Madison Medical Center

All Charges

Charge

Type

Setting

Price

FOOT XRAY LT

Facility

$480.00

Service Code	CPT 73630
Hospital Charge Code	326138
Hospital Revenue Code	320
Rate for Payer: Cash Price	$432.00

FOOT XRAY LT

Facility

$480.00

Service Code	CPT 73630
Hospital Charge Code	326138
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$342.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$284.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$342.72
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$172.80

FOOT XRAY RT

Facility

$480.00

Service Code	CPT 73630
Hospital Charge Code	326137
Hospital Revenue Code	320
Rate for Payer: Cash Price	$432.00

FOOT XRAY RT

Facility

$480.00

Service Code	CPT 73630
Hospital Charge Code	326137
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$342.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$284.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$342.72
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$172.80

FORANE

Facility

$264.00

Hospital Charge Code	207954
Hospital Revenue Code	370
Rate for Payer: Cash Price	$237.60

FORANE

Facility

$264.00

Hospital Charge Code	207954
Hospital Revenue Code	370
Min. Negotiated Rate	$95.04
Max. Negotiated Rate	$188.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$156.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$188.50
Rate for Payer: Cash Price	$237.60
Rate for Payer: UnitedHealthcare Commercial	$176.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.04

FORCEP-BIOPSY THERMAL

Facility

$268.00

Hospital Charge Code	126683
Hospital Revenue Code	272
Rate for Payer: Cash Price	$241.20

FORCEP-BIOPSY THERMAL

Facility

$268.00

Hospital Charge Code	126683
Hospital Revenue Code	272
Min. Negotiated Rate	$96.48
Max. Negotiated Rate	$191.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$158.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$191.35
Rate for Payer: Cash Price	$241.20
Rate for Payer: UnitedHealthcare Commercial	$178.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$96.48

FOREARM XRAY LT

Facility

$414.00

Service Code	CPT 73090
Hospital Charge Code	326129
Hospital Revenue Code	320
Rate for Payer: Cash Price	$372.60

FOREARM XRAY LT

Facility

$414.00

Service Code	CPT 73090
Hospital Charge Code	326129
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$295.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$245.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$295.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$149.04

FOREARM XRAY RT

Facility

$414.00

Service Code	CPT 73090
Hospital Charge Code	326128
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$295.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$245.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$295.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$149.04

FOREARM XRAY RT

Facility

$414.00

Service Code	CPT 73090
Hospital Charge Code	326128
Hospital Revenue Code	320
Rate for Payer: Cash Price	$372.60

FOREIGN BODY DEEP OR COMPLICATED

Facility

$800.00

Service Code	CPT 20525
Hospital Charge Code	9820525
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$5,935.26
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,618.45
Rate for Payer: Aetna Medicare Advantage	$2,967.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$473.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$571.20
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cigna Commercial HMO & PPO	$2,967.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,356.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2,801.74
Rate for Payer: Home State Health Plan Medicare Advantage	$2,967.63
Rate for Payer: Humana Commercial	$5,935.26
Rate for Payer: Humana Medicare Advantage	$2,967.63
Rate for Payer: UnitedHealthcare Commercial	$533.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,618.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FOREIGN BODY DEEP OR COMPLICATED

Facility

$800.00

Service Code	CPT 20525
Hospital Charge Code	9820525
Hospital Revenue Code	521
Rate for Payer: Cash Price	$720.00

FOREIGN BODY REMOVAL- EXTERNAL

Professional

Both

$539.00

Service Code	CPT 69200
Hospital Charge Code	1869200
Hospital Revenue Code	981
Min. Negotiated Rate	$39.86
Max. Negotiated Rate	$188.65
Rate for Payer: Aetna Commercial/Medicare Advantage	$39.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$73.37
Rate for Payer: Cash Price	$485.10
Rate for Payer: Cash Price	$485.10
Rate for Payer: Cigna Commercial HMO & PPO	$39.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$73.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$80.71
Rate for Payer: Home State Health Plan Medicare Advantage	$39.86
Rate for Payer: Optum Medicare Advantage	$188.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$73.37

FOREIGN BODY REMOVAL KNEE

Professional

Both

$6,007.00

Service Code	CPT 27310
Hospital Charge Code	1827310
Hospital Revenue Code	981
Min. Negotiated Rate	$553.88
Max. Negotiated Rate	$2,102.45
Rate for Payer: Aetna Commercial/Medicare Advantage	$646.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$553.88
Rate for Payer: Cash Price	$5,406.30
Rate for Payer: Cash Price	$5,406.30
Rate for Payer: Cigna Commercial HMO & PPO	$646.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$553.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$609.27
Rate for Payer: Home State Health Plan Medicare Advantage	$646.58
Rate for Payer: Optum Medicare Advantage	$2,102.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$553.88

FOREIGN BODY REMOVAL OF CORNEA

Professional

Both

$518.00

Service Code	CPT 65220
Hospital Charge Code	1865220
Hospital Revenue Code	981
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$181.30
Rate for Payer: Aetna Commercial/Medicare Advantage	$36.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$45.08
Rate for Payer: Cash Price	$466.20
Rate for Payer: Cash Price	$466.20
Rate for Payer: Cigna Commercial HMO & PPO	$36.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$45.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$49.59
Rate for Payer: Home State Health Plan Medicare Advantage	$36.05
Rate for Payer: Optum Medicare Advantage	$181.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$45.08

FOREIGN BODY RMVL-SUBCUTANEOUS

Professional

Both

$1,171.00

Service Code	CPT 28190
Hospital Charge Code	1869011
Hospital Revenue Code	981
Min. Negotiated Rate	$119.80
Max. Negotiated Rate	$409.85
Rate for Payer: Aetna Commercial/Medicare Advantage	$119.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$183.95
Rate for Payer: Cash Price	$1,053.90
Rate for Payer: Cash Price	$1,053.90
Rate for Payer: Cigna Commercial HMO & PPO	$119.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$183.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$202.34
Rate for Payer: Home State Health Plan Medicare Advantage	$119.80
Rate for Payer: Optum Medicare Advantage	$409.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$183.95

FOREIGN BODY SIMPLE

Facility

$341.00

Service Code	CPT 20520
Hospital Charge Code	9820520
Hospital Revenue Code	521
Rate for Payer: Cash Price	$306.90

FOREIGN BODY SIMPLE

Facility

$341.00

Service Code	CPT 20520
Hospital Charge Code	9820520
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	$201.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$243.47
Rate for Payer: Cash Price	$306.90
Rate for Payer: Cash Price	$306.90
Rate for Payer: Cash Price	$306.90
Rate for Payer: Cash Price	$306.90
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	$227.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FORIGN BODY REMOVAL-LOCAL ANEST.

Professional

Both

$128.00

Service Code	CPT 10120
Hospital Charge Code	4110120
Hospital Revenue Code	975
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$124.82
Rate for Payer: Aetna Commercial/Medicare Advantage	$94.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$113.47
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cigna Commercial HMO & PPO	$94.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$113.47
Rate for Payer: Home State Health Plan Medicaid Managed Care	$124.82
Rate for Payer: Home State Health Plan Medicare Advantage	$94.11
Rate for Payer: Optum Medicare Advantage	$44.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$113.47

FORMOT (PERFOROMIST)20MCG2MLINHSOL

Facility

$65.00

Service Code	HCPCS J7606
Hospital Charge Code	2626548
Hospital Revenue Code	250
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

FORMOT (PERFOROMIST)20MCG2MLINHSOL

Facility

$65.00

Service Code	HCPCS J7606
Hospital Charge Code	2626548
Hospital Revenue Code	250
Rate for Payer: Cash Price	$58.50

FOSPHENYTOIN(CEREBYX)100MGPE/2MLINJ

Facility

$199.00

Service Code	HCPCS Q2009
Hospital Charge Code	2618199
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$142.09
Rate for Payer: Aetna Medicare Advantage	$0.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$117.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.09
Rate for Payer: Cash Price	$179.10
Rate for Payer: Cash Price	$179.10
Rate for Payer: Cigna Commercial HMO & PPO	$0.67
Rate for Payer: Home State Health Plan Medicare Advantage	$0.67
Rate for Payer: Humana Commercial	$1.34
Rate for Payer: Humana Medicare Advantage	$0.67
Rate for Payer: UnitedHealthcare Commercial	$132.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.64

FOSPHENYTOIN(CEREBYX)100MGPE/2MLINJ

Facility

$199.00

Service Code	HCPCS Q2009
Hospital Charge Code	2618199
Hospital Revenue Code	250
Rate for Payer: Cash Price	$179.10

Know your out-of-pocket cost for care.

All Charges