Madison Medical Center

All Charges

Charge

Type

Setting

Price

AFP TUMOR MARKER

Facility

$76.00

Service Code	CPT 82105
Hospital Charge Code	2282105
Hospital Revenue Code	301
Min. Negotiated Rate	$15.09
Max. Negotiated Rate	$54.26
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.09
Rate for Payer: Aetna Medicare Advantage	$16.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$54.26
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cigna Commercial HMO & PPO	$16.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.15
Rate for Payer: Home State Health Plan Medicare Advantage	$16.77
Rate for Payer: Humana Commercial	$33.54
Rate for Payer: Humana Medicare Advantage	$16.77
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.36

AFP TUMOR MARKER

Facility

$76.00

Service Code	CPT 82105
Hospital Charge Code	2282105
Hospital Revenue Code	301
Rate for Payer: Cash Price	$68.40

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$21,267.28

Service Code	MSDRG 560
Min. Negotiated Rate	$10,633.64
Max. Negotiated Rate	$21,267.28
Rate for Payer: Aetna Medicare Advantage	$10,633.64
Rate for Payer: Cigna Commercial HMO & PPO	$10,633.64
Rate for Payer: Home State Health Plan Medicare Advantage	$10,633.64
Rate for Payer: Humana Commercial	$21,267.28
Rate for Payer: Humana Medicare Advantage	$10,633.64

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$32,871.08

Service Code	MSDRG 559
Min. Negotiated Rate	$16,435.54
Max. Negotiated Rate	$32,871.08
Rate for Payer: Aetna Medicare Advantage	$16,435.54
Rate for Payer: Cigna Commercial HMO & PPO	$16,435.54
Rate for Payer: Home State Health Plan Medicare Advantage	$16,435.54
Rate for Payer: Humana Commercial	$32,871.08
Rate for Payer: Humana Medicare Advantage	$16,435.54

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$16,225.06

Service Code	MSDRG 561
Min. Negotiated Rate	$8,112.53
Max. Negotiated Rate	$16,225.06
Rate for Payer: Aetna Medicare Advantage	$8,112.53
Rate for Payer: Cigna Commercial HMO & PPO	$8,112.53
Rate for Payer: Home State Health Plan Medicare Advantage	$8,112.53
Rate for Payer: Humana Commercial	$16,225.06
Rate for Payer: Humana Medicare Advantage	$8,112.53

AFTERCARE WITH CC/MCC

Facility

$22,262.56

Service Code	MSDRG 949
Min. Negotiated Rate	$11,131.28
Max. Negotiated Rate	$22,262.56
Rate for Payer: Aetna Medicare Advantage	$11,131.28
Rate for Payer: Cigna Commercial HMO & PPO	$11,131.28
Rate for Payer: Home State Health Plan Medicare Advantage	$11,131.28
Rate for Payer: Humana Commercial	$22,262.56
Rate for Payer: Humana Medicare Advantage	$11,131.28

AFTERCARE WITHOUT CC/MCC

Facility

$13,475.34

Service Code	MSDRG 950
Min. Negotiated Rate	$6,737.67
Max. Negotiated Rate	$13,475.34
Rate for Payer: Aetna Medicare Advantage	$6,737.67
Rate for Payer: Cigna Commercial HMO & PPO	$6,737.67
Rate for Payer: Home State Health Plan Medicare Advantage	$6,737.67
Rate for Payer: Humana Commercial	$13,475.34
Rate for Payer: Humana Medicare Advantage	$6,737.67

AGYL SPECIMEN TRAP

Facility

$4.00

Service Code	CPT 94640
Hospital Charge Code	4500361
Hospital Revenue Code	460
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2.86
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$2.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

AGYL SPECIMEN TRAP

Facility

$4.00

Service Code	CPT 94640
Hospital Charge Code	4500361
Hospital Revenue Code	460
Rate for Payer: Cash Price	$3.60

AICD GENERATOR PROCEDURES

Facility

$75,560.96

Service Code	MSDRG 245
Min. Negotiated Rate	$37,780.48
Max. Negotiated Rate	$75,560.96
Rate for Payer: Aetna Medicare Advantage	$37,780.48
Rate for Payer: Cigna Commercial HMO & PPO	$37,780.48
Rate for Payer: Home State Health Plan Medicare Advantage	$37,780.48
Rate for Payer: Humana Commercial	$75,560.96
Rate for Payer: Humana Medicare Advantage	$37,780.48

AICD LEAD PROCEDURES

Facility

$60,579.94

Service Code	MSDRG 265
Min. Negotiated Rate	$30,289.97
Max. Negotiated Rate	$60,579.94
Rate for Payer: Aetna Medicare Advantage	$30,289.97
Rate for Payer: Cigna Commercial HMO & PPO	$30,289.97
Rate for Payer: Home State Health Plan Medicare Advantage	$30,289.97
Rate for Payer: Humana Commercial	$60,579.94
Rate for Payer: Humana Medicare Advantage	$30,289.97

AIR CAST - ALL SIZES

Facility

$121.00

Service Code	CPT 99201
Hospital Charge Code	4070003
Hospital Revenue Code	271
Rate for Payer: Cash Price	$108.90

AIR CAST - ALL SIZES

Facility

$121.00

Service Code	CPT 99201
Hospital Charge Code	4070003
Hospital Revenue Code	271
Min. Negotiated Rate	$43.56
Max. Negotiated Rate	$86.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$71.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$86.39
Rate for Payer: Cash Price	$108.90
Rate for Payer: UnitedHealthcare Commercial	$80.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$43.56

AIR CONTRAST ENEMA

Facility

$836.00

Service Code	CPT 74280
Hospital Charge Code	325146
Hospital Revenue Code	320
Rate for Payer: Cash Price	$752.40

AIR CONTRAST ENEMA

Facility

$836.00

Service Code	CPT 74280
Hospital Charge Code	325146
Hospital Revenue Code	320
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$596.90
Rate for Payer: Aetna Better Health Medicaid/QHP	$158.12
Rate for Payer: Aetna Medicare Advantage	$179.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$494.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$596.90
Rate for Payer: Cash Price	$752.40
Rate for Payer: Cash Price	$752.40
Rate for Payer: Cash Price	$752.40
Rate for Payer: Cigna Commercial HMO & PPO	$179.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$158.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$169.19
Rate for Payer: Home State Health Plan Medicare Advantage	$179.20
Rate for Payer: Humana Commercial	$358.40
Rate for Payer: Humana Medicare Advantage	$179.20
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$158.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$300.96

AIR SPLINT

Facility

$215.00

Hospital Charge Code	2819813
Hospital Revenue Code	271
Min. Negotiated Rate	$77.40
Max. Negotiated Rate	$153.51
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: UnitedHealthcare Commercial	$143.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$77.40

AIR SPLINT

Facility

$215.00

Hospital Charge Code	2819813
Hospital Revenue Code	271
Rate for Payer: Cash Price	$193.50

AIR TRAQ OPTICAL LARYNGOSCOPE

Facility

$504.00

Hospital Charge Code	1201112
Hospital Revenue Code	271
Min. Negotiated Rate	$181.44
Max. Negotiated Rate	$359.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$298.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$359.86
Rate for Payer: Cash Price	$453.60
Rate for Payer: UnitedHealthcare Commercial	$336.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$181.44

AIR TRAQ OPTICAL LARYNGOSCOPE

Facility

$504.00

Hospital Charge Code	1201112
Hospital Revenue Code	271
Rate for Payer: Cash Price	$453.60

AIRWAY COMBI

Facility

$317.00

Hospital Charge Code	2810039
Hospital Revenue Code	270
Rate for Payer: Cash Price	$285.30

AIRWAY COMBI

Facility

$317.00

Hospital Charge Code	2810039
Hospital Revenue Code	270
Min. Negotiated Rate	$114.12
Max. Negotiated Rate	$226.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$187.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$226.34
Rate for Payer: Cash Price	$285.30
Rate for Payer: UnitedHealthcare Commercial	$211.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$114.12

AIRWAY NASAL 22FR

Facility

$89.00

Hospital Charge Code	281280
Hospital Revenue Code	272
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$63.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.55
Rate for Payer: Cash Price	$80.10
Rate for Payer: UnitedHealthcare Commercial	$59.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

AIRWAY NASAL 22FR

Facility

$89.00

Hospital Charge Code	281280
Hospital Revenue Code	272
Rate for Payer: Cash Price	$80.10

AIRWAY NASAL 24FR

Facility

$89.00

Hospital Charge Code	281281
Hospital Revenue Code	272
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$63.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.55
Rate for Payer: Cash Price	$80.10
Rate for Payer: UnitedHealthcare Commercial	$59.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

AIRWAY NASAL 24FR

Facility

$89.00

Hospital Charge Code	281281
Hospital Revenue Code	272
Rate for Payer: Cash Price	$80.10

Know your out-of-pocket cost for care.

All Charges