Medicare Advantage	$18.40
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.68

ACHR MODULATING ANTIBODY

Facility

$445.00

Service Code	CPT 83519
Hospital Charge Code	2283537
Hospital Revenue Code	301
Rate for Payer: Cash Price	$400.50

ACHR MODULATING ANTIBODY

Facility

$445.00

Service Code	CPT 83519
Hospital Charge Code	2283537
Hospital Revenue Code	301
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$317.73
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.56
Rate for Payer: Aetna Medicare Advantage	$18.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$263.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$317.73
Rate for Payer: Cash Price	$400.50
Rate for Payer: Cash Price	$400.50
Rate for Payer: Cash Price	$400.50
Rate for Payer: Cigna Commercial HMO & PPO	$18.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.72
Rate for Payer: Home State Health Plan Medicare Advantage	$18.40
Rate for Payer: Humana Commercial	$36.80
Rate for Payer: Humana Medicare Advantage	$18.40
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$160.20

ACID PHOS

Facility

$112.00

Service Code	CPT 84066
Hospital Charge Code	221165
Hospital Revenue Code	301
Min. Negotiated Rate	$8.69
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.69
Rate for Payer: Aetna Medicare Advantage	$9.66
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	$9.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.30
Rate for Payer: Home State Health Plan Medicare Advantage	$9.66
Rate for Payer: Humana Commercial	$19.32
Rate for Payer: Humana Medicare Advantage	$9.66
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

ACID PHOS

Facility

$112.00

Service Code	CPT 84066
Hospital Charge Code	221165
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

AC JOINTS

Facility

$555.00

Service Code	CPT 73050
Hospital Charge Code	322421
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$396.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$328.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$396.27
Rate for Payer: Cash Price	$499.50
Rate for Payer: Cash Price	$499.50
Rate for Payer: Cash Price	$499.50
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$199.80

AC JOINTS

Facility

$555.00

Service Code	CPT 73050
Hospital Charge Code	322421
Hospital Revenue Code	320
Rate for Payer: Cash Price	$499.50

ACNE SURGERY EXAMPLE MARSUPIALIZATION OP

Facility

$185.00

Service Code	CPT 10040
Hospital Charge Code	9810040
Hospital Revenue Code	521
Rate for Payer: Cash Price	$166.50

ACNE SURGERY EXAMPLE MARSUPIALIZATION OP

Facility

$185.00

Service Code	CPT 10040
Hospital Charge Code	9810040
Hospital Revenue Code	521
Min. Negotiated Rate	$109.52
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	$109.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.09
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
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	$123.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ACTH

Facility

$199.00

Service Code	CPT 82024
Hospital Charge Code	2282024
Hospital Revenue Code	301
Rate for Payer: Cash Price	$179.10

ACTH

Facility

$199.00

Service Code	CPT 82024
Hospital Charge Code	2282024
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$142.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$34.76
Rate for Payer: Aetna Medicare Advantage	$38.62
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: Cash Price	$179.10
Rate for Payer: Cash Price	$179.10
Rate for Payer: Cigna Commercial HMO & PPO	$38.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$34.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37.19
Rate for Payer: Home State Health Plan Medicare Advantage	$38.62
Rate for Payer: Humana Commercial	$77.24
Rate for Payer: Humana Medicare Advantage	$38.62
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$34.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.64

ACTIVASE (ALTEPLASE) 100MG INJ

Facility

$48,141.00

Service Code	HCPCS J2997
Hospital Charge Code	2656423
Hospital Revenue Code	250
Min. Negotiated Rate	$98.59
Max. Negotiated Rate	$34,372.67
Rate for Payer: Aetna Medicare Advantage	$98.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28,499.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34,372.67
Rate for Payer: Cash Price	$43,326.90
Rate for Payer: Cash Price	$43,326.90
Rate for Payer: Cigna Commercial HMO & PPO	$98.59
Rate for Payer: Home State Health Plan Medicare Advantage	$98.59
Rate for Payer: Humana Commercial	$197.18
Rate for Payer: Humana Medicare Advantage	$98.59
Rate for Payer: UnitedHealthcare Commercial	$32,110.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,330.76

ACTIVASE (ALTEPLASE) 100MG INJ

Facility

$48,141.00

Service Code	HCPCS J2997
Hospital Charge Code	2656423
Hospital Revenue Code	250
Rate for Payer: Cash Price	$43,326.90

ACTIVASE (ALTEPLASE) 50MG INJ

Facility

$48,141.00

Service Code	HCPCS J2997
Hospital Charge Code	2626823
Hospital Revenue Code	250
Min. Negotiated Rate	$98.59
Max. Negotiated Rate	$34,372.67
Rate for Payer: Aetna Medicare Advantage	$98.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28,499.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34,372.67
Rate for Payer: Cash Price	$43,326.90
Rate for Payer: Cash Price	$43,326.90
Rate for Payer: Cigna Commercial HMO & PPO	$98.59
Rate for Payer: Home State Health Plan Medicare Advantage	$98.59
Rate for Payer: Humana Commercial	$197.18
Rate for Payer: Humana Medicare Advantage	$98.59
Rate for Payer: UnitedHealthcare Commercial	$32,110.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,330.76

ACTIVASE (ALTEPLASE) 50MG INJ

Facility

$48,141.00

Service Code	HCPCS J2997
Hospital Charge Code	2626823
Hospital Revenue Code	250
Rate for Payer: Cash Price	$43,326.90

ACTIVATED CHARCOAL 25GM

Facility

$101.00

Service Code	NDC 574012104
Hospital Charge Code	2654473
Hospital Revenue Code	250
Rate for Payer: Cash Price	$90.90

ACTIVATED CHARCOAL 25GM

Facility

$101.00

Service Code	NDC 574012104
Hospital Charge Code	2654473
Hospital Revenue Code	250
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

ACTIVATED PROTEIN C RESISTANCE

Facility

$135.00

Service Code	CPT 85240
Hospital Charge Code	2285308
Hospital Revenue Code	301
Min. Negotiated Rate	$16.11
Max. Negotiated Rate	$96.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.11
Rate for Payer: Aetna Medicare Advantage	$17.90
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: Cigna Commercial HMO & PPO	$17.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.24
Rate for Payer: Home State Health Plan Medicare Advantage	$17.90
Rate for Payer: Humana Commercial	$35.80
Rate for Payer: Humana Medicare Advantage	$17.90
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$48.60

ACTIVATED PROTEIN C RESISTANCE

Facility

$135.00

Service Code	CPT 85240
Hospital Charge Code	2285308
Hospital Revenue Code	301
Rate for Payer: Cash Price	$121.50

ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION

Facility

$18,671.04

Service Code	MSDRG 880
Min. Negotiated Rate	$9,335.52
Max. Negotiated Rate	$18,671.04
Rate for Payer: Aetna Medicare Advantage	$9,335.52
Rate for Payer: Cigna Commercial HMO & PPO	$9,335.52
Rate for Payer: Home State Health Plan Medicare Advantage	$9,335.52
Rate for Payer: Humana Commercial	$18,671.04
Rate for Payer: Humana Medicare Advantage	$9,335.52

ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$27,681.36

Service Code	APR-DRG 1934
Min. Negotiated Rate	$27,681.36
Max. Negotiated Rate	$27,681.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,681.36
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,681.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,681.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,681.36

ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$14,131.35

Service Code	APR-DRG 1932
Min. Negotiated Rate	$14,131.35
Max. Negotiated Rate	$14,131.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,131.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,131.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,131.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,131.35

Know your out-of-pocket cost for care.

All Charges