Madison Medical Center

All Charges

Charge

Type

Setting

Price

FISCHER RAPID STREP

Facility

$75.00

Service Code	CPT 87880
Hospital Charge Code	3987880
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

FISCHER RAPID STREP

Facility

$75.00

Service Code	CPT 87880
Hospital Charge Code	3987880
Hospital Revenue Code	301
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.88
Rate for Payer: Aetna Medicare Advantage	$16.53
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: Cigna Commercial HMO & PPO	$16.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.92
Rate for Payer: Home State Health Plan Medicare Advantage	$16.53
Rate for Payer: Humana Commercial	$33.06
Rate for Payer: Humana Medicare Advantage	$16.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

FISCHER RSV TEST

Facility

$123.00

Service Code	CPT 87634
Hospital Charge Code	3987634
Hospital Revenue Code	301
Rate for Payer: Cash Price	$110.70

FISCHER RSV TEST

Facility

$123.00

Service Code	CPT 87634
Hospital Charge Code	3987634
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$63.18
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$72.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$87.82
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna Commercial HMO & PPO	$70.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$63.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$67.60
Rate for Payer: Home State Health Plan Medicare Advantage	$70.20
Rate for Payer: Humana Commercial	$140.40
Rate for Payer: Humana Medicare Advantage	$70.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$63.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.28

FISCHER STREP

Facility

$75.00

Service Code	CPT 87651
Hospital Charge Code	3987651
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$70.18
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.58
Rate for Payer: Aetna Medicare Advantage	$35.09
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: Cigna Commercial HMO & PPO	$35.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33.79
Rate for Payer: Home State Health Plan Medicare Advantage	$35.09
Rate for Payer: Humana Commercial	$70.18
Rate for Payer: Humana Medicare Advantage	$35.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

FISCHER STREP

Facility

$75.00

Service Code	CPT 87651
Hospital Charge Code	3987651
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

FISCHER URINE DIP

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	3981002
Hospital Revenue Code	307
Rate for Payer: Cash Price	$24.30

FISCHER URINE DIP

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	3981002
Hospital Revenue Code	307
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$15.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.28
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cigna Commercial HMO & PPO	$3.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.35
Rate for Payer: Home State Health Plan Medicare Advantage	$3.48
Rate for Payer: Humana Commercial	$6.96
Rate for Payer: Humana Medicare Advantage	$3.48
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72

FISCHER URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	3981025
Hospital Revenue Code	307
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.75
Rate for Payer: Aetna Medicare Advantage	$8.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$8.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.29
Rate for Payer: Home State Health Plan Medicare Advantage	$8.61
Rate for Payer: Humana Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$8.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

FISCHER URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	3981025
Hospital Revenue Code	307
Rate for Payer: Cash Price	$36.00

FISSURECTOMY,W OR W/O SPHINCTEROTOMY

Professional

Both

$1,260.00

Service Code	CPT 46200
Hospital Charge Code	5446200
Hospital Revenue Code	975
Min. Negotiated Rate	$318.10
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$318.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$364.10
Rate for Payer: Cash Price	$1,134.00
Rate for Payer: Cash Price	$1,134.00
Rate for Payer: Cigna Commercial HMO & PPO	$318.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$364.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$400.51
Rate for Payer: Home State Health Plan Medicare Advantage	$318.10
Rate for Payer: Optum Medicare Advantage	$441.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$364.10

FISSURECTOMY, W/WO SPHINCTEROTOMY-EXCISI

Professional

Both

$866.00

Service Code	CPT 46200
Hospital Charge Code	4146200
Hospital Revenue Code	975
Min. Negotiated Rate	$303.10
Max. Negotiated Rate	$400.51
Rate for Payer: Aetna Commercial/Medicare Advantage	$318.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$364.10
Rate for Payer: Cash Price	$779.40
Rate for Payer: Cash Price	$779.40
Rate for Payer: Cigna Commercial HMO & PPO	$318.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$364.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$400.51
Rate for Payer: Home State Health Plan Medicare Advantage	$318.10
Rate for Payer: Optum Medicare Advantage	$303.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$364.10

FISTULA - SINUS TRACK

Facility

$368.00

Hospital Charge Code	326155
Hospital Revenue Code	320
Min. Negotiated Rate	$132.48
Max. Negotiated Rate	$262.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$217.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$262.75
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$132.48

FISTULA - SINUS TRACK

Facility

$368.00

Hospital Charge Code	326155
Hospital Revenue Code	320
Rate for Payer: Cash Price	$331.20

FISTULECTOMY

Professional

Both

$824.00

Service Code	CPT 46270
Hospital Charge Code	4146270
Hospital Revenue Code	975
Min. Negotiated Rate	$288.40
Max. Negotiated Rate	$452.12
Rate for Payer: Aetna Commercial/Medicare Advantage	$377.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$411.02
Rate for Payer: Cash Price	$741.60
Rate for Payer: Cash Price	$741.60
Rate for Payer: Cigna Commercial HMO & PPO	$377.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$411.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$452.12
Rate for Payer: Home State Health Plan Medicare Advantage	$377.66
Rate for Payer: Optum Medicare Advantage	$288.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$411.02

FIXATION OF CONTRALATERAL TESTIS

Professional

Both

$1,300.00

Service Code	CPT 54620
Hospital Charge Code	9354620
Hospital Revenue Code	975
Min. Negotiated Rate	$223.01
Max. Negotiated Rate	$455.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$260.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$223.01
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Cigna Commercial HMO & PPO	$260.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$223.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$245.31
Rate for Payer: Home State Health Plan Medicare Advantage	$260.79
Rate for Payer: Optum Medicare Advantage	$455.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$223.01

FLECAINIDE 100MG TAB EMP

Facility

$25.00

Service Code	NDC 5.3746E+10
Hospital Charge Code	2623237
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$17.85
Rate for Payer: Cash Price	$22.50
Rate for Payer: UnitedHealthcare Commercial	$16.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.00

FLECAINIDE 100MG TAB EMP

Facility

$25.00

Service Code	NDC 5.3746E+10
Hospital Charge Code	2623237
Hospital Revenue Code	250
Rate for Payer: Cash Price	$22.50

FLECAINIDE 150MG TAB EMP

Facility

$25.00

Service Code	NDC 5.3746E+10
Hospital Charge Code	2622763
Hospital Revenue Code	250
Rate for Payer: Cash Price	$22.50

FLECAINIDE 150MG TAB EMP

Facility

$25.00

Service Code	NDC 5.3746E+10
Hospital Charge Code	2622763
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$17.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.85
Rate for Payer: Cash Price	$22.50
Rate for Payer: UnitedHealthcare Commercial	$16.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.00

FLECAINIDE 50MG TAB EMP

Facility

$25.00

Service Code	NDC 6.2559E+10
Hospital Charge Code	2625753
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$17.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.85
Rate for Payer: Cash Price	$22.50
Rate for Payer: UnitedHealthcare Commercial	$16.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.00

FLECAINIDE 50MG TAB EMP

Facility

$25.00

Service Code	NDC 6.2559E+10
Hospital Charge Code	2625753
Hospital Revenue Code	250
Rate for Payer: Cash Price	$22.50

FLECANIDE

Facility

$165.00

Service Code	CPT 80299
Hospital Charge Code	2280029
Hospital Revenue Code	301
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$117.81
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.78
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cigna Commercial HMO & PPO	$18.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.95
Rate for Payer: Home State Health Plan Medicare Advantage	$18.64
Rate for Payer: Humana Commercial	$37.28
Rate for Payer: Humana Medicare Advantage	$18.64
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

FLECANIDE

Facility

$165.00

Service Code	CPT 80299
Hospital Charge Code	2280029
Hospital Revenue Code	301
Rate for Payer: Cash Price	$148.50

FLEXIBLE TAUT CATHETER 4.5 FRENCH

Facility

$282.00

Service Code	CPT Y7506
Hospital Charge Code	123060
Hospital Revenue Code	271
Min. Negotiated Rate	$101.52
Max. Negotiated Rate	$201.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$166.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$201.35
Rate for Payer: Cash Price	$253.80
Rate for Payer: UnitedHealthcare Commercial	$188.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$101.52

Know your out-of-pocket cost for care.

All Charges