Madison Medical Center

All Charges

Charge

Type

Setting

Price

FASCIECTOMY, PARTIAL PALMAR W/REL OF SIN

Professional

Both

$3,650.00

Service Code	CPT 26123
Hospital Charge Code	9326123
Hospital Revenue Code	975
Min. Negotiated Rate	$631.99
Max. Negotiated Rate	$1,277.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$729.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$631.99
Rate for Payer: Cash Price	$3,285.00
Rate for Payer: Cash Price	$3,285.00
Rate for Payer: Cigna Commercial HMO & PPO	$729.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$631.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$695.19
Rate for Payer: Home State Health Plan Medicare Advantage	$729.90
Rate for Payer: Optum Medicare Advantage	$1,277.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$631.99

FASCIOTOMY, PALMAR PERCUTANEOUS

Facility

$1,400.00

Service Code	CPT 26040
Hospital Charge Code	9326040
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,260.00

FASCIOTOMY, PALMAR PERCUTANEOUS

Facility

$1,400.00

Service Code	CPT 26040
Hospital Charge Code	9326040
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$3,285.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,449.52
Rate for Payer: Aetna Medicare Advantage	$1,642.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$828.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$999.60
Rate for Payer: Cash Price	$1,260.00
Rate for Payer: Cash Price	$1,260.00
Rate for Payer: Cash Price	$1,260.00
Rate for Payer: Cash Price	$1,260.00
Rate for Payer: Cigna Commercial HMO & PPO	$1,642.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,304.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,550.99
Rate for Payer: Home State Health Plan Medicare Advantage	$1,642.82
Rate for Payer: Humana Commercial	$3,285.64
Rate for Payer: Humana Medicare Advantage	$1,642.82
Rate for Payer: UnitedHealthcare Commercial	$933.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,449.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FAT EMULSION (INTRALIPID)20% 500ML

Facility

$494.00

Service Code	NDC 338051913
Hospital Charge Code	2626292
Hospital Revenue Code	250
Rate for Payer: Cash Price	$444.60

FAT EMULSION (INTRALIPID)20% 500ML

Facility

$494.00

Service Code	NDC 338051913
Hospital Charge Code	2626292
Hospital Revenue Code	250
Min. Negotiated Rate	$177.84
Max. Negotiated Rate	$352.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$292.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$352.72
Rate for Payer: Cash Price	$444.60
Rate for Payer: UnitedHealthcare Commercial	$329.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$177.84

FATTY ACID PROFILE

Facility

$578.00

Service Code	CPT 82726
Hospital Charge Code	2282726
Hospital Revenue Code	301
Rate for Payer: Cash Price	$520.20

FATTY ACID PROFILE

Facility

$578.00

Service Code	CPT 82726
Hospital Charge Code	2282726
Hospital Revenue Code	301
Min. Negotiated Rate	$17.78
Max. Negotiated Rate	$412.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$17.78
Rate for Payer: Aetna Medicare Advantage	$19.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$342.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$412.69
Rate for Payer: Cash Price	$520.20
Rate for Payer: Cash Price	$520.20
Rate for Payer: Cash Price	$520.20
Rate for Payer: Cigna Commercial HMO & PPO	$19.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19.02
Rate for Payer: Home State Health Plan Medicare Advantage	$19.75
Rate for Payer: Humana Commercial	$39.50
Rate for Payer: Humana Medicare Advantage	$19.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.08

F/B REMOVAL EXTERNAL AUDITORY CANAL W/O

Facility

$300.00

Service Code	CPT 69200
Hospital Charge Code	9369200
Hospital Revenue Code	521
Rate for Payer: Cash Price	$270.00

F/B REMOVAL EXTERNAL AUDITORY CANAL W/O

Facility

$300.00

Service Code	CPT 69200
Hospital Charge Code	9369200
Hospital Revenue Code	521
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$271.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$177.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.20
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$200.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

F/B REMOVAL FROM EAR

Facility

$300.00

Service Code	CPT 69200
Hospital Charge Code	5269200
Hospital Revenue Code	521
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$271.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$177.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.20
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$200.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

F/B REMOVAL FROM EAR

Facility

$300.00

Service Code	CPT 69200
Hospital Charge Code	5269200
Hospital Revenue Code	521
Rate for Payer: Cash Price	$270.00

F/B REMOVAL FROM EAR CANAL SIMPLE NO ANE

Facility

$72.00

Service Code	CPT 69200
Hospital Charge Code	4169200
Hospital Revenue Code	521
Rate for Payer: Cash Price	$64.80

F/B REMOVAL FROM EAR CANAL SIMPLE NO ANE

Facility

$72.00

Service Code	CPT 69200
Hospital Charge Code	4169200
Hospital Revenue Code	521
Min. Negotiated Rate	$42.62
Max. Negotiated Rate	$271.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$51.41
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$48.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

F/B REMOVAL FROM EAR SUPERFICIAL

Facility

$75.00

Service Code	CPT 69200
Hospital Charge Code	9669200
Hospital Revenue Code	521
Rate for Payer: Cash Price	$67.50

F/B REMOVAL FROM EAR SUPERFICIAL

Facility

$75.00

Service Code	CPT 69200
Hospital Charge Code	9669200
Hospital Revenue Code	521
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$271.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FDP (FIBRIN SPLIT PRODUCTS)

Facility

$159.00

Service Code	CPT 85362
Hospital Charge Code	226300
Hospital Revenue Code	301
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$113.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.20
Rate for Payer: Aetna Medicare Advantage	$6.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$94.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$113.53
Rate for Payer: Cash Price	$143.10
Rate for Payer: Cash Price	$143.10
Rate for Payer: Cash Price	$143.10
Rate for Payer: Cigna Commercial HMO & PPO	$6.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.63
Rate for Payer: Home State Health Plan Medicare Advantage	$6.89
Rate for Payer: Humana Commercial	$13.78
Rate for Payer: Humana Medicare Advantage	$6.89
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$57.24

FDP (FIBRIN SPLIT PRODUCTS)

Facility

$159.00

Service Code	CPT 85362
Hospital Charge Code	226300
Hospital Revenue Code	301
Rate for Payer: Cash Price	$143.10

FECAL COLLECTION BAG

Facility

$81.00

Hospital Charge Code	288800
Hospital Revenue Code	271
Rate for Payer: Cash Price	$72.90

FECAL COLLECTION BAG

Facility

$81.00

Hospital Charge Code	288800
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

FECAL FAT QUAL

Facility

$52.00

Service Code	CPT 82710
Hospital Charge Code	226290
Hospital Revenue Code	301
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$37.13
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.12
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.13
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cigna Commercial HMO & PPO	$16.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.18
Rate for Payer: Home State Health Plan Medicare Advantage	$16.80
Rate for Payer: Humana Commercial	$33.60
Rate for Payer: Humana Medicare Advantage	$16.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.72

FECAL FAT QUAL

Facility

$52.00

Service Code	CPT 82710
Hospital Charge Code	226290
Hospital Revenue Code	301
Rate for Payer: Cash Price	$46.80

FECAL FAT QUANT

Facility

$138.00

Service Code	CPT 82710
Hospital Charge Code	226289
Hospital Revenue Code	301
Rate for Payer: Cash Price	$124.20

FECAL FAT QUANT

Facility

$138.00

Service Code	CPT 82710
Hospital Charge Code	226289
Hospital Revenue Code	301
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$98.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.12
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$81.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$98.53
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cigna Commercial HMO & PPO	$16.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.18
Rate for Payer: Home State Health Plan Medicare Advantage	$16.80
Rate for Payer: Humana Commercial	$33.60
Rate for Payer: Humana Medicare Advantage	$16.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$49.68

FECAL K

Facility

$178.00

Service Code	CPT 84311
Hospital Charge Code	2282190
Hospital Revenue Code	301
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$127.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.29
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cigna Commercial HMO & PPO	$8.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.80
Rate for Payer: Home State Health Plan Medicare Advantage	$8.10
Rate for Payer: Humana Commercial	$16.20
Rate for Payer: Humana Medicare Advantage	$8.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

FECAL K

Facility

$178.00

Service Code	CPT 84311
Hospital Charge Code	2282190
Hospital Revenue Code	301
Rate for Payer: Cash Price	$160.20

Know your out-of-pocket cost for care.

All Charges