Madison Medical Center

All Charges

Charge

Type

Setting

Price

ADM FLU VAC

Facility

$8.00

Service Code	CPT G0008
Hospital Charge Code	5200008
Hospital Revenue Code	521
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Medicare Advantage	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.71
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial HMO & PPO	$47.84
Rate for Payer: Home State Health Plan Medicare Advantage	$47.84
Rate for Payer: Humana Commercial	$95.68
Rate for Payer: Humana Medicare Advantage	$47.84
Rate for Payer: UnitedHealthcare Commercial	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ADMIN FLU SHOT

Facility

$8.00

Service Code	CPT G0008
Hospital Charge Code	410008
Hospital Revenue Code	636
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$95.68
Rate for Payer: Aetna Medicare Advantage	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.71
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial HMO & PPO	$47.84
Rate for Payer: Home State Health Plan Medicare Advantage	$47.84
Rate for Payer: Humana Commercial	$95.68
Rate for Payer: Humana Medicare Advantage	$47.84
Rate for Payer: UnitedHealthcare Commercial	$47.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.84

ADMIN FLU SHOT

Facility

$8.00

Service Code	CPT G0008
Hospital Charge Code	410008
Hospital Revenue Code	636
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: UnitedHealthcare Commercial	$5.34

ADMIN FLU VAC

Facility

$8.00

Service Code	CPT G0008
Hospital Charge Code	4100008
Hospital Revenue Code	636
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: UnitedHealthcare Commercial	$5.34

ADMIN FLU VAC

Facility

$8.00

Service Code	CPT G0008
Hospital Charge Code	4100008
Hospital Revenue Code	636
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$95.68
Rate for Payer: Aetna Medicare Advantage	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.71
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial HMO & PPO	$47.84
Rate for Payer: Home State Health Plan Medicare Advantage	$47.84
Rate for Payer: Humana Commercial	$95.68
Rate for Payer: Humana Medicare Advantage	$47.84
Rate for Payer: UnitedHealthcare Commercial	$47.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.84

ADMIN FLU VAC

Facility

$8.00

Service Code	CPT G0008
Hospital Charge Code	3900008
Hospital Revenue Code	771
Rate for Payer: Cash Price	$7.20

ADMIN FLU VAC

Facility

$8.00

Service Code	CPT G0008
Hospital Charge Code	3900008
Hospital Revenue Code	771
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$95.68
Rate for Payer: Aetna Medicare Advantage	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.71
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial HMO & PPO	$47.84
Rate for Payer: Home State Health Plan Medicare Advantage	$47.84
Rate for Payer: Humana Commercial	$95.68
Rate for Payer: Humana Medicare Advantage	$47.84
Rate for Payer: UnitedHealthcare Commercial	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.84

ADMINISTRATION FEE FLU VACCINE

Facility

$43.00

Service Code	HCPCS G0008
Hospital Charge Code	2654061
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

ADMINISTRATION FEE FLU VACCINE

Facility

$43.00

Service Code	HCPCS G0008
Hospital Charge Code	2654061
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$95.68
Rate for Payer: Aetna Medicare Advantage	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cigna Commercial HMO & PPO	$47.84
Rate for Payer: Home State Health Plan Medicare Advantage	$47.84
Rate for Payer: Humana Commercial	$95.68
Rate for Payer: Humana Medicare Advantage	$47.84
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

ADMINISTRATION FEE PNEUMONIA VACC

Facility

$45.00

Service Code	HCPCS G0009
Hospital Charge Code	2626315
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$95.68
Rate for Payer: Aetna Medicare Advantage	$47.84
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: Cash Price	$40.50
Rate for Payer: Cigna Commercial HMO & PPO	$47.84
Rate for Payer: Home State Health Plan Medicare Advantage	$47.84
Rate for Payer: Humana Commercial	$95.68
Rate for Payer: Humana Medicare Advantage	$47.84
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

ADMINISTRATION FEE PNEUMONIA VACC

Facility

$45.00

Service Code	HCPCS G0009
Hospital Charge Code	2626315
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

ADMIN OF INFLUENZA

Facility

$6.00

Service Code	CPT G0008
Hospital Charge Code	4400008
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Cash Price	$5.40
Rate for Payer: UnitedHealthcare Commercial	$4.00

ADMIN OF INFLUENZA

Facility

$6.00

Service Code	CPT G0008
Hospital Charge Code	4400008
Hospital Revenue Code	636
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$95.68
Rate for Payer: Aetna Medicare Advantage	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$3.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$4.28
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna Commercial HMO & PPO	$47.84
Rate for Payer: Home State Health Plan Medicare Advantage	$47.84
Rate for Payer: Humana Commercial	$95.68
Rate for Payer: Humana Medicare Advantage	$47.84
Rate for Payer: UnitedHealthcare Commercial	$47.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.84

ADMIN OF PNEUM. Vac

Facility

$6.00

Service Code	CPT G0009
Hospital Charge Code	4400009
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Cash Price	$5.40
Rate for Payer: UnitedHealthcare Commercial	$4.00

ADMIN OF PNEUM. Vac

Facility

$6.00

Service Code	CPT G0009
Hospital Charge Code	4400009
Hospital Revenue Code	636
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$95.68
Rate for Payer: Aetna Medicare Advantage	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$3.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$4.28
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna Commercial HMO & PPO	$47.84
Rate for Payer: Home State Health Plan Medicare Advantage	$47.84
Rate for Payer: Humana Commercial	$95.68
Rate for Payer: Humana Medicare Advantage	$47.84
Rate for Payer: UnitedHealthcare Commercial	$47.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.84

ADMIN PNEUMO VAC

Facility

$8.00

Service Code	CPT G0009
Hospital Charge Code	4100009
Hospital Revenue Code	636
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$95.68
Rate for Payer: Aetna Medicare Advantage	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.71
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial HMO & PPO	$47.84
Rate for Payer: Home State Health Plan Medicare Advantage	$47.84
Rate for Payer: Humana Commercial	$95.68
Rate for Payer: Humana Medicare Advantage	$47.84
Rate for Payer: UnitedHealthcare Commercial	$47.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.84

ADMIN PNEUMO VAC

Facility

$8.00

Service Code	CPT G0009
Hospital Charge Code	3900009
Hospital Revenue Code	771
Rate for Payer: Cash Price	$7.20

ADMIN PNEUMO VAC

Facility

$8.00

Service Code	CPT G0009
Hospital Charge Code	4100009
Hospital Revenue Code	636
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: UnitedHealthcare Commercial	$5.34

ADMIN PNEUMO VAC

Facility

$8.00

Service Code	CPT G0009
Hospital Charge Code	3900009
Hospital Revenue Code	771
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$95.68
Rate for Payer: Aetna Medicare Advantage	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.71
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial HMO & PPO	$47.84
Rate for Payer: Home State Health Plan Medicare Advantage	$47.84
Rate for Payer: Humana Commercial	$95.68
Rate for Payer: Humana Medicare Advantage	$47.84
Rate for Payer: UnitedHealthcare Commercial	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.84

ADMISSION TO OPO

Professional

Both

$250.00

Service Code	CPT 99221
Hospital Charge Code	5299218
Hospital Revenue Code	987
Min. Negotiated Rate	$72.43
Max. Negotiated Rate	$90.62
Rate for Payer: Aetna Commercial/Medicare Advantage	$72.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$82.38
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial HMO & PPO	$72.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$82.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$90.62
Rate for Payer: Home State Health Plan Medicare Advantage	$72.43
Rate for Payer: Optum Medicare Advantage	$87.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$82.38

ADMIT/DISCHARE SAME DAY MODERATE

Facility

$410.00

Service Code	CPT 99235
Hospital Charge Code	9699235
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$292.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$242.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$292.74
Rate for Payer: Cash Price	$369.00
Rate for Payer: Cash Price	$369.00
Rate for Payer: UnitedHealthcare Commercial	$273.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ADMIT/DISCHARE SAME DAY MODERATE

Facility

$410.00

Service Code	CPT 99235
Hospital Charge Code	9699235
Hospital Revenue Code	521
Rate for Payer: Cash Price	$369.00

ADMIT/DISCHARGE INTERMEDIATE

Professional

Both

$465.00

Service Code	CPT 99235
Hospital Charge Code	4199235
Hospital Revenue Code	975
Min. Negotiated Rate	$135.64
Max. Negotiated Rate	$162.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$139.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$135.64
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cigna Commercial HMO & PPO	$139.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$135.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$149.20
Rate for Payer: Home State Health Plan Medicare Advantage	$139.10
Rate for Payer: Optum Medicare Advantage	$162.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$135.64

ADMIT/DISCHARGE OPO SAME DAY

Facility

$353.00

Service Code	CPT 99234
Hospital Charge Code	5499234
Rate for Payer: Cash Price	$317.70

ADMIT/DISCHARGE SAME DAY

Facility

$353.00

Service Code	CPT 99234
Hospital Charge Code	4199234
Hospital Revenue Code	521
Rate for Payer: Cash Price	$317.70

Know your out-of-pocket cost for care.

All Charges