Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

CROTALID POLYVA IMMUN FAB(CROFAB)

Facility

$28,005.00

Service Code	HCPCS J0840
Hospital Charge Code	2626401
Hospital Revenue Code	250
Min. Negotiated Rate	$1,906.91
Max. Negotiated Rate	$18,679.33
Rate for Payer: Aetna Medicare Advantage	$1,906.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5,134.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5,134.00
Rate for Payer: Cash Price	$25,204.50
Rate for Payer: Cash Price	$25,204.50
Rate for Payer: Cigna Commercial HMO & PPO	$1,906.91
Rate for Payer: Home State Health Plan Medicare Advantage	$1,906.91
Rate for Payer: Humana Commercial	$3,813.82
Rate for Payer: Humana Medicare Advantage	$1,906.91
Rate for Payer: UnitedHealthcare Commercial	$18,679.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,081.80

CROTALID POLYVA IMMUN FAB(CROFAB)

Facility

$28,005.00

Service Code	HCPCS J0840
Hospital Charge Code	2626401
Hospital Revenue Code	250
Min. Negotiated Rate	$5,134.00
Max. Negotiated Rate	$5,134.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5,134.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5,134.00
Rate for Payer: Cash Price	$25,204.50

CRP

Facility

$124.00

Service Code	CPT 86140
Hospital Charge Code	2286170
Hospital Revenue Code	302
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$88.54
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	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
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	$44.64

CRP

Facility

$124.00

Service Code	CPT 86140
Hospital Charge Code	2286170
Hospital Revenue Code	302
Rate for Payer: Cash Price	$111.60

CRP HIGH SENSITIVITY

Facility

$223.00

Service Code	CPT 86141
Hospital Charge Code	2286140
Hospital Revenue Code	301
Rate for Payer: Cash Price	$200.70

CRP HIGH SENSITIVITY

Facility

$223.00

Service Code	CPT 86141
Hospital Charge Code	2286140
Hospital Revenue Code	301
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$159.22
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.66
Rate for Payer: Aetna Medicare Advantage	$12.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$132.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$159.22
Rate for Payer: Cash Price	$200.70
Rate for Payer: Cash Price	$200.70
Rate for Payer: Cash Price	$200.70
Rate for Payer: Cigna Commercial HMO & PPO	$12.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.48
Rate for Payer: Home State Health Plan Medicare Advantage	$12.95
Rate for Payer: Humana Commercial	$25.90
Rate for Payer: Humana Medicare Advantage	$12.95
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$80.28

CRP (LABCORP)

Facility

$186.00

Service Code	CPT 86140
Hospital Charge Code	2286141
Hospital Revenue Code	301
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$132.80
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	$110.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.80
Rate for Payer: Cash Price	$167.40
Rate for Payer: Cash Price	$167.40
Rate for Payer: Cash Price	$167.40
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	$66.96

CRP (LABCORP)

Facility

$186.00

Service Code	CPT 86140
Hospital Charge Code	2286141
Hospital Revenue Code	301
Rate for Payer: Cash Price	$167.40

CRUTCHES

Facility

$129.00

Hospital Charge Code	2818014
Hospital Revenue Code	273
Min. Negotiated Rate	$76.37
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04

CRUTCHES

Facility

$129.00

Hospital Charge Code	2818014
Hospital Revenue Code	273
Rate for Payer: Cash Price	$116.10

CRYOCOUTERY CREVIX

Facility

$268.00

Service Code	CPT 57511
Hospital Charge Code	4257511
Hospital Revenue Code	521
Rate for Payer: Cash Price	$241.20

CRYOCOUTERY CREVIX

Facility

$268.00

Service Code	CPT 57511
Hospital Charge Code	4257511
Hospital Revenue Code	521
Min. Negotiated Rate	$158.66
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	$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	$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	$178.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$274.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE

Facility

$145.00

Service Code	CPT 17000
Hospital Charge Code	4417000
Hospital Revenue Code	521
Min. Negotiated Rate	$85.84
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	$85.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$103.53
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
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	$96.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE

Facility

$145.00

Service Code	CPT 17000
Hospital Charge Code	4417000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$130.50

CRYOFREEZE

Facility

$55.00

Service Code	CPT 17003
Hospital Charge Code	4117003
Hospital Revenue Code	521
Min. Negotiated Rate	$32.56
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE

Facility

$55.00

Service Code	CPT 17003
Hospital Charge Code	4117003
Hospital Revenue Code	521
Rate for Payer: Cash Price	$49.50

CRYOFREEZE 2-14 LESION

Facility

$50.00

Service Code	CPT 17003
Hospital Charge Code	9817003
Hospital Revenue Code	521
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE 2-14 LESION

Facility

$50.00

Service Code	CPT 17003
Hospital Charge Code	9817003
Hospital Revenue Code	521
Rate for Payer: Cash Price	$45.00

CRYOFREEZE 2 - 14 LESIONS

Facility

$55.00

Service Code	CPT 17003
Hospital Charge Code	9417003
Hospital Revenue Code	521
Rate for Payer: Cash Price	$49.50

CRYOFREEZE 2 - 14 LESIONS

Facility

$55.00

Service Code	CPT 17003
Hospital Charge Code	9217003
Hospital Revenue Code	521
Rate for Payer: Cash Price	$49.50

CRYOFREEZE 2 - 14 LESIONS

Facility

$55.00

Service Code	CPT 17003
Hospital Charge Code	5217003
Hospital Revenue Code	521
Min. Negotiated Rate	$32.56
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE 2 - 14 LESIONS

Facility

$55.00

Service Code	CPT 17003
Hospital Charge Code	9517003
Hospital Revenue Code	521
Rate for Payer: Cash Price	$49.50

CRYOFREEZE 2 - 14 LESIONS

Facility

$55.00

Service Code	CPT 17003
Hospital Charge Code	5217003
Hospital Revenue Code	521
Rate for Payer: Cash Price	$49.50

CRYOFREEZE 2 - 14 LESIONS

Facility

$55.00

Service Code	CPT 17003
Hospital Charge Code	9517003
Hospital Revenue Code	521
Min. Negotiated Rate	$32.56
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges