Madison Medical Center

All Charges

Charge

Type

Setting

Price

CYSTIC FIBROSIS - PULMONARY DISEASE

Facility

$32,150.39

Service Code	APR-DRG 1313
Min. Negotiated Rate	$32,150.39
Max. Negotiated Rate	$32,150.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$32,150.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$32,150.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32,150.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$32,150.39

CYSTIC FIBROSIS - PULMONARY DISEASE

Facility

$12,868.15

Service Code	APR-DRG 1311
Min. Negotiated Rate	$12,868.15
Max. Negotiated Rate	$12,868.15
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,868.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,868.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,868.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,868.15

CYSTINE URINE

Facility

$153.00

Service Code	CPT 82131
Hospital Charge Code	2221600
Hospital Revenue Code	307
Min. Negotiated Rate	$20.68
Max. Negotiated Rate	$109.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$20.68
Rate for Payer: Aetna Medicare Advantage	$22.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cigna Commercial HMO & PPO	$22.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22.13
Rate for Payer: Home State Health Plan Medicare Advantage	$22.98
Rate for Payer: Humana Commercial	$45.96
Rate for Payer: Humana Medicare Advantage	$22.98
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

CYSTINE URINE

Facility

$153.00

Service Code	CPT 82131
Hospital Charge Code	2221600
Hospital Revenue Code	307
Rate for Payer: Cash Price	$137.70

CYSTO/BLADDER IRRIG. SET

Facility

$58.00

Hospital Charge Code	123355
Hospital Revenue Code	271
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

CYSTO/BLADDER IRRIG. SET

Facility

$58.00

Hospital Charge Code	123355
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

CYSTOCOPY

Professional

Both

$340.00

Service Code	CPT 52000
Hospital Charge Code	4152000
Hospital Revenue Code	975
Min. Negotiated Rate	$68.94
Max. Negotiated Rate	$204.27
Rate for Payer: Aetna Commercial/Medicare Advantage	$68.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$185.70
Rate for Payer: Cash Price	$306.00
Rate for Payer: Cash Price	$306.00
Rate for Payer: Cigna Commercial HMO & PPO	$68.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$185.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$204.27
Rate for Payer: Home State Health Plan Medicare Advantage	$68.94
Rate for Payer: Optum Medicare Advantage	$119.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$185.70

CYSTO FLEX

Facility

$804.00

Service Code	CPT 52000
Hospital Charge Code	283358
Hospital Revenue Code	271
Min. Negotiated Rate	$289.44
Max. Negotiated Rate	$1,424.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$628.57
Rate for Payer: Aetna Medicare Advantage	$712.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$475.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$574.06
Rate for Payer: Cash Price	$723.60
Rate for Payer: Cash Price	$723.60
Rate for Payer: Cash Price	$723.60
Rate for Payer: Cigna Commercial HMO & PPO	$712.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$628.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$672.57
Rate for Payer: Home State Health Plan Medicare Advantage	$712.40
Rate for Payer: Humana Commercial	$1,424.80
Rate for Payer: Humana Medicare Advantage	$712.40
Rate for Payer: UnitedHealthcare Commercial	$536.27
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$628.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$289.44

CYSTO FLEX

Facility

$804.00

Service Code	CPT 52000
Hospital Charge Code	283358
Hospital Revenue Code	271
Rate for Payer: Cash Price	$723.60

CYSTOGRAM CONT. MEDIA

Facility

$211.00

Service Code	CPT 74430
Hospital Charge Code	3200119
Hospital Revenue Code	271
Rate for Payer: Cash Price	$189.90

CYSTOGRAM CONT. MEDIA

Facility

$211.00

Service Code	CPT 74430
Hospital Charge Code	3200119
Hospital Revenue Code	271
Min. Negotiated Rate	$75.96
Max. Negotiated Rate	$712.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$314.49
Rate for Payer: Aetna Medicare Advantage	$356.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$124.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$150.65
Rate for Payer: Cash Price	$189.90
Rate for Payer: Cash Price	$189.90
Rate for Payer: Cash Price	$189.90
Rate for Payer: Cigna Commercial HMO & PPO	$356.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$314.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$336.50
Rate for Payer: Home State Health Plan Medicare Advantage	$356.43
Rate for Payer: Humana Commercial	$712.86
Rate for Payer: Humana Medicare Advantage	$356.43
Rate for Payer: UnitedHealthcare Commercial	$140.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$75.96

CYSTOGRAM XRAY

Facility

$550.00

Service Code	CPT 74430
Hospital Charge Code	323156
Hospital Revenue Code	320
Rate for Payer: Cash Price	$495.00

CYSTOGRAM XRAY

Facility

$550.00

Service Code	CPT 74430
Hospital Charge Code	323156
Hospital Revenue Code	320
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$712.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$314.49
Rate for Payer: Aetna Medicare Advantage	$356.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$325.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$392.70
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cigna Commercial HMO & PPO	$356.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$314.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$336.50
Rate for Payer: Home State Health Plan Medicare Advantage	$356.43
Rate for Payer: Humana Commercial	$712.86
Rate for Payer: Humana Medicare Advantage	$356.43
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$198.00

CYSTOMETROGRAM (SIMPLE)

Facility

$203.00

Service Code	CPT 51725
Hospital Charge Code	5251725
Hospital Revenue Code	521
Rate for Payer: Cash Price	$182.70

CYSTOMETROGRAM (SIMPLE)

Facility

$203.00

Service Code	CPT 51725
Hospital Charge Code	5251725
Hospital Revenue Code	521
Min. Negotiated Rate	$120.18
Max. Negotiated Rate	$510.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$225.22
Rate for Payer: Aetna Medicare Advantage	$255.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$120.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$144.94
Rate for Payer: Cash Price	$182.70
Rate for Payer: Cash Price	$182.70
Rate for Payer: Cash Price	$182.70
Rate for Payer: Cash Price	$182.70
Rate for Payer: Cigna Commercial HMO & PPO	$255.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$202.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$240.99
Rate for Payer: Home State Health Plan Medicare Advantage	$255.26
Rate for Payer: Humana Commercial	$510.52
Rate for Payer: Humana Medicare Advantage	$255.26
Rate for Payer: UnitedHealthcare Commercial	$135.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$225.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CYSTOSCOPE

Facility

$715.00

Hospital Charge Code	283846
Hospital Revenue Code	271
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$510.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$423.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$510.51
Rate for Payer: Cash Price	$643.50
Rate for Payer: UnitedHealthcare Commercial	$476.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$257.40

CYSTOSCOPE

Facility

$1,394.00

Hospital Charge Code	123170
Hospital Revenue Code	360
Min. Negotiated Rate	$501.84
Max. Negotiated Rate	$929.80
Rate for Payer: Cash Price	$1,254.60
Rate for Payer: UnitedHealthcare Commercial	$929.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$501.84

CYSTOSCOPE

Facility

$1,394.00

Hospital Charge Code	123170
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,254.60

CYSTOSCOPE

Facility

$715.00

Hospital Charge Code	283846
Hospital Revenue Code	271
Rate for Payer: Cash Price	$643.50

CYSTOSCOPE(EQUIP CHARGE)

Facility

$1,419.00

Hospital Charge Code	1211814
Hospital Revenue Code	360
Min. Negotiated Rate	$510.84
Max. Negotiated Rate	$946.47
Rate for Payer: Cash Price	$1,277.10
Rate for Payer: UnitedHealthcare Commercial	$946.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$510.84

CYSTOSCOPE(EQUIP CHARGE)

Facility

$1,419.00

Hospital Charge Code	1211814
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,277.10

CYSTO TUBING

Facility

$48.00

Hospital Charge Code	283355
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

CYSTO TUBING

Facility

$48.00

Hospital Charge Code	283355
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

CYSTOURETHROSCOPY

Professional

Both

$990.00

Service Code	CPT 52000
Hospital Charge Code	9352000
Hospital Revenue Code	975
Min. Negotiated Rate	$68.94
Max. Negotiated Rate	$346.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$68.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$185.70
Rate for Payer: Cash Price	$891.00
Rate for Payer: Cash Price	$891.00
Rate for Payer: Cigna Commercial HMO & PPO	$68.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$185.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$204.27
Rate for Payer: Home State Health Plan Medicare Advantage	$68.94
Rate for Payer: Optum Medicare Advantage	$346.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$185.70

CYSTOURETHROSCOPY

Facility

$261.00

Service Code	CPT 520000
Hospital Charge Code	5252000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.90

Know your out-of-pocket cost for care.

All Charges