Madison Medical Center

All Charges

Charge

Type

Setting

Price

CONSULT LEVEL 4

Facility

$400.00

Service Code	CPT 99244
Hospital Charge Code	9399244
Hospital Revenue Code	521
Rate for Payer: Cash Price	$360.00

CONSULT LEVEL 4

Facility

$400.00

Service Code	CPT 99244
Hospital Charge Code	9399244
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$285.60
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: UnitedHealthcare Commercial	$266.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULT LEVEL 5

Facility

$500.00

Service Code	CPT 99245
Hospital Charge Code	9399245
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$357.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$296.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$357.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: UnitedHealthcare Commercial	$333.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULT LEVEL 5

Facility

$500.00

Service Code	CPT 99245
Hospital Charge Code	9399245
Hospital Revenue Code	521
Rate for Payer: Cash Price	$450.00

CONSULT OFFICE COMPLEX

Facility

$500.00

Service Code	CPT 99245
Hospital Charge Code	9899245
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$357.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$296.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$357.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: UnitedHealthcare Commercial	$333.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULT OFFICE COMPLEX

Facility

$500.00

Service Code	CPT 99245
Hospital Charge Code	9899245
Hospital Revenue Code	521
Rate for Payer: Cash Price	$450.00

CONSULT OFFICE COMPREHENSIVE

Facility

$400.00

Service Code	CPT 99244
Hospital Charge Code	9899244
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$285.60
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: UnitedHealthcare Commercial	$266.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULT OFFICE COMPREHENSIVE

Facility

$400.00

Service Code	CPT 99244
Hospital Charge Code	9899244
Hospital Revenue Code	521
Rate for Payer: Cash Price	$360.00

CONSULT OFFICE EXTENDED

Facility

$300.00

Service Code	CPT 99243
Hospital Charge Code	9899243
Hospital Revenue Code	521
Rate for Payer: Cash Price	$270.00

CONSULT OFFICE EXTENDED

Facility

$300.00

Service Code	CPT 99243
Hospital Charge Code	9899243
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$214.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$177.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.20
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: UnitedHealthcare Commercial	$200.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULT OFFICE INTERMEDIATE

Facility

$225.00

Service Code	CPT 99242
Hospital Charge Code	9899242
Hospital Revenue Code	521
Rate for Payer: Cash Price	$202.50

CONSULT OFFICE INTERMEDIATE

Facility

$225.00

Service Code	CPT 99242
Hospital Charge Code	9899242
Hospital Revenue Code	521
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$133.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$160.65
Rate for Payer: Cash Price	$202.50
Rate for Payer: Cash Price	$202.50
Rate for Payer: UnitedHealthcare Commercial	$150.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONTRACTION STRESS TEST

Facility

$143.00

Service Code	CPT 59020
Hospital Charge Code	4259020
Rate for Payer: Cash Price	$128.70

CONTRAST OMNISCAN PER 15 ML

Facility

$307.00

Service Code	CPT A9579
Hospital Charge Code	3309579
Hospital Revenue Code	329
Rate for Payer: Cash Price	$276.30

CONTRAST OMNISCAN PER 15 ML

Facility

$307.00

Service Code	CPT A9579
Hospital Charge Code	3309579
Hospital Revenue Code	329
Min. Negotiated Rate	$110.52
Max. Negotiated Rate	$219.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$181.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$219.20
Rate for Payer: Cash Price	$276.30
Rate for Payer: Cash Price	$276.30
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$110.52

CONTRAVE 8/90MG ER TAB EMP

Facility

$16.00

Service Code	NDC 5.1267E+10
Hospital Charge Code	2622564
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

CONTRAVE 8/90MG ER TAB EMP

Facility

$16.00

Service Code	NDC 5.1267E+10
Hospital Charge Code	2622564
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

CONTROL NASAL HEMORRHAGE; CAUT/PACKING

Facility

$100.00

Service Code	CPT 30901
Hospital Charge Code	9830901
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.00

CONTROL NASAL HEMORRHAGE; CAUT/PACKING

Facility

$100.00

Service Code	CPT 30901
Hospital Charge Code	9830901
Hospital Revenue Code	521
Min. Negotiated Rate	$59.20
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	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.95
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	$66.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONTROL OF NOSE BLEED

Professional

Both

$863.00

Service Code	CPT 30903
Hospital Charge Code	1830903
Hospital Revenue Code	981
Min. Negotiated Rate	$68.14
Max. Negotiated Rate	$302.05
Rate for Payer: Aetna Commercial/Medicare Advantage	$68.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$189.11
Rate for Payer: Cash Price	$776.70
Rate for Payer: Cash Price	$776.70
Rate for Payer: Cigna Commercial HMO & PPO	$68.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$189.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$208.02
Rate for Payer: Home State Health Plan Medicare Advantage	$68.14
Rate for Payer: Optum Medicare Advantage	$302.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$189.11

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$5,315.06

Service Code	APR-DRG 3842
Min. Negotiated Rate	$5,315.06
Max. Negotiated Rate	$5,315.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,315.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,315.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,315.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,315.06

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$13,996.29

Service Code	APR-DRG 3843
Min. Negotiated Rate	$13,996.29
Max. Negotiated Rate	$13,996.29
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,996.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,996.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,996.29
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,996.29

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$4,168.66

Service Code	APR-DRG 3841
Min. Negotiated Rate	$4,168.66
Max. Negotiated Rate	$4,168.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,168.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,168.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,168.66
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,168.66

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$27,753.14

Service Code	APR-DRG 3844
Min. Negotiated Rate	$27,753.14
Max. Negotiated Rate	$27,753.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,753.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,753.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,753.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,753.14

CONVENIENCE BAGS

Facility

$16.00

Hospital Charge Code	285339
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

Know your out-of-pocket cost for care.

All Charges