Madison Medical Center

All Charges

Charge

Type

Setting

Price

EATING DISORDERS

Facility

$23,283.68

Service Code	APR-DRG 7592
Min. Negotiated Rate	$23,283.68
Max. Negotiated Rate	$23,283.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,283.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,283.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,283.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,283.68

EATING DISORDERS

Facility

$14,237.89

Service Code	APR-DRG 7591
Min. Negotiated Rate	$14,237.89
Max. Negotiated Rate	$14,237.89
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,237.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,237.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,237.89
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,237.89

EATING DISORDERS

Facility

$41,025.57

Service Code	APR-DRG 7593
Min. Negotiated Rate	$41,025.57
Max. Negotiated Rate	$41,025.57
Rate for Payer: Aetna Better Health Medicaid/QHP	$41,025.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$41,025.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$41,025.57
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$41,025.57

EATING DISORDERS

Facility

$63,627.62

Service Code	APR-DRG 7594
Min. Negotiated Rate	$63,627.62
Max. Negotiated Rate	$63,627.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$63,627.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$63,627.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$63,627.62
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$63,627.62

ECF-HIGH SEVERITY

Facility

$215.00

Service Code	CPT 99310
Hospital Charge Code	9699310
Hospital Revenue Code	521
Rate for Payer: Cash Price	$193.50

ECF-HIGH SEVERITY

Facility

$215.00

Service Code	CPT 99310
Hospital Charge Code	9699310
Hospital Revenue Code	521
Min. Negotiated Rate	$127.28
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$127.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$153.51
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: UnitedHealthcare Commercial	$143.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ECF-LOW SEVERITY

Facility

$125.00

Service Code	CPT 99308
Hospital Charge Code	9699308
Hospital Revenue Code	521
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: UnitedHealthcare Commercial	$83.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ECF-LOW SEVERITY

Facility

$125.00

Service Code	CPT 99308
Hospital Charge Code	9699308
Hospital Revenue Code	521
Rate for Payer: Cash Price	$112.50

ECF-MODERATE SEVERITY

Facility

$165.00

Service Code	CPT 99309
Hospital Charge Code	9699309
Hospital Revenue Code	521
Rate for Payer: Cash Price	$148.50

ECF-MODERATE SEVERITY

Facility

$165.00

Service Code	CPT 99309
Hospital Charge Code	9699309
Hospital Revenue Code	521
Min. Negotiated Rate	$97.68
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: UnitedHealthcare Commercial	$110.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

.E CHAFFEENIS IGG

Facility

$17.00

Service Code	CPT 86666
Hospital Charge Code	2286666
Hospital Revenue Code	302
Rate for Payer: Cash Price	$15.30

.E CHAFFEENIS IGG

Facility

$17.00

Service Code	CPT 86666
Hospital Charge Code	2286666
Hospital Revenue Code	302
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.16
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.14
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cigna Commercial HMO & PPO	$10.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.80
Rate for Payer: Home State Health Plan Medicare Advantage	$10.18
Rate for Payer: Humana Commercial	$20.36
Rate for Payer: Humana Medicare Advantage	$10.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.12

.E CHAFFEENIS IGG MONOCYTIC LABCORP

Facility

$21.00

Service Code	CPT 86666
Hospital Charge Code	228001
Hospital Revenue Code	302
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.16
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cigna Commercial HMO & PPO	$10.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.80
Rate for Payer: Home State Health Plan Medicare Advantage	$10.18
Rate for Payer: Humana Commercial	$20.36
Rate for Payer: Humana Medicare Advantage	$10.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

.E CHAFFEENIS IGG MONOCYTIC LABCORP

Facility

$21.00

Service Code	CPT 86666
Hospital Charge Code	228001
Hospital Revenue Code	302
Rate for Payer: Cash Price	$18.90

.E CHAFFEENIS IGM

Facility

$17.00

Service Code	CPT 86666
Hospital Charge Code	2286000
Hospital Revenue Code	302
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.16
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.14
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cigna Commercial HMO & PPO	$10.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.80
Rate for Payer: Home State Health Plan Medicare Advantage	$10.18
Rate for Payer: Humana Commercial	$20.36
Rate for Payer: Humana Medicare Advantage	$10.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.12

.E CHAFFEENIS IGM

Facility

$17.00

Service Code	CPT 86666
Hospital Charge Code	2286000
Hospital Revenue Code	302
Rate for Payer: Cash Price	$15.30

.E CHAFFEENIS IGM MONOCYTIC LABCORP

Facility

$21.00

Service Code	CPT 86666
Hospital Charge Code	228002
Hospital Revenue Code	302
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.16
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cigna Commercial HMO & PPO	$10.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.80
Rate for Payer: Home State Health Plan Medicare Advantage	$10.18
Rate for Payer: Humana Commercial	$20.36
Rate for Payer: Humana Medicare Advantage	$10.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

.E CHAFFEENIS IGM MONOCYTIC LABCORP

Facility

$21.00

Service Code	CPT 86666
Hospital Charge Code	228002
Hospital Revenue Code	302
Rate for Payer: Cash Price	$18.90

ECHOENCEPHALOGRAPHY

Facility

$849.00

Service Code	CPT 76506
Hospital Charge Code	350490
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$606.19
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$502.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$606.19
Rate for Payer: Cash Price	$764.10
Rate for Payer: Cash Price	$764.10
Rate for Payer: Cash Price	$764.10
Rate for Payer: Cash Price	$764.10
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$305.64

ECHOENCEPHALOGRAPHY

Facility

$849.00

Service Code	CPT 76506
Hospital Charge Code	350490
Hospital Revenue Code	402
Rate for Payer: Cash Price	$764.10

ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$340,077.48

Service Code	MSDRG 003
Min. Negotiated Rate	$170,038.74
Max. Negotiated Rate	$340,077.48
Rate for Payer: Aetna Medicare Advantage	$170,038.74
Rate for Payer: Cigna Commercial HMO & PPO	$170,038.74
Rate for Payer: Home State Health Plan Medicare Advantage	$170,038.74
Rate for Payer: Humana Commercial	$340,077.48
Rate for Payer: Humana Medicare Advantage	$170,038.74

ECSL LITHOTRIPSY

Facility

$2,837.00

Hospital Charge Code	123162
Hospital Revenue Code	360
Min. Negotiated Rate	$1,021.32
Max. Negotiated Rate	$1,892.28
Rate for Payer: Cash Price	$2,553.30
Rate for Payer: UnitedHealthcare Commercial	$1,892.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,021.32

ECSL LITHOTRIPSY

Facility

$2,837.00

Hospital Charge Code	123162
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,553.30

ECTOPIC PREG. TUBE REMOVED

Facility

$2,547.00

Service Code	CPT 59120
Hospital Charge Code	5259120
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,818.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,507.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,818.56
Rate for Payer: Cash Price	$2,292.30
Rate for Payer: Cash Price	$2,292.30
Rate for Payer: UnitedHealthcare Commercial	$1,698.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ECTOPIC PREG. TUBE REMOVED

Facility

$2,547.00

Service Code	CPT 59120
Hospital Charge Code	5259120
Hospital Revenue Code	521
Rate for Payer: Cash Price	$2,292.30

Know your out-of-pocket cost for care.

All Charges