Madison Medical Center

All Charges

Charge

Type

Setting

Price

COLLAGENASE (SANTYL) 30GM OINT

Facility

$1,225.00

Service Code	NDC 64501030
Hospital Charge Code	2626308
Hospital Revenue Code	250
Min. Negotiated Rate	$441.00
Max. Negotiated Rate	$874.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$725.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$874.65
Rate for Payer: Cash Price	$1,102.50
Rate for Payer: UnitedHealthcare Commercial	$817.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$441.00

COLLAGENASE (SANTYL) 30GM OINT

Facility

$1,225.00

Service Code	NDC 64501030
Hospital Charge Code	2626308
Hospital Revenue Code	250
Rate for Payer: Cash Price	$1,102.50

COLLECTION OF BLOOD FROM CENTRAL OR PERI

Facility

$165.00

Service Code	CPT 36592
Hospital Charge Code	536592
Hospital Revenue Code	300
Rate for Payer: Cash Price	$148.50

COLLECTION OF BLOOD FROM CENTRAL OR PERI

Facility

$165.00

Service Code	CPT 36592
Hospital Charge Code	536592
Hospital Revenue Code	300
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$271.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$119.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

COLLECTION OF BLOOD FROM IMPLANTED DEVIC

Facility

$201.00

Service Code	CPT 36591
Hospital Charge Code	536591
Hospital Revenue Code	300
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$271.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$118.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$143.51
Rate for Payer: Cash Price	$180.90
Rate for Payer: Cash Price	$180.90
Rate for Payer: Cash Price	$180.90
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$119.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$72.36

COLLECTION OF BLOOD FROM IMPLANTED DEVIC

Facility

$201.00

Service Code	CPT 36591
Hospital Charge Code	536591
Hospital Revenue Code	300
Rate for Payer: Cash Price	$180.90

COLONOSCOPE

Facility

$1,712.00

Hospital Charge Code	123160
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,540.80

COLONOSCOPE

Facility

$1,712.00

Hospital Charge Code	123160
Hospital Revenue Code	360
Min. Negotiated Rate	$616.32
Max. Negotiated Rate	$1,141.90
Rate for Payer: Cash Price	$1,540.80
Rate for Payer: UnitedHealthcare Commercial	$1,141.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$616.32

COLONOSCOPY DIAG BRUSHING & WASHING

Professional

Both

$1,500.00

Service Code	CPT 45378
Hospital Charge Code	9345378
Hospital Revenue Code	975
Min. Negotiated Rate	$158.13
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$158.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$290.56
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Cigna Commercial HMO & PPO	$158.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$290.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$319.62
Rate for Payer: Home State Health Plan Medicare Advantage	$158.13
Rate for Payer: Optum Medicare Advantage	$525.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$290.56

COLONOSCOPY, FLEXIBLE

Professional

Both

$1,260.00

Service Code	CPT 45378
Hospital Charge Code	5445378
Hospital Revenue Code	975
Min. Negotiated Rate	$158.13
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$158.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$290.56
Rate for Payer: Cash Price	$1,134.00
Rate for Payer: Cash Price	$1,134.00
Rate for Payer: Cigna Commercial HMO & PPO	$158.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$290.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$319.62
Rate for Payer: Home State Health Plan Medicare Advantage	$158.13
Rate for Payer: Optum Medicare Advantage	$441.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$290.56

COLONOSCOPY, FLEXIBLE

Facility

$1,155.00

Service Code	CPT 45378
Hospital Charge Code	9645378
Rate for Payer: Cash Price	$1,039.50

Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

Facility

$1,900.20

Service Code	CPT 45378
Hospital Revenue Code	360
Min. Negotiated Rate	$838.31
Max. Negotiated Rate	$1,900.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$838.31
Rate for Payer: Aetna Medicare Advantage	$950.10
Rate for Payer: Cigna Commercial HMO & PPO	$950.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$838.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$896.99
Rate for Payer: Home State Health Plan Medicare Advantage	$950.10
Rate for Payer: Humana Commercial	$1,900.20
Rate for Payer: Humana Medicare Advantage	$950.10
Rate for Payer: UnitedHealthcare Commercial	$1,462.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$838.31

Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

Facility

$1,900.20

Service Code	CPT 45378
Hospital Revenue Code	490
Min. Negotiated Rate	$838.31
Max. Negotiated Rate	$1,900.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$838.31
Rate for Payer: Aetna Medicare Advantage	$950.10
Rate for Payer: Cigna Commercial HMO & PPO	$950.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$838.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$896.99
Rate for Payer: Home State Health Plan Medicare Advantage	$950.10
Rate for Payer: Humana Commercial	$1,900.20
Rate for Payer: Humana Medicare Advantage	$950.10
Rate for Payer: UnitedHealthcare Commercial	$1,462.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$838.31

COLONOSCOPY, FLEXIBLE, WITH BIOPSY(S)

Professional

Both

$1,365.00

Service Code	CPT 45380
Hospital Charge Code	5445380
Hospital Revenue Code	975
Min. Negotiated Rate	$170.74
Max. Negotiated Rate	$477.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$170.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$374.28
Rate for Payer: Cash Price	$1,228.50
Rate for Payer: Cash Price	$1,228.50
Rate for Payer: Cigna Commercial HMO & PPO	$170.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$374.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$411.71
Rate for Payer: Home State Health Plan Medicare Advantage	$170.74
Rate for Payer: Optum Medicare Advantage	$477.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$374.28

COLONOSCOPY, FLEXIBLE, WITH BIOPSY(S)

Professional

Both

$1,260.00

Service Code	CPT 45380
Hospital Charge Code	54380
Hospital Revenue Code	975
Min. Negotiated Rate	$170.74
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$170.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$374.28
Rate for Payer: Cash Price	$1,134.00
Rate for Payer: Cash Price	$1,134.00
Rate for Payer: Cigna Commercial HMO & PPO	$170.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$374.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$411.71
Rate for Payer: Home State Health Plan Medicare Advantage	$170.74
Rate for Payer: Optum Medicare Advantage	$441.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$374.28

Colonoscopy, flexible; with biopsy, single or multiple

Facility

$2,445.12

Service Code	CPT 45380
Hospital Revenue Code	490
Min. Negotiated Rate	$1,078.71
Max. Negotiated Rate	$2,445.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,078.71
Rate for Payer: Aetna Medicare Advantage	$1,222.56
Rate for Payer: Cigna Commercial HMO & PPO	$1,222.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,078.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,154.22
Rate for Payer: Home State Health Plan Medicare Advantage	$1,222.56
Rate for Payer: Humana Commercial	$2,445.12
Rate for Payer: Humana Medicare Advantage	$1,222.56
Rate for Payer: UnitedHealthcare Commercial	$1,462.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,078.71

Colonoscopy, flexible; with biopsy, single or multiple

Facility

$2,445.12

Service Code	CPT 45380
Hospital Revenue Code	360
Min. Negotiated Rate	$1,078.71
Max. Negotiated Rate	$2,445.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,078.71
Rate for Payer: Aetna Medicare Advantage	$1,222.56
Rate for Payer: Cigna Commercial HMO & PPO	$1,222.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,078.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,154.22
Rate for Payer: Home State Health Plan Medicare Advantage	$1,222.56
Rate for Payer: Humana Commercial	$2,445.12
Rate for Payer: Humana Medicare Advantage	$1,222.56
Rate for Payer: UnitedHealthcare Commercial	$1,462.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,078.71

Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

Facility

$2,445.12

Service Code	CPT 45385
Hospital Revenue Code	360
Min. Negotiated Rate	$1,078.71
Max. Negotiated Rate	$2,445.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,078.71
Rate for Payer: Aetna Medicare Advantage	$1,222.56
Rate for Payer: Cigna Commercial HMO & PPO	$1,222.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,078.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,154.22
Rate for Payer: Home State Health Plan Medicare Advantage	$1,222.56
Rate for Payer: Humana Commercial	$2,445.12
Rate for Payer: Humana Medicare Advantage	$1,222.56
Rate for Payer: UnitedHealthcare Commercial	$1,462.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,078.71

Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

Facility

$2,445.12

Service Code	CPT 45385
Hospital Revenue Code	490
Min. Negotiated Rate	$1,078.71
Max. Negotiated Rate	$2,445.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,078.71
Rate for Payer: Aetna Medicare Advantage	$1,222.56
Rate for Payer: Cigna Commercial HMO & PPO	$1,222.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,078.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,154.22
Rate for Payer: Home State Health Plan Medicare Advantage	$1,222.56
Rate for Payer: Humana Commercial	$2,445.12
Rate for Payer: Humana Medicare Advantage	$1,222.56
Rate for Payer: UnitedHealthcare Commercial	$1,462.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,078.71

COLONOSCOPY, FLEXIBLE, W/SUBMUC INJECTIO

Professional

Both

$1,418.00

Service Code	CPT 45381
Hospital Charge Code	5445381
Hospital Revenue Code	975
Min. Negotiated Rate	$170.74
Max. Negotiated Rate	$496.30
Rate for Payer: Aetna Commercial/Medicare Advantage	$170.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$381.85
Rate for Payer: Cash Price	$1,276.20
Rate for Payer: Cash Price	$1,276.20
Rate for Payer: Cigna Commercial HMO & PPO	$170.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$381.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$420.04
Rate for Payer: Home State Health Plan Medicare Advantage	$170.74
Rate for Payer: Optum Medicare Advantage	$496.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$381.85

COLONOSCOPY THRU STOMA, DIAGNOSTIC

Professional

Both

$1,155.00

Service Code	CPT 44388
Hospital Charge Code	5444388
Hospital Revenue Code	975
Min. Negotiated Rate	$135.25
Max. Negotiated Rate	$404.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$135.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$244.23
Rate for Payer: Cash Price	$1,039.50
Rate for Payer: Cash Price	$1,039.50
Rate for Payer: Cigna Commercial HMO & PPO	$135.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$244.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$268.65
Rate for Payer: Home State Health Plan Medicare Advantage	$135.25
Rate for Payer: Optum Medicare Advantage	$404.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$244.23

COLONOSCOPY W/BIOPSY

Facility

$1,058.00

Service Code	CPT 45380
Hospital Charge Code	4145380
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$2,445.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,078.71
Rate for Payer: Aetna Medicare Advantage	$1,222.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$626.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$755.41
Rate for Payer: Cash Price	$952.20
Rate for Payer: Cash Price	$952.20
Rate for Payer: Cash Price	$952.20
Rate for Payer: Cash Price	$952.20
Rate for Payer: Cigna Commercial HMO & PPO	$1,222.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$970.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,154.22
Rate for Payer: Home State Health Plan Medicare Advantage	$1,222.56
Rate for Payer: Humana Commercial	$2,445.12
Rate for Payer: Humana Medicare Advantage	$1,222.56
Rate for Payer: UnitedHealthcare Commercial	$705.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,078.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

COLONOSCOPY W/BIOPSY

Facility

$1,058.00

Service Code	CPT 45380
Hospital Charge Code	4145380
Hospital Revenue Code	521
Rate for Payer: Cash Price	$952.20

COLONOSCOPY W BIOPSY ADD ON CODE

Professional

Both

$1,800.00

Service Code	CPT 45380
Hospital Charge Code	9345380
Hospital Revenue Code	975
Min. Negotiated Rate	$170.74
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$170.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$374.28
Rate for Payer: Cash Price	$1,620.00
Rate for Payer: Cash Price	$1,620.00
Rate for Payer: Cigna Commercial HMO & PPO	$170.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$374.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$411.71
Rate for Payer: Home State Health Plan Medicare Advantage	$170.74
Rate for Payer: Optum Medicare Advantage	$630.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$374.28

COLONOSCOPY W/BIOPSY SINGLE OR MULTIPLE

Facility

$1,260.00

Service Code	CPT 45380
Hospital Charge Code	9645380
Rate for Payer: Cash Price	$1,134.00

Know your out-of-pocket cost for care.

All Charges