Madison Medical Center

All Charges

Charge

Type

Setting

Price

COLONOSCOPY W/DIRECTED SUBMUCOSAL INJ

Professional

Both

$1,850.00

Service Code	CPT 45381
Hospital Charge Code	9345381
Hospital Revenue Code	975
Min. Negotiated Rate	$170.74
Max. Negotiated Rate	$647.50
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	$1,665.00
Rate for Payer: Cash Price	$1,665.00
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	$647.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$381.85

COLONOSCOPY WITH REM POLYP

Professional

Both

$1,950.00

Service Code	CPT 45384
Hospital Charge Code	9345384
Hospital Revenue Code	975
Min. Negotiated Rate	$195.92
Max. Negotiated Rate	$682.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$195.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$420.98
Rate for Payer: Cash Price	$1,755.00
Rate for Payer: Cash Price	$1,755.00
Rate for Payer: Cigna Commercial HMO & PPO	$195.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$420.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$463.08
Rate for Payer: Home State Health Plan Medicare Advantage	$195.92
Rate for Payer: Optum Medicare Advantage	$682.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$420.98

COLONOSCOPY WITH REM POLYP BY SNARE

Professional

Both

$2,150.00

Service Code	CPT 45385
Hospital Charge Code	9345385
Hospital Revenue Code	975
Min. Negotiated Rate	$215.08
Max. Negotiated Rate	$752.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$215.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$389.51
Rate for Payer: Cash Price	$1,935.00
Rate for Payer: Cash Price	$1,935.00
Rate for Payer: Cigna Commercial HMO & PPO	$215.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$389.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$428.46
Rate for Payer: Home State Health Plan Medicare Advantage	$215.08
Rate for Payer: Optum Medicare Advantage	$752.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$389.51

COLONOSCOPY W/REM OF FOREIGN BODY

Professional

Both

$1,470.00

Service Code	CPT 45379
Hospital Charge Code	5445379
Hospital Revenue Code	975
Min. Negotiated Rate	$202.15
Max. Negotiated Rate	$514.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$202.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$373.10
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Cigna Commercial HMO & PPO	$202.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$373.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$410.41
Rate for Payer: Home State Health Plan Medicare Advantage	$202.15
Rate for Payer: Optum Medicare Advantage	$514.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$373.10

COLONOSCOPY W/REM POLYPS BY HOT SNARE

Professional

Both

$1,733.00

Service Code	CPT 45385
Hospital Charge Code	5445385
Hospital Revenue Code	975
Min. Negotiated Rate	$215.08
Max. Negotiated Rate	$606.55
Rate for Payer: Aetna Commercial/Medicare Advantage	$215.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$389.51
Rate for Payer: Cash Price	$1,559.70
Rate for Payer: Cash Price	$1,559.70
Rate for Payer: Cigna Commercial HMO & PPO	$215.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$389.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$428.46
Rate for Payer: Home State Health Plan Medicare Advantage	$215.08
Rate for Payer: Optum Medicare Advantage	$606.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$389.51

.COLORADO TICK FEVER IGG

Facility

$190.00

Service Code	CPT 86790
Hospital Charge Code	2259119
Hospital Revenue Code	302
Rate for Payer: Cash Price	$171.00

.COLORADO TICK FEVER IGG

Facility

$190.00

Service Code	CPT 86790
Hospital Charge Code	2259119
Hospital Revenue Code	302
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$135.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.59
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cigna Commercial HMO & PPO	$12.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.40
Rate for Payer: Home State Health Plan Medicare Advantage	$12.88
Rate for Payer: Humana Commercial	$25.76
Rate for Payer: Humana Medicare Advantage	$12.88
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.40

.COLORADO TICK FEVER IGM

Facility

$190.00

Service Code	CPT 86790
Hospital Charge Code	2259120
Hospital Revenue Code	302
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$135.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.59
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cigna Commercial HMO & PPO	$12.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.40
Rate for Payer: Home State Health Plan Medicare Advantage	$12.88
Rate for Payer: Humana Commercial	$25.76
Rate for Payer: Humana Medicare Advantage	$12.88
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.40

.COLORADO TICK FEVER IGM

Facility

$190.00

Service Code	CPT 86790
Hospital Charge Code	2259120
Hospital Revenue Code	302
Rate for Payer: Cash Price	$171.00

COLOSCOPE

Facility

$365.00

Hospital Charge Code	283160
Hospital Revenue Code	271
Min. Negotiated Rate	$131.40
Max. Negotiated Rate	$260.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$216.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$260.61
Rate for Payer: Cash Price	$328.50
Rate for Payer: UnitedHealthcare Commercial	$243.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$131.40

COLOSCOPE

Facility

$365.00

Hospital Charge Code	283160
Hospital Revenue Code	271
Rate for Payer: Cash Price	$328.50

COLOST BG

Facility

$70.00

Hospital Charge Code	283408
Hospital Revenue Code	271
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$49.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

COLOST BG

Facility

$70.00

Hospital Charge Code	283408
Hospital Revenue Code	271
Rate for Payer: Cash Price	$63.00

COLPOSCOPY OF CERVIX WITH BIOPSY

Facility

$400.00

Service Code	CPT 57454
Hospital Charge Code	9857454
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$622.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$274.70
Rate for Payer: Aetna Medicare Advantage	$311.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$236.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$285.60
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cigna Commercial HMO & PPO	$311.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$247.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$293.93
Rate for Payer: Home State Health Plan Medicare Advantage	$311.33
Rate for Payer: Humana Commercial	$622.66
Rate for Payer: Humana Medicare Advantage	$311.33
Rate for Payer: UnitedHealthcare Commercial	$266.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$274.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

COLPOSCOPY OF CERVIX WITH BIOPSY

Facility

$400.00

Service Code	CPT 57454
Hospital Charge Code	9857454
Hospital Revenue Code	521
Rate for Payer: Cash Price	$360.00

COLPOSCOPY W/BIOPSY

Facility

$533.00

Service Code	CPT 57454
Hospital Charge Code	4257454
Hospital Revenue Code	521
Rate for Payer: Cash Price	$479.70

COLPOSCOPY W/BIOPSY

Facility

$405.00

Service Code	CPT 57454
Hospital Charge Code	5257454
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$622.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$274.70
Rate for Payer: Aetna Medicare Advantage	$311.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$239.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$289.17
Rate for Payer: Cash Price	$364.50
Rate for Payer: Cash Price	$364.50
Rate for Payer: Cash Price	$364.50
Rate for Payer: Cash Price	$364.50
Rate for Payer: Cigna Commercial HMO & PPO	$311.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$247.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$293.93
Rate for Payer: Home State Health Plan Medicare Advantage	$311.33
Rate for Payer: Humana Commercial	$622.66
Rate for Payer: Humana Medicare Advantage	$311.33
Rate for Payer: UnitedHealthcare Commercial	$270.13
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$274.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

COLPOSCOPY W/BIOPSY

Facility

$533.00

Service Code	CPT 57454
Hospital Charge Code	4257454
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$622.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$274.70
Rate for Payer: Aetna Medicare Advantage	$311.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$315.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$380.56
Rate for Payer: Cash Price	$479.70
Rate for Payer: Cash Price	$479.70
Rate for Payer: Cash Price	$479.70
Rate for Payer: Cash Price	$479.70
Rate for Payer: Cigna Commercial HMO & PPO	$311.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$247.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$293.93
Rate for Payer: Home State Health Plan Medicare Advantage	$311.33
Rate for Payer: Humana Commercial	$622.66
Rate for Payer: Humana Medicare Advantage	$311.33
Rate for Payer: UnitedHealthcare Commercial	$355.51
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$274.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

COLPOSCOPY W/BIOPSY

Facility

$405.00

Service Code	CPT 57454
Hospital Charge Code	5257454
Hospital Revenue Code	521
Rate for Payer: Cash Price	$364.50

COLPOSCOPY W/BIOPSY & ENDO CURRETTAGE

Facility

$530.00

Service Code	CPT 57454
Hospital Charge Code	9257454
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$622.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$274.70
Rate for Payer: Aetna Medicare Advantage	$311.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$313.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$378.42
Rate for Payer: Cash Price	$477.00
Rate for Payer: Cash Price	$477.00
Rate for Payer: Cash Price	$477.00
Rate for Payer: Cash Price	$477.00
Rate for Payer: Cigna Commercial HMO & PPO	$311.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$247.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$293.93
Rate for Payer: Home State Health Plan Medicare Advantage	$311.33
Rate for Payer: Humana Commercial	$622.66
Rate for Payer: Humana Medicare Advantage	$311.33
Rate for Payer: UnitedHealthcare Commercial	$353.51
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$274.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

COLPOSCOPY W/BIOPSY & ENDO CURRETTAGE

Facility

$530.00

Service Code	CPT 57454
Hospital Charge Code	9257454
Hospital Revenue Code	521
Rate for Payer: Cash Price	$477.00

COLPOSCOPY W/OUT BIOPSY

Facility

$268.00

Service Code	CPT 57452
Hospital Charge Code	4257452
Hospital Revenue Code	521
Min. Negotiated Rate	$158.66
Max. Negotiated Rate	$413.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$182.25
Rate for Payer: Aetna Medicare Advantage	$206.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$158.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$191.35
Rate for Payer: Cash Price	$241.20
Rate for Payer: Cash Price	$241.20
Rate for Payer: Cash Price	$241.20
Rate for Payer: Cash Price	$241.20
Rate for Payer: Cigna Commercial HMO & PPO	$206.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$164.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$195.01
Rate for Payer: Home State Health Plan Medicare Advantage	$206.55
Rate for Payer: Humana Commercial	$413.10
Rate for Payer: Humana Medicare Advantage	$206.55
Rate for Payer: UnitedHealthcare Commercial	$178.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$182.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

COLPOSCOPY W/OUT BIOPSY

Facility

$268.00

Service Code	CPT 57452
Hospital Charge Code	4257452
Hospital Revenue Code	521
Rate for Payer: Cash Price	$241.20

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC

Facility

$146,158.82

Service Code	MSDRG 429
Min. Negotiated Rate	$73,079.41
Max. Negotiated Rate	$146,158.82
Rate for Payer: Aetna Medicare Advantage	$73,079.41
Rate for Payer: Cigna Commercial HMO & PPO	$73,079.41
Rate for Payer: Home State Health Plan Medicare Advantage	$73,079.41
Rate for Payer: Humana Commercial	$146,158.82
Rate for Payer: Humana Medicare Advantage	$73,079.41

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC

Facility

$94,685.18

Service Code	MSDRG 430
Min. Negotiated Rate	$47,342.59
Max. Negotiated Rate	$94,685.18
Rate for Payer: Aetna Medicare Advantage	$47,342.59
Rate for Payer: Cigna Commercial HMO & PPO	$47,342.59
Rate for Payer: Home State Health Plan Medicare Advantage	$47,342.59
Rate for Payer: Humana Commercial	$94,685.18
Rate for Payer: Humana Medicare Advantage	$47,342.59

Know your out-of-pocket cost for care.

All Charges