Madison Medical Center

All Charges

Charge

Type

Setting

Price

DEFRAN INFLUENZA A&B TEST

Facility

$123.00

Service Code	CPT 87502
Hospital Charge Code	9487502
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$191.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$86.22
Rate for Payer: Aetna Medicare Advantage	$95.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$72.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$87.82
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna Commercial HMO & PPO	$95.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$86.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$92.26
Rate for Payer: Home State Health Plan Medicare Advantage	$95.80
Rate for Payer: Humana Commercial	$191.60
Rate for Payer: Humana Medicare Advantage	$95.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$86.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.28

DEFRAN INFLUENZA A&B TEST

Facility

$123.00

Service Code	CPT 87502
Hospital Charge Code	9487502
Hospital Revenue Code	301
Rate for Payer: Cash Price	$110.70

DEFRAN KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	9487210
Hospital Revenue Code	301
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.24
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$5.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.61
Rate for Payer: Home State Health Plan Medicare Advantage	$5.82
Rate for Payer: Humana Commercial	$11.64
Rate for Payer: Humana Medicare Advantage	$5.82
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

DEFRAN KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	9487210
Hospital Revenue Code	301
Rate for Payer: Cash Price	$36.00

DEFRAN OCCULT BLOOD

Facility

$25.00

Service Code	CPT 82270
Hospital Charge Code	9482270
Hospital Revenue Code	301
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.94
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.85
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna Commercial HMO & PPO	$4.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.22
Rate for Payer: Home State Health Plan Medicare Advantage	$4.38
Rate for Payer: Humana Commercial	$8.76
Rate for Payer: Humana Medicare Advantage	$4.38
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.00

DEFRAN OCCULT BLOOD

Facility

$25.00

Service Code	CPT 82270
Hospital Charge Code	9482270
Hospital Revenue Code	301
Rate for Payer: Cash Price	$22.50

DEFRAN RAPID STREP

Facility

$75.00

Service Code	CPT 87880
Hospital Charge Code	9487880
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

DEFRAN RAPID STREP

Facility

$75.00

Service Code	CPT 87880
Hospital Charge Code	9487880
Hospital Revenue Code	301
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.88
Rate for Payer: Aetna Medicare Advantage	$16.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$16.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.92
Rate for Payer: Home State Health Plan Medicare Advantage	$16.53
Rate for Payer: Humana Commercial	$33.06
Rate for Payer: Humana Medicare Advantage	$16.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

DEFRAN RSV

Facility

$123.00

Service Code	CPT 87634
Hospital Charge Code	9487634
Hospital Revenue Code	301
Rate for Payer: Cash Price	$110.70

DEFRAN RSV

Facility

$123.00

Service Code	CPT 87634
Hospital Charge Code	9487634
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$63.18
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$72.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$87.82
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna Commercial HMO & PPO	$70.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$63.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$67.60
Rate for Payer: Home State Health Plan Medicare Advantage	$70.20
Rate for Payer: Humana Commercial	$140.40
Rate for Payer: Humana Medicare Advantage	$70.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$63.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.28

DEFRAN STREP

Facility

$75.00

Service Code	CPT 87651
Hospital Charge Code	9487651
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

DEFRAN STREP

Facility

$75.00

Service Code	CPT 87651
Hospital Charge Code	9487651
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$70.18
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.58
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$35.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33.79
Rate for Payer: Home State Health Plan Medicare Advantage	$35.09
Rate for Payer: Humana Commercial	$70.18
Rate for Payer: Humana Medicare Advantage	$35.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

DEFRAN URINE DIP

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	9481002
Hospital Revenue Code	307
Rate for Payer: Cash Price	$24.30

DEFRAN URINE DIP

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	9481002
Hospital Revenue Code	307
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$15.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.28
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cigna Commercial HMO & PPO	$3.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.35
Rate for Payer: Home State Health Plan Medicare Advantage	$3.48
Rate for Payer: Humana Commercial	$6.96
Rate for Payer: Humana Medicare Advantage	$3.48
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72

DEFRAN URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	9481025
Hospital Revenue Code	307
Rate for Payer: Cash Price	$36.00

DEFRAN URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	9481025
Hospital Revenue Code	307
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.75
Rate for Payer: Aetna Medicare Advantage	$8.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$8.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.29
Rate for Payer: Home State Health Plan Medicare Advantage	$8.61
Rate for Payer: Humana Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$8.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS

Facility

$13,907.54

Service Code	APR-DRG 0423
Min. Negotiated Rate	$13,907.54
Max. Negotiated Rate	$13,907.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,907.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,907.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,907.54
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,907.54

DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS

Facility

$11,177.43

Service Code	APR-DRG 0422
Min. Negotiated Rate	$11,177.43
Max. Negotiated Rate	$11,177.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,177.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,177.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,177.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,177.43

DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS

Facility

$31,024.08

Service Code	APR-DRG 0424
Min. Negotiated Rate	$31,024.08
Max. Negotiated Rate	$31,024.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$31,024.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31,024.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$31,024.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31,024.08

DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS

Facility

$6,892.29

Service Code	APR-DRG 0421
Min. Negotiated Rate	$6,892.29
Max. Negotiated Rate	$6,892.29
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,892.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,892.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,892.29
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,892.29

DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC

Facility

$40,089.46

Service Code	MSDRG 056
Min. Negotiated Rate	$20,044.73
Max. Negotiated Rate	$40,089.46
Rate for Payer: Aetna Medicare Advantage	$20,044.73
Rate for Payer: Cigna Commercial HMO & PPO	$20,044.73
Rate for Payer: Home State Health Plan Medicare Advantage	$20,044.73
Rate for Payer: Humana Commercial	$40,089.46
Rate for Payer: Humana Medicare Advantage	$20,044.73

DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC

Facility

$23,919.82

Service Code	MSDRG 057
Min. Negotiated Rate	$11,959.91
Max. Negotiated Rate	$23,919.82
Rate for Payer: Aetna Medicare Advantage	$11,959.91
Rate for Payer: Cigna Commercial HMO & PPO	$11,959.91
Rate for Payer: Home State Health Plan Medicare Advantage	$11,959.91
Rate for Payer: Humana Commercial	$23,919.82
Rate for Payer: Humana Medicare Advantage	$11,959.91

DELIVERY, C-SECTION (POST P)

Facility

$1,852.00

Service Code	CPT 59515
Hospital Charge Code	5259515
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,322.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,096.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,322.33
Rate for Payer: Cash Price	$1,666.80
Rate for Payer: Cash Price	$1,666.80
Rate for Payer: UnitedHealthcare Commercial	$1,235.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DELIVERY, C-SECTION (POST P)

Facility

$1,852.00

Service Code	CPT 59515
Hospital Charge Code	5259515
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,666.80

DELIVERY (VAGINAL)

Facility

$1,153.00

Service Code	CPT 59409
Hospital Charge Code	5259409
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$6,614.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,918.10
Rate for Payer: Aetna Medicare Advantage	$3,307.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$682.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$823.24
Rate for Payer: Cash Price	$1,037.70
Rate for Payer: Cash Price	$1,037.70
Rate for Payer: Cash Price	$1,037.70
Rate for Payer: Cash Price	$1,037.70
Rate for Payer: Cigna Commercial HMO & PPO	$3,307.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,626.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,122.37
Rate for Payer: Home State Health Plan Medicare Advantage	$3,307.24
Rate for Payer: Humana Commercial	$6,614.48
Rate for Payer: Humana Medicare Advantage	$3,307.24
Rate for Payer: UnitedHealthcare Commercial	$769.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,918.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges