Madison Medical Center

All Charges

Charge

Type

Setting

Price

ADD'L LESION SEP ID BY RAD MARKER

Professional

Both

$735.00

Service Code	CPT 19126
Hospital Charge Code	5419126
Hospital Revenue Code	975
Min. Negotiated Rate	$121.01
Max. Negotiated Rate	$257.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$140.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$121.01
Rate for Payer: Cash Price	$661.50
Rate for Payer: Cash Price	$661.50
Rate for Payer: Cigna Commercial HMO & PPO	$140.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$121.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$133.11
Rate for Payer: Home State Health Plan Medicare Advantage	$140.01
Rate for Payer: Optum Medicare Advantage	$257.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$121.01

ADENOIDECTOMY < 12 YRS AGE

Professional

Both

$950.00

Service Code	CPT 42830
Hospital Charge Code	9342830
Hospital Revenue Code	975
Min. Negotiated Rate	$177.94
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$181.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$177.94
Rate for Payer: Cash Price	$855.00
Rate for Payer: Cash Price	$855.00
Rate for Payer: Cigna Commercial HMO & PPO	$181.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$177.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$195.73
Rate for Payer: Home State Health Plan Medicare Advantage	$181.74
Rate for Payer: Optum Medicare Advantage	$332.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$177.94

ADENOSINE (ADENOCARD) 3MG/ML 2ML INJ

Facility

$365.00

Service Code	HCPCS J0153
Hospital Charge Code	2657103
Hospital Revenue Code	250
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

ADENOSINE (ADENOCARD) 3MG/ML 2ML INJ

Facility

$365.00

Service Code	HCPCS J0153
Hospital Charge Code	2657103
Hospital Revenue Code	250
Rate for Payer: Cash Price	$328.50

ADENOVIRUS AB

Facility

$111.00

Service Code	CPT 86603
Hospital Charge Code	2259113
Hospital Revenue Code	302
Rate for Payer: Cash Price	$99.90

ADENOVIRUS AB

Facility

$111.00

Service Code	CPT 86603
Hospital Charge Code	2259113
Hospital Revenue Code	302
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$79.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.58
Rate for Payer: Aetna Medicare Advantage	$12.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.25
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cigna Commercial HMO & PPO	$12.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.39
Rate for Payer: Home State Health Plan Medicare Advantage	$12.87
Rate for Payer: Humana Commercial	$25.74
Rate for Payer: Humana Medicare Advantage	$12.87
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.96

.ADENOVIRUS DFA (LC CHARGE)

Facility

$65.00

Service Code	CPT 87260
Hospital Charge Code	2287260
Hospital Revenue Code	305
Rate for Payer: Cash Price	$58.50

.ADENOVIRUS DFA (LC CHARGE)

Facility

$65.00

Service Code	CPT 87260
Hospital Charge Code	2287260
Hospital Revenue Code	305
Min. Negotiated Rate	$12.99
Max. Negotiated Rate	$46.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.99
Rate for Payer: Aetna Medicare Advantage	$14.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial HMO & PPO	$14.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.90
Rate for Payer: Home State Health Plan Medicare Advantage	$14.43
Rate for Payer: Humana Commercial	$28.86
Rate for Payer: Humana Medicare Advantage	$14.43
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

ADH

Facility

$73.00

Service Code	CPT 84588
Hospital Charge Code	2220112
Hospital Revenue Code	301
Rate for Payer: Cash Price	$65.70

ADH

Facility

$73.00

Service Code	CPT 84588
Hospital Charge Code	2220112
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$67.88
Rate for Payer: Aetna Better Health Medicaid/QHP	$30.55
Rate for Payer: Aetna Medicare Advantage	$33.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$43.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$52.12
Rate for Payer: Cash Price	$65.70
Rate for Payer: Cash Price	$65.70
Rate for Payer: Cash Price	$65.70
Rate for Payer: Cigna Commercial HMO & PPO	$33.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32.69
Rate for Payer: Home State Health Plan Medicare Advantage	$33.94
Rate for Payer: Humana Commercial	$67.88
Rate for Payer: Humana Medicare Advantage	$33.94
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$30.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.28

ADH-ANTIDIURETIC HORMONE

Facility

$95.00

Service Code	CPT 84588
Hospital Charge Code	2220100
Hospital Revenue Code	301
Rate for Payer: Cash Price	$85.50

ADH-ANTIDIURETIC HORMONE

Facility

$95.00

Service Code	CPT 84588
Hospital Charge Code	2220100
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$67.88
Rate for Payer: Aetna Better Health Medicaid/QHP	$30.55
Rate for Payer: Aetna Medicare Advantage	$33.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$67.83
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cigna Commercial HMO & PPO	$33.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32.69
Rate for Payer: Home State Health Plan Medicare Advantage	$33.94
Rate for Payer: Humana Commercial	$67.88
Rate for Payer: Humana Medicare Advantage	$33.94
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$30.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.20

ADH PROFILE

Facility

$190.00

Service Code	CPT 84588
Hospital Charge Code	2220111
Hospital Revenue Code	301
Rate for Payer: Cash Price	$171.00

ADH PROFILE

Facility

$190.00

Service Code	CPT 84588
Hospital Charge Code	2220111
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$135.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$30.55
Rate for Payer: Aetna Medicare Advantage	$33.94
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	$33.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32.69
Rate for Payer: Home State Health Plan Medicare Advantage	$33.94
Rate for Payer: Humana Commercial	$67.88
Rate for Payer: Humana Medicare Advantage	$33.94
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$30.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.40

ADJUSTMENT DISORDERS

Facility

$22,949.96

Service Code	APR-DRG 7554
Min. Negotiated Rate	$22,949.96
Max. Negotiated Rate	$22,949.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,949.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,949.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,949.96
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,949.96

ADJUSTMENT DISORDERS

Facility

$9,525.06

Service Code	APR-DRG 7552
Min. Negotiated Rate	$9,525.06
Max. Negotiated Rate	$9,525.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,525.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,525.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,525.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,525.06

ADJUSTMENT DISORDERS

Facility

$20,945.90

Service Code	APR-DRG 7553
Min. Negotiated Rate	$20,945.90
Max. Negotiated Rate	$20,945.90
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,945.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,945.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,945.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,945.90

ADJUSTMENT DISORDERS

Facility

$7,579.58

Service Code	APR-DRG 7551
Min. Negotiated Rate	$7,579.58
Max. Negotiated Rate	$7,579.58
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,579.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,579.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,579.58
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,579.58

ADMA/SDMA

Facility

$214.00

Service Code	CPT 82542
Hospital Charge Code	229403
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$152.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.68
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$126.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$152.80
Rate for Payer: Cash Price	$192.60
Rate for Payer: Cash Price	$192.60
Rate for Payer: Cash Price	$192.60
Rate for Payer: Cigna Commercial HMO & PPO	$24.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.20
Rate for Payer: Home State Health Plan Medicare Advantage	$24.09
Rate for Payer: Humana Commercial	$48.18
Rate for Payer: Humana Medicare Advantage	$24.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$77.04

ADMA/SDMA

Facility

$214.00

Service Code	CPT 82542
Hospital Charge Code	229403
Hospital Revenue Code	301
Rate for Payer: Cash Price	$192.60

ADM, BLOOD PUMP

Facility

$45.00

Hospital Charge Code	281543
Hospital Revenue Code	271
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

ADM, BLOOD PUMP

Facility

$45.00

Hospital Charge Code	281543
Hospital Revenue Code	271
Rate for Payer: Cash Price	$40.50

ADM FEEDING PUMP

Facility

$81.00

Hospital Charge Code	281540
Hospital Revenue Code	271
Rate for Payer: Cash Price	$72.90

ADM FEEDING PUMP

Facility

$81.00

Hospital Charge Code	281540
Hospital Revenue Code	271
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$57.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

ADM FLU VAC

Facility

$8.00

Service Code	CPT G0008
Hospital Charge Code	5200008
Hospital Revenue Code	521
Rate for Payer: Cash Price	$7.20

Know your out-of-pocket cost for care.

All Charges