Madison Medical Center

All Charges

Charge

Type

Setting

Price

FREE T3

Facility

$251.00

Service Code	CPT 84481
Hospital Charge Code	2284481
Hospital Revenue Code	301
Min. Negotiated Rate	$15.25
Max. Negotiated Rate	$179.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.25
Rate for Payer: Aetna Medicare Advantage	$16.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$179.21
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cigna Commercial HMO & PPO	$16.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.32
Rate for Payer: Home State Health Plan Medicare Advantage	$16.94
Rate for Payer: Humana Commercial	$33.88
Rate for Payer: Humana Medicare Advantage	$16.94
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.36

FREE T3

Facility

$251.00

Service Code	CPT 84481
Hospital Charge Code	2284481
Hospital Revenue Code	301
Rate for Payer: Cash Price	$225.90

FREE T3 (LABCORP)

Facility

$198.00

Service Code	CPT 84481
Hospital Charge Code	2284483
Hospital Revenue Code	301
Rate for Payer: Cash Price	$178.20

FREE T3 (LABCORP)

Facility

$198.00

Service Code	CPT 84481
Hospital Charge Code	2284483
Hospital Revenue Code	301
Min. Negotiated Rate	$15.25
Max. Negotiated Rate	$141.37
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.25
Rate for Payer: Aetna Medicare Advantage	$16.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$117.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$141.37
Rate for Payer: Cash Price	$178.20
Rate for Payer: Cash Price	$178.20
Rate for Payer: Cash Price	$178.20
Rate for Payer: Cigna Commercial HMO & PPO	$16.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.32
Rate for Payer: Home State Health Plan Medicare Advantage	$16.94
Rate for Payer: Humana Commercial	$33.88
Rate for Payer: Humana Medicare Advantage	$16.94
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.28

FREE T4

Facility

$272.00

Service Code	CPT 84439
Hospital Charge Code	2227051
Hospital Revenue Code	301
Rate for Payer: Cash Price	$244.80

FREE T4

Facility

$272.00

Service Code	CPT 84439
Hospital Charge Code	2227051
Hospital Revenue Code	301
Min. Negotiated Rate	$8.12
Max. Negotiated Rate	$194.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.12
Rate for Payer: Aetna Medicare Advantage	$9.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$161.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$194.21
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cigna Commercial HMO & PPO	$9.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.69
Rate for Payer: Home State Health Plan Medicare Advantage	$9.02
Rate for Payer: Humana Commercial	$18.04
Rate for Payer: Humana Medicare Advantage	$9.02
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.92

FREE T4 (LABCORP)

Facility

$576.00

Service Code	CPT 84439
Hospital Charge Code	2284439
Hospital Revenue Code	301
Rate for Payer: Cash Price	$518.40

FREE T4 (LABCORP)

Facility

$576.00

Service Code	CPT 84439
Hospital Charge Code	2284439
Hospital Revenue Code	301
Min. Negotiated Rate	$8.12
Max. Negotiated Rate	$411.26
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.12
Rate for Payer: Aetna Medicare Advantage	$9.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$340.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$411.26
Rate for Payer: Cash Price	$518.40
Rate for Payer: Cash Price	$518.40
Rate for Payer: Cash Price	$518.40
Rate for Payer: Cigna Commercial HMO & PPO	$9.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.69
Rate for Payer: Home State Health Plan Medicare Advantage	$9.02
Rate for Payer: Humana Commercial	$18.04
Rate for Payer: Humana Medicare Advantage	$9.02
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$207.36

FRENOPLASTY

Professional

Both

$920.00

Service Code	CPT 41520
Hospital Charge Code	9341520
Hospital Revenue Code	975
Min. Negotiated Rate	$212.88
Max. Negotiated Rate	$322.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$212.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$279.00
Rate for Payer: Cash Price	$828.00
Rate for Payer: Cash Price	$828.00
Rate for Payer: Cigna Commercial HMO & PPO	$212.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$279.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$306.90
Rate for Payer: Home State Health Plan Medicare Advantage	$212.88
Rate for Payer: Optum Medicare Advantage	$322.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$279.00

FRGN BODY DRAINAGE, SQ TISSUES

Professional

Both

$448.00

Service Code	CPT 10120
Hospital Charge Code	1810122
Hospital Revenue Code	981
Min. Negotiated Rate	$94.11
Max. Negotiated Rate	$156.80
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	$403.20
Rate for Payer: Cash Price	$403.20
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	$156.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$113.47

FRGN BODY RMVL-SQ TISSUE,COMPL

Professional

Both

$2,482.00

Service Code	CPT 10121
Hospital Charge Code	1810121
Hospital Revenue Code	981
Min. Negotiated Rate	$161.72
Max. Negotiated Rate	$868.70
Rate for Payer: Aetna Commercial/Medicare Advantage	$161.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$200.69
Rate for Payer: Cash Price	$2,233.80
Rate for Payer: Cash Price	$2,233.80
Rate for Payer: Cigna Commercial HMO & PPO	$161.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$220.76
Rate for Payer: Home State Health Plan Medicare Advantage	$161.72
Rate for Payer: Optum Medicare Advantage	$868.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$200.69

FRGN BODY RMVL-SQ TISSUE,SIMPL

Professional

Both

$448.00

Service Code	CPT 10120
Hospital Charge Code	1810120
Hospital Revenue Code	981
Min. Negotiated Rate	$94.11
Max. Negotiated Rate	$156.80
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	$403.20
Rate for Payer: Cash Price	$403.20
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	$156.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$113.47

FRUCTOSAMINE

Facility

$62.00

Service Code	CPT 82985
Hospital Charge Code	2282985
Hospital Revenue Code	301
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$44.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.08
Rate for Payer: Aetna Medicare Advantage	$16.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cigna Commercial HMO & PPO	$16.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.14
Rate for Payer: Home State Health Plan Medicare Advantage	$16.76
Rate for Payer: Humana Commercial	$33.52
Rate for Payer: Humana Medicare Advantage	$16.76
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

FRUCTOSAMINE

Facility

$62.00

Service Code	CPT 82985
Hospital Charge Code	2282985
Hospital Revenue Code	301
Rate for Payer: Cash Price	$55.80

FRUCTOSE, SEMEN

Facility

$112.00

Service Code	CPT 83986
Hospital Charge Code	2282757
Hospital Revenue Code	301
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.22
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$3.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.45
Rate for Payer: Home State Health Plan Medicare Advantage	$3.58
Rate for Payer: Humana Commercial	$7.16
Rate for Payer: Humana Medicare Advantage	$3.58
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

FRUCTOSE, SEMEN

Facility

$112.00

Service Code	CPT 83986
Hospital Charge Code	2282757
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

FSH

Facility

$58.00

Service Code	CPT 83001
Hospital Charge Code	4283001
Hospital Revenue Code	521
Rate for Payer: Cash Price	$52.20

FSH

Facility

$153.00

Service Code	CPT 83001
Hospital Charge Code	226218
Hospital Revenue Code	301
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$109.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.72
Rate for Payer: Aetna Medicare Advantage	$18.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cigna Commercial HMO & PPO	$18.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.89
Rate for Payer: Home State Health Plan Medicare Advantage	$18.58
Rate for Payer: Humana Commercial	$37.16
Rate for Payer: Humana Medicare Advantage	$18.58
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

FSH

Facility

$153.00

Service Code	CPT 83001
Hospital Charge Code	226218
Hospital Revenue Code	301
Rate for Payer: Cash Price	$137.70

FSH

Facility

$58.00

Service Code	CPT 83001
Hospital Charge Code	4283001
Hospital Revenue Code	521
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.72
Rate for Payer: Aetna Medicare Advantage	$18.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cigna Commercial HMO & PPO	$18.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.89
Rate for Payer: Home State Health Plan Medicare Advantage	$18.58
Rate for Payer: Humana Commercial	$37.16
Rate for Payer: Humana Medicare Advantage	$18.58
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FTA-ABS (TREPONEMAL)

Facility

$112.00

Service Code	CPT 86780
Hospital Charge Code	2227053
Hospital Revenue Code	301
Min. Negotiated Rate	$11.92
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.92
Rate for Payer: Aetna Medicare Advantage	$13.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$13.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.75
Rate for Payer: Home State Health Plan Medicare Advantage	$13.24
Rate for Payer: Humana Commercial	$26.48
Rate for Payer: Humana Medicare Advantage	$13.24
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

FTA-ABS (TREPONEMAL)

Facility

$112.00

Service Code	CPT 86780
Hospital Charge Code	2227053
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

.F TULEREMIA AB, IGG

Facility

$190.00

Service Code	CPT 86668
Hospital Charge Code	2286668
Hospital Revenue Code	302
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$135.66
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	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
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	$68.40

.F TULEREMIA AB, IGG

Facility

$190.00

Service Code	CPT 86668
Hospital Charge Code	2286668
Hospital Revenue Code	302
Rate for Payer: Cash Price	$171.00

.F TULEREMIA AB, IGM

Facility

$190.00

Service Code	CPT 86668
Hospital Charge Code	2286669
Hospital Revenue Code	302
Rate for Payer: Cash Price	$171.00

Know your out-of-pocket cost for care.

All Charges