Madison Medical Center

All Charges

Charge

Type

Setting

Price

CREATININE ISTAT

Facility

$87.00

Service Code	CPT 82565
Hospital Charge Code	221375
Hospital Revenue Code	301
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$62.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.61
Rate for Payer: Aetna Medicare Advantage	$5.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$51.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.12
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cigna Commercial HMO & PPO	$5.12
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.93
Rate for Payer: Home State Health Plan Medicare Advantage	$5.12
Rate for Payer: Humana Commercial	$10.24
Rate for Payer: Humana Medicare Advantage	$5.12
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.32

CREATININE ISTAT

Facility

$87.00

Service Code	CPT 82565
Hospital Charge Code	221375
Hospital Revenue Code	301
Rate for Payer: Cash Price	$78.30

CREATININE RANDOM URINE

Facility

$59.00

Service Code	CPT 82570
Hospital Charge Code	2221207
Hospital Revenue Code	301
Rate for Payer: Cash Price	$53.10

CREATININE RANDOM URINE

Facility

$59.00

Service Code	CPT 82570
Hospital Charge Code	2221207
Hospital Revenue Code	301
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$42.13
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.66
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.13
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cigna Commercial HMO & PPO	$5.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.99
Rate for Payer: Home State Health Plan Medicare Advantage	$5.18
Rate for Payer: Humana Commercial	$10.36
Rate for Payer: Humana Medicare Advantage	$5.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.24

CRE WIREGUIDED CATHETER 12/13.5/15

Facility

$766.00

Hospital Charge Code	126686
Hospital Revenue Code	271
Rate for Payer: Cash Price	$689.40

CRE WIREGUIDED CATHETER 12/13.5/15

Facility

$766.00

Hospital Charge Code	126686
Hospital Revenue Code	271
Min. Negotiated Rate	$275.76
Max. Negotiated Rate	$546.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$453.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$546.92
Rate for Payer: Cash Price	$689.40
Rate for Payer: UnitedHealthcare Commercial	$510.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$275.76

CRE WIREGUIDED CATHETER 8/9/10

Facility

$766.00

Hospital Charge Code	126685
Hospital Revenue Code	271
Rate for Payer: Cash Price	$689.40

CRE WIREGUIDED CATHETER 8/9/10

Facility

$766.00

Hospital Charge Code	126685
Hospital Revenue Code	271
Min. Negotiated Rate	$275.76
Max. Negotiated Rate	$546.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$453.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$546.92
Rate for Payer: Cash Price	$689.40
Rate for Payer: UnitedHealthcare Commercial	$510.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$275.76

CRITICAL CARE 1 HOUR

Professional

Both

$331.00

Service Code	CPT 99291
Hospital Charge Code	5299291
Hospital Revenue Code	987
Min. Negotiated Rate	$115.85
Max. Negotiated Rate	$254.47
Rate for Payer: Aetna Commercial/Medicare Advantage	$194.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$231.34
Rate for Payer: Cash Price	$297.90
Rate for Payer: Cash Price	$297.90
Rate for Payer: Cigna Commercial HMO & PPO	$194.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$231.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$254.47
Rate for Payer: Home State Health Plan Medicare Advantage	$194.06
Rate for Payer: Optum Medicare Advantage	$115.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$231.34

CRITICAL CARE 1ST HR.

Facility

$331.00

Service Code	CPT 99291
Hospital Charge Code	4499291
Hospital Revenue Code	525
Rate for Payer: Cash Price	$297.90

CRITICAL CARE 1ST HR.

Facility

$331.00

Service Code	CPT 99291
Hospital Charge Code	4499291
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,687.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$744.63
Rate for Payer: Aetna Medicare Advantage	$843.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$195.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$236.33
Rate for Payer: Cash Price	$297.90
Rate for Payer: Cash Price	$297.90
Rate for Payer: Cash Price	$297.90
Rate for Payer: Cash Price	$297.90
Rate for Payer: Cigna Commercial HMO & PPO	$843.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$670.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$796.75
Rate for Payer: Home State Health Plan Medicare Advantage	$843.92
Rate for Payer: Humana Commercial	$1,687.84
Rate for Payer: Humana Medicare Advantage	$843.92
Rate for Payer: UnitedHealthcare Commercial	$220.78
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$744.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRITICAL CARE 1ST HR.)

Facility

$348.00

Service Code	CPT 99291
Hospital Charge Code	4199291
Hospital Revenue Code	521
Rate for Payer: Cash Price	$313.20

CRITICAL CARE 1ST HR.)

Facility

$348.00

Service Code	CPT 99291
Hospital Charge Code	4199291
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,687.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$744.63
Rate for Payer: Aetna Medicare Advantage	$843.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$206.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$248.47
Rate for Payer: Cash Price	$313.20
Rate for Payer: Cash Price	$313.20
Rate for Payer: Cash Price	$313.20
Rate for Payer: Cash Price	$313.20
Rate for Payer: Cigna Commercial HMO & PPO	$843.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$670.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$796.75
Rate for Payer: Home State Health Plan Medicare Advantage	$843.92
Rate for Payer: Humana Commercial	$1,687.84
Rate for Payer: Humana Medicare Advantage	$843.92
Rate for Payer: UnitedHealthcare Commercial	$232.12
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$744.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRITICAL CARE + 30 MIN

Professional

Both

$156.00

Service Code	CPT 99292
Hospital Charge Code	5299292
Hospital Revenue Code	987
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$110.91
Rate for Payer: Aetna Commercial/Medicare Advantage	$97.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$100.83
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial HMO & PPO	$97.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$100.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$110.91
Rate for Payer: Home State Health Plan Medicare Advantage	$97.61
Rate for Payer: Optum Medicare Advantage	$54.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$100.83

CRITICAL CARE +30 MIN

Facility

$164.00

Service Code	CPT 99292
Hospital Charge Code	4199292
Hospital Revenue Code	521
Rate for Payer: Cash Price	$147.60

CRITICAL CARE +30 MIN

Facility

$164.00

Service Code	CPT 99292
Hospital Charge Code	4199292
Hospital Revenue Code	521
Min. Negotiated Rate	$97.09
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.10
Rate for Payer: Cash Price	$147.60
Rate for Payer: Cash Price	$147.60
Rate for Payer: UnitedHealthcare Commercial	$109.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRITICAL CARE ADDL 30 MIN.

Facility

$156.00

Service Code	CPT 99292
Hospital Charge Code	4499292
Hospital Revenue Code	525
Rate for Payer: Cash Price	$140.40

CRITICAL CARE ADDL 30 MIN.

Facility

$156.00

Service Code	CPT 99292
Hospital Charge Code	4499292
Hospital Revenue Code	525
Min. Negotiated Rate	$92.35
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: UnitedHealthcare Commercial	$104.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRITICAL CARE, EA. AD1/2 HR.

Professional

Both

$729.00

Service Code	CPT 99292
Hospital Charge Code	1899292
Hospital Revenue Code	981
Min. Negotiated Rate	$97.61
Max. Negotiated Rate	$255.15
Rate for Payer: Aetna Commercial/Medicare Advantage	$97.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$100.83
Rate for Payer: Cash Price	$656.10
Rate for Payer: Cash Price	$656.10
Rate for Payer: Cigna Commercial HMO & PPO	$97.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$100.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$110.91
Rate for Payer: Home State Health Plan Medicare Advantage	$97.61
Rate for Payer: Optum Medicare Advantage	$255.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$100.83

CRITICAL CARE, INIT.1ST HR.

Professional

Both

$1,374.00

Service Code	CPT 99291
Hospital Charge Code	1899291
Hospital Revenue Code	981
Min. Negotiated Rate	$194.06
Max. Negotiated Rate	$480.90
Rate for Payer: Aetna Commercial/Medicare Advantage	$194.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$231.34
Rate for Payer: Cash Price	$1,236.60
Rate for Payer: Cash Price	$1,236.60
Rate for Payer: Cigna Commercial HMO & PPO	$194.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$231.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$254.47
Rate for Payer: Home State Health Plan Medicare Advantage	$194.06
Rate for Payer: Optum Medicare Advantage	$480.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$231.34

CRITICAL CARE IP 30 - 74 MINUTES

Facility

$610.00

Service Code	CPT 99291
Hospital Charge Code	4299291
Rate for Payer: Cash Price	$549.00

CRITICAL CARE IP EA ADD'L 30 MIN

Facility

$270.00

Service Code	CPT 99292
Hospital Charge Code	4299292
Rate for Payer: Cash Price	$243.00

CROSS CUT BUR (STRYKER)

Facility

$93.00

Hospital Charge Code	127784
Hospital Revenue Code	271
Rate for Payer: Cash Price	$83.70

CROSS CUT BUR (STRYKER)

Facility

$93.00

Hospital Charge Code	127784
Hospital Revenue Code	271
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$66.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: UnitedHealthcare Commercial	$62.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

CROSS INFLOW CAS TUBIN

Facility

$124.00

Hospital Charge Code	1220710
Hospital Revenue Code	271
Min. Negotiated Rate	$44.64
Max. Negotiated Rate	$88.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: UnitedHealthcare Commercial	$82.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

Know your out-of-pocket cost for care.

All Charges