Madison Medical Center

All Charges

Charge

Type

Setting

Price

EVENT MONITOR HOOK UP & DISCONNECT

Facility

$160.00

Service Code	CPT 93270
Hospital Charge Code	4293270
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

EVENT MONITOR HOOK UP & DISCONNECT

Facility

$263.00

Service Code	CPT 93270
Hospital Charge Code	9693270
Hospital Revenue Code	521
Min. Negotiated Rate	$30.28
Max. Negotiated Rate	$187.78
Rate for Payer: Aetna Better Health Medicaid/QHP	$33.64
Rate for Payer: Aetna Medicare Advantage	$38.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$155.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$187.78
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cigna Commercial HMO & PPO	$38.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$35.99
Rate for Payer: Home State Health Plan Medicare Advantage	$38.13
Rate for Payer: Humana Commercial	$76.26
Rate for Payer: Humana Medicare Advantage	$38.13
Rate for Payer: UnitedHealthcare Commercial	$175.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EVENT MONITOR HOOK UP & DISCONNECT

Facility

$160.00

Service Code	CPT 93270
Hospital Charge Code	4293270
Hospital Revenue Code	521
Min. Negotiated Rate	$30.28
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$33.64
Rate for Payer: Aetna Medicare Advantage	$38.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$94.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$114.24
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna Commercial HMO & PPO	$38.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$35.99
Rate for Payer: Home State Health Plan Medicare Advantage	$38.13
Rate for Payer: Humana Commercial	$76.26
Rate for Payer: Humana Medicare Advantage	$38.13
Rate for Payer: UnitedHealthcare Commercial	$106.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EVENT MONITOR HOOK UP & DISCONNECT

Facility

$263.00

Service Code	CPT 93270
Hospital Charge Code	4193270
Hospital Revenue Code	521
Rate for Payer: Cash Price	$236.70

EVENT MONITOR HOOK UP & DISCONNECT

Facility

$263.00

Service Code	CPT 93270
Hospital Charge Code	4193270
Hospital Revenue Code	521
Min. Negotiated Rate	$30.28
Max. Negotiated Rate	$187.78
Rate for Payer: Aetna Better Health Medicaid/QHP	$33.64
Rate for Payer: Aetna Medicare Advantage	$38.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$155.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$187.78
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cigna Commercial HMO & PPO	$38.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$35.99
Rate for Payer: Home State Health Plan Medicare Advantage	$38.13
Rate for Payer: Humana Commercial	$76.26
Rate for Payer: Humana Medicare Advantage	$38.13
Rate for Payer: UnitedHealthcare Commercial	$175.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EVENT MONITORING GLOBAL PRE/POST SYM MON

Facility

$556.00

Service Code	CPT 93268
Hospital Charge Code	4493268
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$396.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$329.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$396.98
Rate for Payer: Cash Price	$500.40
Rate for Payer: Cash Price	$500.40
Rate for Payer: UnitedHealthcare Commercial	$370.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EVENT MONITORING GLOBAL PRE/POST SYM MON

Facility

$556.00

Service Code	CPT 93268
Hospital Charge Code	4493268
Hospital Revenue Code	521
Rate for Payer: Cash Price	$500.40

EVENT MONITORING HOOK-UP, DISCON SYM MON

Facility

$263.00

Service Code	CPT 93270
Hospital Charge Code	4493270
Hospital Revenue Code	521
Rate for Payer: Cash Price	$236.70

EVENT MONITORING HOOK-UP, DISCON SYM MON

Facility

$263.00

Service Code	CPT 93270
Hospital Charge Code	4493270
Hospital Revenue Code	521
Min. Negotiated Rate	$30.28
Max. Negotiated Rate	$187.78
Rate for Payer: Aetna Better Health Medicaid/QHP	$33.64
Rate for Payer: Aetna Medicare Advantage	$38.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$155.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$187.78
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cigna Commercial HMO & PPO	$38.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$35.99
Rate for Payer: Home State Health Plan Medicare Advantage	$38.13
Rate for Payer: Humana Commercial	$76.26
Rate for Payer: Humana Medicare Advantage	$38.13
Rate for Payer: UnitedHealthcare Commercial	$175.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EVENT MONITORING PHY REV&INTERPR SYM MON

Facility

$315.00

Service Code	CPT 93272
Hospital Charge Code	4493272
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$224.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$186.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$224.91
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: UnitedHealthcare Commercial	$210.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EVENT MONITORING PHY REV&INTERPR SYM MON

Facility

$315.00

Service Code	CPT 93272
Hospital Charge Code	4493272
Hospital Revenue Code	521
Rate for Payer: Cash Price	$283.50

EVENT MONITOR PHY REVIEW & INTERPRET

Facility

$315.00

Service Code	CPT 93272
Hospital Charge Code	4193272
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$224.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$186.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$224.91
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: UnitedHealthcare Commercial	$210.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EVENT MONITOR PHY REVIEW & INTERPRET

Facility

$315.00

Service Code	CPT 93272
Hospital Charge Code	4193272
Hospital Revenue Code	521
Rate for Payer: Cash Price	$283.50

EXALATION PORT DISPOSABLE

Facility

$11.00

Service Code	CPT 94660
Hospital Charge Code	4500222
Hospital Revenue Code	271
Rate for Payer: Cash Price	$9.90

EXALATION PORT DISPOSABLE

Facility

$11.00

Service Code	CPT 94660
Hospital Charge Code	4500222
Hospital Revenue Code	271
Min. Negotiated Rate	$3.96
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	$6.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.85
Rate for Payer: Cash Price	$9.90
Rate for Payer: Cash Price	$9.90
Rate for Payer: Cash Price	$9.90
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	$7.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.96

EXC .6 - 1.0 CM BEN EXC NECK

Facility

$105.00

Service Code	CPT 11421
Hospital Charge Code	4211421
Hospital Revenue Code	521
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$1,446.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$638.34
Rate for Payer: Aetna Medicare Advantage	$723.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cigna Commercial HMO & PPO	$723.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$574.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$683.02
Rate for Payer: Home State Health Plan Medicare Advantage	$723.47
Rate for Payer: Humana Commercial	$1,446.94
Rate for Payer: Humana Medicare Advantage	$723.47
Rate for Payer: UnitedHealthcare Commercial	$70.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC .6 - 1.0 CM BEN EXC NECK

Facility

$105.00

Service Code	CPT 11421
Hospital Charge Code	4211421
Hospital Revenue Code	521
Rate for Payer: Cash Price	$94.50

EXC ANAL POLYP

Professional

Both

$866.00

Service Code	CPT 46220
Hospital Charge Code	4146220
Hospital Revenue Code	975
Min. Negotiated Rate	$111.40
Max. Negotiated Rate	$303.10
Rate for Payer: Aetna Commercial/Medicare Advantage	$111.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$193.37
Rate for Payer: Cash Price	$779.40
Rate for Payer: Cash Price	$779.40
Rate for Payer: Cigna Commercial HMO & PPO	$111.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$193.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$212.71
Rate for Payer: Home State Health Plan Medicare Advantage	$111.40
Rate for Payer: Optum Medicare Advantage	$303.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$193.37

EXC BEN 1.1 TO 2.0 CM SCALP NECK HANDS F

Facility

$350.00

Service Code	CPT 11422
Hospital Charge Code	9811422
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$3,374.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,488.83
Rate for Payer: Aetna Medicare Advantage	$1,687.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$207.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$249.90
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cigna Commercial HMO & PPO	$1,687.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,339.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,593.05
Rate for Payer: Home State Health Plan Medicare Advantage	$1,687.37
Rate for Payer: Humana Commercial	$3,374.74
Rate for Payer: Humana Medicare Advantage	$1,687.37
Rate for Payer: UnitedHealthcare Commercial	$233.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN 1.1 TO 2.0 CM SCALP NECK HANDS F

Facility

$350.00

Service Code	CPT 11422
Hospital Charge Code	9811422
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

EXC BEN 3.1 - 4.0 CM SCALP NECK HANDS F

Facility

$650.00

Service Code	CPT 11424
Hospital Charge Code	9811424
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$3,374.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,488.83
Rate for Payer: Aetna Medicare Advantage	$1,687.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$384.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$464.10
Rate for Payer: Cash Price	$585.00
Rate for Payer: Cash Price	$585.00
Rate for Payer: Cash Price	$585.00
Rate for Payer: Cash Price	$585.00
Rate for Payer: Cigna Commercial HMO & PPO	$1,687.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,339.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,593.05
Rate for Payer: Home State Health Plan Medicare Advantage	$1,687.37
Rate for Payer: Humana Commercial	$3,374.74
Rate for Payer: Humana Medicare Advantage	$1,687.37
Rate for Payer: UnitedHealthcare Commercial	$433.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN 3.1 - 4.0 CM SCALP NECK HANDS F

Facility

$650.00

Service Code	CPT 11424
Hospital Charge Code	9811424
Hospital Revenue Code	521
Rate for Payer: Cash Price	$585.00

EXC BEN LES <1.0 TRUNK,ARMS,LEGS

Facility

$210.00

Service Code	CPT 11400
Hospital Charge Code	5411400
Hospital Revenue Code	521
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$1,446.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$638.34
Rate for Payer: Aetna Medicare Advantage	$723.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$124.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.94
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cigna Commercial HMO & PPO	$723.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$574.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$683.02
Rate for Payer: Home State Health Plan Medicare Advantage	$723.47
Rate for Payer: Humana Commercial	$1,446.94
Rate for Payer: Humana Medicare Advantage	$723.47
Rate for Payer: UnitedHealthcare Commercial	$140.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN LES <1.0 TRUNK,ARMS,LEGS

Facility

$210.00

Service Code	CPT 11400
Hospital Charge Code	5411400
Hospital Revenue Code	521
Rate for Payer: Cash Price	$189.00

EXC BEN LES 1.1 TO 2.0 CM SCALP,NECK,HAN

Facility

$350.00

Service Code	CPT 11422
Hospital Charge Code	9711422
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

Know your out-of-pocket cost for care.

All Charges