Madison Medical Center

All Charges

Charge

Type

Setting

Price

FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK

Facility

$8,824.53

Service Code	APR-DRG 3422
Min. Negotiated Rate	$8,824.53
Max. Negotiated Rate	$8,824.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,824.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,824.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,824.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,824.53

FRACTURES OF FEMUR WITH MCC

Facility

$28,189.06

Service Code	MSDRG 533
Min. Negotiated Rate	$14,094.53
Max. Negotiated Rate	$28,189.06
Rate for Payer: Aetna Medicare Advantage	$14,094.53
Rate for Payer: Cigna Commercial HMO & PPO	$14,094.53
Rate for Payer: Home State Health Plan Medicare Advantage	$14,094.53
Rate for Payer: Humana Commercial	$28,189.06
Rate for Payer: Humana Medicare Advantage	$14,094.53

FRACTURES OF FEMUR WITHOUT MCC

Facility

$16,259.48

Service Code	MSDRG 534
Min. Negotiated Rate	$8,129.74
Max. Negotiated Rate	$16,259.48
Rate for Payer: Aetna Medicare Advantage	$8,129.74
Rate for Payer: Cigna Commercial HMO & PPO	$8,129.74
Rate for Payer: Home State Health Plan Medicare Advantage	$8,129.74
Rate for Payer: Humana Commercial	$16,259.48
Rate for Payer: Humana Medicare Advantage	$8,129.74

FRACTURES OF HIP AND PELVIS WITH MCC

Facility

$23,707.00

Service Code	MSDRG 535
Min. Negotiated Rate	$11,853.50
Max. Negotiated Rate	$23,707.00
Rate for Payer: Aetna Medicare Advantage	$11,853.50
Rate for Payer: Cigna Commercial HMO & PPO	$11,853.50
Rate for Payer: Home State Health Plan Medicare Advantage	$11,853.50
Rate for Payer: Humana Commercial	$23,707.00
Rate for Payer: Humana Medicare Advantage	$11,853.50

FRACTURES OF HIP AND PELVIS WITHOUT MCC

Facility

$16,282.96

Service Code	MSDRG 536
Min. Negotiated Rate	$8,141.48
Max. Negotiated Rate	$16,282.96
Rate for Payer: Aetna Medicare Advantage	$8,141.48
Rate for Payer: Cigna Commercial HMO & PPO	$8,141.48
Rate for Payer: Home State Health Plan Medicare Advantage	$8,141.48
Rate for Payer: Humana Commercial	$16,282.96
Rate for Payer: Humana Medicare Advantage	$8,141.48

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC

Facility

$25,944.54

Service Code	MSDRG 562
Min. Negotiated Rate	$12,972.27
Max. Negotiated Rate	$25,944.54
Rate for Payer: Aetna Medicare Advantage	$12,972.27
Rate for Payer: Cigna Commercial HMO & PPO	$12,972.27
Rate for Payer: Home State Health Plan Medicare Advantage	$12,972.27
Rate for Payer: Humana Commercial	$25,944.54
Rate for Payer: Humana Medicare Advantage	$12,972.27

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC

Facility

$17,658.54

Service Code	MSDRG 563
Min. Negotiated Rate	$8,829.27
Max. Negotiated Rate	$17,658.54
Rate for Payer: Aetna Medicare Advantage	$8,829.27
Rate for Payer: Cigna Commercial HMO & PPO	$8,829.27
Rate for Payer: Home State Health Plan Medicare Advantage	$8,829.27
Rate for Payer: Humana Commercial	$17,658.54
Rate for Payer: Humana Medicare Advantage	$8,829.27

FRAGILE X WITH CHROM HIGH RES

Facility

$731.00

Service Code	CPT 81243
Hospital Charge Code	2281243
Hospital Revenue Code	305
Rate for Payer: Cash Price	$657.90

FRAGILE X WITH CHROM HIGH RES

Facility

$731.00

Service Code	CPT 81243
Hospital Charge Code	2281243
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$521.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$51.34
Rate for Payer: Aetna Medicare Advantage	$57.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$432.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$521.93
Rate for Payer: Cash Price	$657.90
Rate for Payer: Cash Price	$657.90
Rate for Payer: Cash Price	$657.90
Rate for Payer: Cigna Commercial HMO & PPO	$57.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$51.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$54.93
Rate for Payer: Home State Health Plan Medicare Advantage	$57.04
Rate for Payer: Humana Commercial	$114.08
Rate for Payer: Humana Medicare Advantage	$57.04
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$51.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$263.16

FRANCISELLA TULARENSIS ANTIBODY

Facility

$174.00

Service Code	CPT 86668
Hospital Charge Code	2287081
Hospital Revenue Code	305
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$124.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.74
Rate for Payer: Aetna Medicare Advantage	$14.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$103.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$124.24
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cigna Commercial HMO & PPO	$14.16
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.63
Rate for Payer: Home State Health Plan Medicare Advantage	$14.16
Rate for Payer: Humana Commercial	$28.32
Rate for Payer: Humana Medicare Advantage	$14.16
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.64

FRANCISELLA TULARENSIS ANTIBODY

Facility

$174.00

Service Code	CPT 86668
Hospital Charge Code	2287081
Hospital Revenue Code	305
Rate for Payer: Cash Price	$156.60

FRANCISELLA TULARENSIS SCREEN

Facility

$195.00

Service Code	CPT 87081
Hospital Charge Code	2286111
Hospital Revenue Code	302
Rate for Payer: Cash Price	$175.50

FRANCISELLA TULARENSIS SCREEN

Facility

$195.00

Service Code	CPT 87081
Hospital Charge Code	2286111
Hospital Revenue Code	302
Min. Negotiated Rate	$5.97
Max. Negotiated Rate	$139.23
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.97
Rate for Payer: Aetna Medicare Advantage	$6.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$115.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$139.23
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cigna Commercial HMO & PPO	$6.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.39
Rate for Payer: Home State Health Plan Medicare Advantage	$6.63
Rate for Payer: Humana Commercial	$13.26
Rate for Payer: Humana Medicare Advantage	$6.63
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.20

FREE KAPPA LAMBDA

Facility

$319.00

Service Code	CPT 83883
Hospital Charge Code	2223883
Hospital Revenue Code	301
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$227.77
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.24
Rate for Payer: Aetna Medicare Advantage	$13.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$188.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$227.77
Rate for Payer: Cash Price	$287.10
Rate for Payer: Cash Price	$287.10
Rate for Payer: Cash Price	$287.10
Rate for Payer: Cigna Commercial HMO & PPO	$13.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.10
Rate for Payer: Home State Health Plan Medicare Advantage	$13.60
Rate for Payer: Humana Commercial	$27.20
Rate for Payer: Humana Medicare Advantage	$13.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$114.84

FREE KAPPA LAMBDA

Facility

$319.00

Service Code	CPT 83883
Hospital Charge Code	2223883
Hospital Revenue Code	301
Rate for Payer: Cash Price	$287.10

FREE KAPPA/LAMBDA RATIO SERUM

Facility

$166.00

Service Code	CPT 83883
Hospital Charge Code	223883
Hospital Revenue Code	305
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$118.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.24
Rate for Payer: Aetna Medicare Advantage	$13.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$98.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$118.52
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cigna Commercial HMO & PPO	$13.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.10
Rate for Payer: Home State Health Plan Medicare Advantage	$13.60
Rate for Payer: Humana Commercial	$27.20
Rate for Payer: Humana Medicare Advantage	$13.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

FREE KAPPA/LAMBDA RATIO SERUM

Facility

$166.00

Service Code	CPT 83883
Hospital Charge Code	223883
Hospital Revenue Code	305
Rate for Payer: Cash Price	$149.40

FREESTYLE LANCETS 100CT

Facility

$18.00

Service Code	NDC 9.9073E+10
Hospital Charge Code	2697347
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

FREESTYLE LANCETS 100CT

Facility

$18.00

Service Code	NDC 9.9073E+10
Hospital Charge Code	2697347
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

FREESTYLE LIBRE 2 (14 DAY) SENSOR EMP

Facility

$147.00

Service Code	NDC 5.7599E+10
Hospital Charge Code	2625321
Hospital Revenue Code	250
Min. Negotiated Rate	$52.92
Max. Negotiated Rate	$104.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$87.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$104.96
Rate for Payer: Cash Price	$132.30
Rate for Payer: UnitedHealthcare Commercial	$98.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$52.92

FREESTYLE LIBRE 2 (14 DAY) SENSOR EMP

Facility

$147.00

Service Code	NDC 5.7599E+10
Hospital Charge Code	2625321
Hospital Revenue Code	250
Rate for Payer: Cash Price	$132.30

FREESTYLE LIBRE 2 READER EMP

Facility

$165.00

Service Code	NDC 1E+11
Hospital Charge Code	2625320
Hospital Revenue Code	250
Rate for Payer: Cash Price	$148.50

FREESTYLE LIBRE 2 READER EMP

Facility

$165.00

Service Code	NDC 1E+11
Hospital Charge Code	2625320
Hospital Revenue Code	250
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$117.81
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: UnitedHealthcare Commercial	$110.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

FREESTYLE LITE TEST STRIPS 100CT

Facility

$255.00

Service Code	NDC 9.9073E+10
Hospital Charge Code	2697346
Hospital Revenue Code	250
Rate for Payer: Cash Price	$229.50

FREESTYLE LITE TEST STRIPS 100CT

Facility

$255.00

Service Code	NDC 9.9073E+10
Hospital Charge Code	2697346
Hospital Revenue Code	250
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$182.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.07
Rate for Payer: Cash Price	$229.50
Rate for Payer: UnitedHealthcare Commercial	$170.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$91.80

Know your out-of-pocket cost for care.

All Charges