Madison Medical Center

All Charges

Charge

Type

Setting

Price

EMERGENCY SURGERY

Facility

$1,815.00

Hospital Charge Code	1200100
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,633.50

EMERGENCY SURGERY

Facility

$1,815.00

Hospital Charge Code	1200100
Hospital Revenue Code	360
Min. Negotiated Rate	$653.40
Max. Negotiated Rate	$1,210.61
Rate for Payer: Cash Price	$1,633.50
Rate for Payer: UnitedHealthcare Commercial	$1,210.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$653.40

EMERG. ROOM VISIT (BRIEF)

Facility

$68.00

Service Code	CPT 99281
Hospital Charge Code	4499281
Hospital Revenue Code	525
Min. Negotiated Rate	$40.26
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$76.01
Rate for Payer: Aetna Medicare Advantage	$86.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$40.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$48.55
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cigna Commercial HMO & PPO	$86.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$68.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$81.33
Rate for Payer: Home State Health Plan Medicare Advantage	$86.15
Rate for Payer: Humana Commercial	$172.30
Rate for Payer: Humana Medicare Advantage	$86.15
Rate for Payer: UnitedHealthcare Commercial	$45.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$76.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EMERG. ROOM VISIT (BRIEF)

Facility

$68.00

Service Code	CPT 99281
Hospital Charge Code	4499281
Hospital Revenue Code	525
Rate for Payer: Cash Price	$61.20

EMERG. ROOM VISIT (COMPRE)

Facility

$307.00

Service Code	CPT 99285
Hospital Charge Code	4499285
Hospital Revenue Code	525
Rate for Payer: Cash Price	$276.30

EMERG. ROOM VISIT (COMPRE)

Facility

$307.00

Service Code	CPT 99285
Hospital Charge Code	4499285
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,216.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$536.84
Rate for Payer: Aetna Medicare Advantage	$608.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$181.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$219.20
Rate for Payer: Cash Price	$276.30
Rate for Payer: Cash Price	$276.30
Rate for Payer: Cash Price	$276.30
Rate for Payer: Cash Price	$276.30
Rate for Payer: Cigna Commercial HMO & PPO	$608.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$483.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$574.42
Rate for Payer: Home State Health Plan Medicare Advantage	$608.43
Rate for Payer: Humana Commercial	$1,216.86
Rate for Payer: Humana Medicare Advantage	$608.43
Rate for Payer: UnitedHealthcare Commercial	$204.77
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$536.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EMERG. ROOM VISIT (EXTENDED)

Facility

$214.00

Service Code	CPT 99284
Hospital Charge Code	4499284
Hospital Revenue Code	525
Rate for Payer: Cash Price	$192.60

EMERG. ROOM VISIT (EXTENDED)

Facility

$214.00

Service Code	CPT 99284
Hospital Charge Code	4499284
Hospital Revenue Code	525
Min. Negotiated Rate	$126.69
Max. Negotiated Rate	$852.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$376.14
Rate for Payer: Aetna Medicare Advantage	$426.30
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: Cash Price	$192.60
Rate for Payer: Cigna Commercial HMO & PPO	$426.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$338.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$402.47
Rate for Payer: Home State Health Plan Medicare Advantage	$426.30
Rate for Payer: Humana Commercial	$852.60
Rate for Payer: Humana Medicare Advantage	$426.30
Rate for Payer: UnitedHealthcare Commercial	$142.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$376.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EMERG. ROOM VISIT (INTER)

Facility

$141.00

Service Code	CPT 99283
Hospital Charge Code	4499283
Hospital Revenue Code	525
Min. Negotiated Rate	$83.47
Max. Negotiated Rate	$557.78
Rate for Payer: Aetna Better Health Medicaid/QHP	$246.07
Rate for Payer: Aetna Medicare Advantage	$278.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$83.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$100.67
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cigna Commercial HMO & PPO	$278.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$221.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$263.29
Rate for Payer: Home State Health Plan Medicare Advantage	$278.89
Rate for Payer: Humana Commercial	$557.78
Rate for Payer: Humana Medicare Advantage	$278.89
Rate for Payer: UnitedHealthcare Commercial	$94.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$246.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EMERG. ROOM VISIT (INTER)

Facility

$141.00

Service Code	CPT 99283
Hospital Charge Code	4499283
Hospital Revenue Code	525
Rate for Payer: Cash Price	$126.90

EMERG. ROOM VISIT (LIMITED)

Facility

$93.00

Service Code	CPT 99282
Hospital Charge Code	4499282
Hospital Revenue Code	525
Min. Negotiated Rate	$55.06
Max. Negotiated Rate	$313.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$138.41
Rate for Payer: Aetna Medicare Advantage	$156.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cigna Commercial HMO & PPO	$156.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$124.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$148.10
Rate for Payer: Home State Health Plan Medicare Advantage	$156.87
Rate for Payer: Humana Commercial	$313.74
Rate for Payer: Humana Medicare Advantage	$156.87
Rate for Payer: UnitedHealthcare Commercial	$62.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$138.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EMERG. ROOM VISIT (LIMITED)

Facility

$93.00

Service Code	CPT 99282
Hospital Charge Code	4499282
Hospital Revenue Code	525
Rate for Payer: Cash Price	$83.70

EMERG SERVICES REQ PT OUTSIDE OF OFFICE

Facility

$100.00

Service Code	CPT 99056
Hospital Charge Code	9899056
Hospital Revenue Code	521
Min. Negotiated Rate	$59.20
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EMERG SERVICES REQ PT OUTSIDE OF OFFICE

Facility

$100.00

Service Code	CPT 99056
Hospital Charge Code	9899056
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.00

EMERG VISIT(MOD-COMPLEX)

Facility

$110.00

Service Code	CPT 99283
Hospital Charge Code	5299283
Hospital Revenue Code	521
Min. Negotiated Rate	$65.12
Max. Negotiated Rate	$557.78
Rate for Payer: Aetna Better Health Medicaid/QHP	$246.07
Rate for Payer: Aetna Medicare Advantage	$278.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$278.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$221.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$263.29
Rate for Payer: Home State Health Plan Medicare Advantage	$278.89
Rate for Payer: Humana Commercial	$557.78
Rate for Payer: Humana Medicare Advantage	$278.89
Rate for Payer: UnitedHealthcare Commercial	$73.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$246.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EMERG VISIT(MOD-COMPLEX)

Facility

$110.00

Service Code	CPT 99283
Hospital Charge Code	5299283
Hospital Revenue Code	521
Rate for Payer: Cash Price	$99.00

EMERG VISIT(STREIGHTFORWARD)

Facility

$70.00

Service Code	CPT 99281
Hospital Charge Code	5299281
Hospital Revenue Code	521
Min. Negotiated Rate	$41.44
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$76.01
Rate for Payer: Aetna Medicare Advantage	$86.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$86.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$68.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$81.33
Rate for Payer: Home State Health Plan Medicare Advantage	$86.15
Rate for Payer: Humana Commercial	$172.30
Rate for Payer: Humana Medicare Advantage	$86.15
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$76.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EMERG VISIT(STREIGHTFORWARD)

Facility

$70.00

Service Code	CPT 99281
Hospital Charge Code	5299281
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

EMESIS BASIN

Facility

$21.00

Hospital Charge Code	285338
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

EMESIS BASIN

Facility

$21.00

Hospital Charge Code	285338
Hospital Revenue Code	271
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
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: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

EMPAGLIFLOZIN (JARDIANCE) 10MG TAB EMP

Facility

$77.00

Service Code	NDC 597015230
Hospital Charge Code	2622368
Hospital Revenue Code	250
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$54.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$45.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$54.98
Rate for Payer: Cash Price	$69.30
Rate for Payer: UnitedHealthcare Commercial	$51.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.72

EMPAGLIFLOZIN (JARDIANCE) 10MG TAB EMP

Facility

$77.00

Service Code	NDC 597015230
Hospital Charge Code	2622368
Hospital Revenue Code	250
Rate for Payer: Cash Price	$69.30

EMPAGLIFLOZIN (JARDIANCE) 25MG TAB

Facility

$80.00

Service Code	NDC 597015330
Hospital Charge Code	2622370
Hospital Revenue Code	250
Rate for Payer: Cash Price	$72.00

EMPAGLIFLOZIN (JARDIANCE) 25MG TAB

Facility

$80.00

Service Code	NDC 597015330
Hospital Charge Code	2622370
Hospital Revenue Code	250
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$57.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: UnitedHealthcare Commercial	$53.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.80

EMPAGLIFLOZIN (JARDIANCE) 25MG TAB EMP

Facility

$77.00

Service Code	NDC 597015330
Hospital Charge Code	2622167
Hospital Revenue Code	250
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$54.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$45.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$54.98
Rate for Payer: Cash Price	$69.30
Rate for Payer: UnitedHealthcare Commercial	$51.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.72

Know your out-of-pocket cost for care.

All Charges