Madison Medical Center

All Charges

Charge

Type

Setting

Price

ENDOSCOPIC INST SET

Facility

$2,451.00

Hospital Charge Code	285344
Hospital Revenue Code	271
Min. Negotiated Rate	$882.36
Max. Negotiated Rate	$1,750.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,450.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,750.01
Rate for Payer: Cash Price	$2,205.90
Rate for Payer: UnitedHealthcare Commercial	$1,634.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$882.36

ENDOSCOPIC RETRO

Facility

$1,234.00

Service Code	CPT 74330
Hospital Charge Code	3274330
Hospital Revenue Code	324
Rate for Payer: Cash Price	$1,110.60

ENDOSCOPIC RETRO

Facility

$1,234.00

Service Code	CPT 74330
Hospital Charge Code	3274330
Hospital Revenue Code	324
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$881.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$730.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$881.08
Rate for Payer: Cash Price	$1,110.60
Rate for Payer: Cash Price	$1,110.60
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.24

ENDOSCOPY-BILE DUCT

Professional

Both

$865.00

Service Code	CPT 47550 51
Hospital Charge Code	4147550
Hospital Revenue Code	975
Min. Negotiated Rate	$302.75
Max. Negotiated Rate	$302.75
Rate for Payer: Cash Price	$778.50
Rate for Payer: Optum Medicare Advantage	$302.75

ENDOSCOPY WITH REMOVAL OF SINGLE POLYP

Professional

Both

$248.00

Service Code	CPT 46610
Hospital Charge Code	4146610
Hospital Revenue Code	975
Min. Negotiated Rate	$72.27
Max. Negotiated Rate	$239.06
Rate for Payer: Aetna Commercial/Medicare Advantage	$72.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$217.33
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cigna Commercial HMO & PPO	$72.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$217.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$239.06
Rate for Payer: Home State Health Plan Medicare Advantage	$72.27
Rate for Payer: Optum Medicare Advantage	$86.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$217.33

ENDOSCOPY W/REMOVAL OF FOREIGN OBJECT.

Facility

$842.00

Service Code	CPT 43215
Hospital Charge Code	4143215
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$3,920.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,729.79
Rate for Payer: Aetna Medicare Advantage	$1,960.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$498.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$601.19
Rate for Payer: Cash Price	$757.80
Rate for Payer: Cash Price	$757.80
Rate for Payer: Cash Price	$757.80
Rate for Payer: Cash Price	$757.80
Rate for Payer: Cigna Commercial HMO & PPO	$1,960.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,556.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,850.88
Rate for Payer: Home State Health Plan Medicare Advantage	$1,960.47
Rate for Payer: Humana Commercial	$3,920.94
Rate for Payer: Humana Medicare Advantage	$1,960.47
Rate for Payer: UnitedHealthcare Commercial	$561.61
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,729.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ENDOSCOPY W/REMOVAL OF FOREIGN OBJECT.

Facility

$842.00

Service Code	CPT 43215
Hospital Charge Code	4143215
Hospital Revenue Code	521
Rate for Payer: Cash Price	$757.80

ENDOSHEARS

Facility

$786.00

Hospital Charge Code	1219112
Hospital Revenue Code	761
Rate for Payer: Cash Price	$707.40

ENDOSHEARS

Facility

$786.00

Hospital Charge Code	1219112
Hospital Revenue Code	761
Min. Negotiated Rate	$282.96
Max. Negotiated Rate	$561.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$465.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$561.20
Rate for Payer: Cash Price	$707.40
Rate for Payer: UnitedHealthcare Commercial	$524.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$282.96

ENDOTRA INTUB EMERG PROCEDURE

Professional

Both

$1,072.00

Service Code	CPT 31500
Hospital Charge Code	1831500
Hospital Revenue Code	981
Min. Negotiated Rate	$106.05
Max. Negotiated Rate	$375.20
Rate for Payer: Aetna Commercial/Medicare Advantage	$129.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$106.05
Rate for Payer: Cash Price	$964.80
Rate for Payer: Cash Price	$964.80
Rate for Payer: Cigna Commercial HMO & PPO	$129.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$106.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$116.66
Rate for Payer: Home State Health Plan Medicare Advantage	$129.89
Rate for Payer: Optum Medicare Advantage	$375.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$106.05

ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES

Facility

$93,729.54

Service Code	MSDRG 213
Min. Negotiated Rate	$46,864.77
Max. Negotiated Rate	$93,729.54
Rate for Payer: Aetna Medicare Advantage	$46,864.77
Rate for Payer: Cigna Commercial HMO & PPO	$46,864.77
Rate for Payer: Home State Health Plan Medicare Advantage	$46,864.77
Rate for Payer: Humana Commercial	$93,729.54
Rate for Payer: Humana Medicare Advantage	$46,864.77

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility

$100,420.72

Service Code	MSDRG 266
Min. Negotiated Rate	$50,210.36
Max. Negotiated Rate	$100,420.72
Rate for Payer: Aetna Medicare Advantage	$50,210.36
Rate for Payer: Cigna Commercial HMO & PPO	$50,210.36
Rate for Payer: Home State Health Plan Medicare Advantage	$50,210.36
Rate for Payer: Humana Commercial	$100,420.72
Rate for Payer: Humana Medicare Advantage	$50,210.36

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility

$78,710.50

Service Code	MSDRG 267
Min. Negotiated Rate	$39,355.25
Max. Negotiated Rate	$78,710.50
Rate for Payer: Aetna Medicare Advantage	$39,355.25
Rate for Payer: Cigna Commercial HMO & PPO	$39,355.25
Rate for Payer: Home State Health Plan Medicare Advantage	$39,355.25
Rate for Payer: Humana Commercial	$78,710.50
Rate for Payer: Humana Medicare Advantage	$39,355.25

ENDTIDAL CO2 INTUBATION SETUP

Facility

$81.00

Hospital Charge Code	1800342
Hospital Revenue Code	271
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$57.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

ENDTIDAL CO2 INTUBATION SETUP

Facility

$81.00

Hospital Charge Code	1800342
Hospital Revenue Code	271
Rate for Payer: Cash Price	$72.90

ENDTIDAL CO2 SETUP

Facility

$58.00

Hospital Charge Code	1800341
Hospital Revenue Code	271
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

ENDTIDAL CO2 SETUP

Facility

$58.00

Hospital Charge Code	1800341
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

ENEMA

Facility

$101.00

Hospital Charge Code	285366
Hospital Revenue Code	271
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

ENEMA

Facility

$101.00

Hospital Charge Code	285366
Hospital Revenue Code	271
Rate for Payer: Cash Price	$90.90

ENEMA BAG

Facility

$101.00

Hospital Charge Code	285367
Hospital Revenue Code	271
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

ENEMA BAG

Facility

$101.00

Hospital Charge Code	285367
Hospital Revenue Code	271
Rate for Payer: Cash Price	$90.90

ENLON-PLUS 1ML

Facility

$48.00

Hospital Charge Code	2058055
Hospital Revenue Code	370
Rate for Payer: Cash Price	$43.20

ENLON-PLUS 1ML

Facility

$48.00

Hospital Charge Code	2058055
Hospital Revenue Code	370
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

ENOXAPARIN 100MG INJ 1ML EMP

Facility

$460.00

Service Code	HCPCS J1650
Hospital Charge Code	2626160
Hospital Revenue Code	250
Rate for Payer: Cash Price	$414.00

ENOXAPARIN 100MG INJ 1ML EMP

Facility

$460.00

Service Code	HCPCS J1650
Hospital Charge Code	2626160
Hospital Revenue Code	250
Min. Negotiated Rate	$165.60
Max. Negotiated Rate	$328.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$272.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$328.44
Rate for Payer: Cash Price	$414.00
Rate for Payer: UnitedHealthcare Commercial	$306.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$165.60

Know your out-of-pocket cost for care.

All Charges