Madison Medical Center

All Charges

Charge

Type

Setting

Price

EDROPHONIUM INJ

Facility

$65.00

Hospital Charge Code	2058064
Hospital Revenue Code	370
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
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: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

EDROPHONIUM INJ

Facility

$65.00

Hospital Charge Code	2058064
Hospital Revenue Code	370
Rate for Payer: Cash Price	$58.50

E E A

Facility

$301.00

Hospital Charge Code	285007
Hospital Revenue Code	271
Min. Negotiated Rate	$108.36
Max. Negotiated Rate	$214.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$178.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.91
Rate for Payer: Cash Price	$270.90
Rate for Payer: UnitedHealthcare Commercial	$200.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.36

E E A

Facility

$301.00

Hospital Charge Code	285007
Hospital Revenue Code	271
Rate for Payer: Cash Price	$270.90

E E A 31 (DISP)

Facility

$1,670.00

Hospital Charge Code	125007
Hospital Revenue Code	271
Rate for Payer: Cash Price	$1,503.00

E E A 31 (DISP)

Facility

$1,670.00

Hospital Charge Code	125007
Hospital Revenue Code	271
Min. Negotiated Rate	$601.20
Max. Negotiated Rate	$1,192.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$988.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,192.38
Rate for Payer: Cash Price	$1,503.00
Rate for Payer: UnitedHealthcare Commercial	$1,113.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$601.20

E E A STAPLES

Facility

$594.00

Hospital Charge Code	285008
Hospital Revenue Code	271
Rate for Payer: Cash Price	$534.60

E E A STAPLES

Facility

$594.00

Hospital Charge Code	285008
Hospital Revenue Code	271
Min. Negotiated Rate	$213.84
Max. Negotiated Rate	$424.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$351.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$424.12
Rate for Payer: Cash Price	$534.60
Rate for Payer: UnitedHealthcare Commercial	$396.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$213.84

EEG

Facility

$1,295.00

Hospital Charge Code	4500150
Hospital Revenue Code	460
Min. Negotiated Rate	$466.20
Max. Negotiated Rate	$924.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$766.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$924.63
Rate for Payer: Cash Price	$1,165.50
Rate for Payer: UnitedHealthcare Commercial	$863.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$466.20

EEG

Facility

$1,295.00

Hospital Charge Code	4500150
Hospital Revenue Code	460
Rate for Payer: Cash Price	$1,165.50

EFC-STRAIGHT FORWARD

Facility

$85.00

Service Code	CPT 99307
Hospital Charge Code	9699307
Hospital Revenue Code	521
Min. Negotiated Rate	$50.32
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$50.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$60.69
Rate for Payer: Cash Price	$76.50
Rate for Payer: Cash Price	$76.50
Rate for Payer: UnitedHealthcare Commercial	$56.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EFC-STRAIGHT FORWARD

Facility

$85.00

Service Code	CPT 99307
Hospital Charge Code	9699307
Hospital Revenue Code	521
Rate for Payer: Cash Price	$76.50

EGD DIAG WITH BRUSHING AND WASHING

Professional

Both

$1,100.00

Service Code	CPT 43235
Hospital Charge Code	9343235
Hospital Revenue Code	975
Min. Negotiated Rate	$105.60
Max. Negotiated Rate	$385.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$105.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$231.00
Rate for Payer: Cash Price	$990.00
Rate for Payer: Cash Price	$990.00
Rate for Payer: Cigna Commercial HMO & PPO	$105.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$231.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$254.10
Rate for Payer: Home State Health Plan Medicare Advantage	$105.60
Rate for Payer: Optum Medicare Advantage	$385.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$231.00

EGD DIAG WITH CONTROL OF BLEEDING ANY ME

Professional

Both

$1,550.00

Service Code	CPT 43255
Hospital Charge Code	9343255
Hospital Revenue Code	975
Min. Negotiated Rate	$170.05
Max. Negotiated Rate	$544.26
Rate for Payer: Aetna Commercial/Medicare Advantage	$170.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$494.78
Rate for Payer: Cash Price	$1,395.00
Rate for Payer: Cash Price	$1,395.00
Rate for Payer: Cigna Commercial HMO & PPO	$170.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$494.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$544.26
Rate for Payer: Home State Health Plan Medicare Advantage	$170.05
Rate for Payer: Optum Medicare Advantage	$542.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$494.78

EGD DIAG WITH INS WIRE/DIALATION

Professional

Both

$1,500.00

Service Code	CPT 43248
Hospital Charge Code	9343248
Hospital Revenue Code	975
Min. Negotiated Rate	$141.91
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$141.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$323.03
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Cigna Commercial HMO & PPO	$141.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$323.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$355.33
Rate for Payer: Home State Health Plan Medicare Advantage	$141.91
Rate for Payer: Optum Medicare Advantage	$525.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$323.03

EGD NO BIOPSY

Facility

$998.00

Service Code	CPT 43235
Hospital Charge Code	9643235
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,853.26
Rate for Payer: Aetna Better Health Medicaid/QHP	$817.60
Rate for Payer: Aetna Medicare Advantage	$926.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$590.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$712.57
Rate for Payer: Cash Price	$898.20
Rate for Payer: Cash Price	$898.20
Rate for Payer: Cash Price	$898.20
Rate for Payer: Cash Price	$898.20
Rate for Payer: Cigna Commercial HMO & PPO	$926.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$735.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$874.83
Rate for Payer: Home State Health Plan Medicare Advantage	$926.63
Rate for Payer: Humana Commercial	$1,853.26
Rate for Payer: Humana Medicare Advantage	$926.63
Rate for Payer: UnitedHealthcare Commercial	$665.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$817.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EGD NO BIOPSY

Facility

$998.00

Service Code	CPT 43235
Hospital Charge Code	9643235
Hospital Revenue Code	521
Rate for Payer: Cash Price	$898.20

EGD UPPER GASTRO ENDOSCOPY W/BIOPSY

Professional

Both

$875.00

Service Code	CPT 43239
Hospital Charge Code	4143239
Hospital Revenue Code	975
Min. Negotiated Rate	$118.28
Max. Negotiated Rate	$325.04
Rate for Payer: Aetna Commercial/Medicare Advantage	$118.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$295.49
Rate for Payer: Cash Price	$787.50
Rate for Payer: Cash Price	$787.50
Rate for Payer: Cigna Commercial HMO & PPO	$118.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$295.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$325.04
Rate for Payer: Home State Health Plan Medicare Advantage	$118.28
Rate for Payer: Optum Medicare Advantage	$306.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$295.49

EGD W/BIOPSY, SINGLE OR MULTIPLE

Professional

Both

$1,050.00

Service Code	CPT 43239
Hospital Charge Code	5443239
Hospital Revenue Code	975
Min. Negotiated Rate	$118.28
Max. Negotiated Rate	$367.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$118.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$295.49
Rate for Payer: Cash Price	$945.00
Rate for Payer: Cash Price	$945.00
Rate for Payer: Cigna Commercial HMO & PPO	$118.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$295.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$325.04
Rate for Payer: Home State Health Plan Medicare Advantage	$118.28
Rate for Payer: Optum Medicare Advantage	$367.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$295.49

EGD WITH BALLOON DIL

Professional

Both

$1,400.00

Service Code	CPT 43249
Hospital Charge Code	9343249
Hospital Revenue Code	975
Min. Negotiated Rate	$130.58
Max. Negotiated Rate	$951.51
Rate for Payer: Aetna Commercial/Medicare Advantage	$130.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$865.01
Rate for Payer: Cash Price	$1,260.00
Rate for Payer: Cash Price	$1,260.00
Rate for Payer: Cigna Commercial HMO & PPO	$130.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$865.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$951.51
Rate for Payer: Home State Health Plan Medicare Advantage	$130.58
Rate for Payer: Optum Medicare Advantage	$490.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$865.01

EGD WITH BIOPSY ADD ON CODE

Professional

Both

$1,400.00

Service Code	CPT 43239
Hospital Charge Code	9343239
Hospital Revenue Code	975
Min. Negotiated Rate	$118.28
Max. Negotiated Rate	$490.00
Rate for Payer: Optum Medicare Advantage	$490.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$118.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$295.49
Rate for Payer: Cash Price	$1,260.00
Rate for Payer: Cash Price	$1,260.00
Rate for Payer: Cigna Commercial HMO & PPO	$118.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$295.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$325.04
Rate for Payer: Home State Health Plan Medicare Advantage	$118.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$295.49

EGD W REM OF TUM,POLYP LESION BY SNARE

Professional

Both

$1,365.00

Service Code	CPT 43251
Hospital Charge Code	5443251
Hospital Revenue Code	975
Min. Negotiated Rate	$166.18
Max. Negotiated Rate	$477.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$166.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$389.09
Rate for Payer: Cash Price	$1,228.50
Rate for Payer: Cash Price	$1,228.50
Rate for Payer: Cigna Commercial HMO & PPO	$166.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$389.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$428.00
Rate for Payer: Home State Health Plan Medicare Advantage	$166.18
Rate for Payer: Optum Medicare Advantage	$477.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$389.09

EGG BUR 5.0(STRYKER)

Facility

$389.00

Hospital Charge Code	127782
Hospital Revenue Code	271
Rate for Payer: Cash Price	$350.10

EGG BUR 5.0(STRYKER)

Facility

$389.00

Hospital Charge Code	127782
Hospital Revenue Code	271
Min. Negotiated Rate	$140.04
Max. Negotiated Rate	$277.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$230.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$277.75
Rate for Payer: Cash Price	$350.10
Rate for Payer: UnitedHealthcare Commercial	$259.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$140.04

EGG BUR 6.0(STRYKER)

Facility

$389.00

Hospital Charge Code	127783
Hospital Revenue Code	271
Min. Negotiated Rate	$140.04
Max. Negotiated Rate	$277.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$230.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$277.75
Rate for Payer: Cash Price	$350.10
Rate for Payer: UnitedHealthcare Commercial	$259.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$140.04

Know your out-of-pocket cost for care.

All Charges