Madison Medical Center

All Charges

Charge

Type

Setting

Price

HEP B SURF AG

Facility

$178.00

Service Code	CPT 87340
Hospital Charge Code	228605
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$127.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.30
Rate for Payer: Aetna Medicare Advantage	$10.33
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	$10.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.95
Rate for Payer: Home State Health Plan Medicare Advantage	$10.33
Rate for Payer: Humana Commercial	$20.66
Rate for Payer: Humana Medicare Advantage	$10.33
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

HER 2

Facility

$826.00

Service Code	CPT 83950
Hospital Charge Code	2288303
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$589.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$57.97
Rate for Payer: Aetna Medicare Advantage	$64.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$488.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$589.76
Rate for Payer: Cash Price	$743.40
Rate for Payer: Cash Price	$743.40
Rate for Payer: Cash Price	$743.40
Rate for Payer: Cigna Commercial HMO & PPO	$64.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$57.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$62.03
Rate for Payer: Home State Health Plan Medicare Advantage	$64.41
Rate for Payer: Humana Commercial	$128.82
Rate for Payer: Humana Medicare Advantage	$64.41
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$57.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$297.36

HER 2

Facility

$826.00

Service Code	CPT 83950
Hospital Charge Code	2288303
Hospital Revenue Code	305
Rate for Payer: Cash Price	$743.40

HEREDITARY HEMOCHROMOTOSIS DNA

Facility

$429.00

Service Code	CPT 81256
Hospital Charge Code	2281256
Hospital Revenue Code	307
Rate for Payer: Cash Price	$386.10

HEREDITARY HEMOCHROMOTOSIS DNA

Facility

$429.00

Service Code	CPT 81256
Hospital Charge Code	2281256
Hospital Revenue Code	307
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$306.31
Rate for Payer: Aetna Better Health Medicaid/QHP	$58.82
Rate for Payer: Aetna Medicare Advantage	$65.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$253.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$306.31
Rate for Payer: Cash Price	$386.10
Rate for Payer: Cash Price	$386.10
Rate for Payer: Cash Price	$386.10
Rate for Payer: Cigna Commercial HMO & PPO	$65.36
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$62.94
Rate for Payer: Home State Health Plan Medicare Advantage	$65.36
Rate for Payer: Humana Commercial	$130.72
Rate for Payer: Humana Medicare Advantage	$65.36
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$58.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$154.44

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC

Facility

$29,996.02

Service Code	MSDRG 354
Min. Negotiated Rate	$14,998.01
Max. Negotiated Rate	$29,996.02
Rate for Payer: Aetna Medicare Advantage	$14,998.01
Rate for Payer: Cigna Commercial HMO & PPO	$14,998.01
Rate for Payer: Home State Health Plan Medicare Advantage	$14,998.01
Rate for Payer: Humana Commercial	$29,996.02
Rate for Payer: Humana Medicare Advantage	$14,998.01

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC

Facility

$49,236.90

Service Code	MSDRG 353
Min. Negotiated Rate	$24,618.45
Max. Negotiated Rate	$49,236.90
Rate for Payer: Aetna Medicare Advantage	$24,618.45
Rate for Payer: Cigna Commercial HMO & PPO	$24,618.45
Rate for Payer: Home State Health Plan Medicare Advantage	$24,618.45
Rate for Payer: Humana Commercial	$49,236.90
Rate for Payer: Humana Medicare Advantage	$24,618.45

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC

Facility

$24,692.90

Service Code	MSDRG 355
Min. Negotiated Rate	$12,346.45
Max. Negotiated Rate	$24,692.90
Rate for Payer: Aetna Medicare Advantage	$12,346.45
Rate for Payer: Cigna Commercial HMO & PPO	$12,346.45
Rate for Payer: Home State Health Plan Medicare Advantage	$12,346.45
Rate for Payer: Humana Commercial	$24,692.90
Rate for Payer: Humana Medicare Advantage	$12,346.45

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL

Facility

$10,015.31

Service Code	APR-DRG 2271
Min. Negotiated Rate	$10,015.31
Max. Negotiated Rate	$10,015.31
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,015.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,015.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,015.31
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,015.31

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL

Facility

$35,180.72

Service Code	APR-DRG 2274
Min. Negotiated Rate	$35,180.72
Max. Negotiated Rate	$35,180.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$35,180.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$35,180.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$35,180.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$35,180.72

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL

Facility

$11,833.84

Service Code	APR-DRG 2272
Min. Negotiated Rate	$11,833.84
Max. Negotiated Rate	$11,833.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,833.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,833.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,833.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,833.84

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL

Facility

$23,839.65

Service Code	APR-DRG 2273
Min. Negotiated Rate	$23,839.65
Max. Negotiated Rate	$23,839.65
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,839.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,839.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,839.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,839.65

HERPES CULTURE SMEAR

Facility

$35.00

Service Code	CPT 87207
Hospital Charge Code	5287207
Hospital Revenue Code	521
Rate for Payer: Cash Price	$31.50

HERPES CULTURE SMEAR

Facility

$35.00

Service Code	CPT 87207
Hospital Charge Code	5287207
Hospital Revenue Code	521
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.39
Rate for Payer: Aetna Medicare Advantage	$5.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cigna Commercial HMO & PPO	$5.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.77
Rate for Payer: Home State Health Plan Medicare Advantage	$5.99
Rate for Payer: Humana Commercial	$11.98
Rate for Payer: Humana Medicare Advantage	$5.99
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HETASTARCH 6% IN NS 500ML

Facility

$312.00

Service Code	NDC 264196510
Hospital Charge Code	2655174
Hospital Revenue Code	258
Min. Negotiated Rate	$112.32
Max. Negotiated Rate	$222.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$184.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$222.77
Rate for Payer: Cash Price	$280.80
Rate for Payer: UnitedHealthcare Commercial	$208.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$112.32

HETASTARCH 6% IN NS 500ML

Facility

$312.00

Service Code	NDC 264196510
Hospital Charge Code	2655174
Hospital Revenue Code	258
Min. Negotiated Rate	$208.10
Max. Negotiated Rate	$208.10
Rate for Payer: Cash Price	$280.80
Rate for Payer: UnitedHealthcare Commercial	$208.10

HF CBC PLT NO DIFF SPOUSE

Facility

$5.00

Service Code	CPT 85027
Hospital Charge Code	22111134
Hospital Revenue Code	305
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.82
Rate for Payer: Aetna Medicare Advantage	$6.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3.57
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna Commercial HMO & PPO	$6.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.23
Rate for Payer: Home State Health Plan Medicare Advantage	$6.47
Rate for Payer: Humana Commercial	$12.94
Rate for Payer: Humana Medicare Advantage	$6.47
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.80

HF CBC PLT NO DIFF SPOUSE

Facility

$5.00

Service Code	CPT 85027
Hospital Charge Code	22111134
Hospital Revenue Code	305
Rate for Payer: Cash Price	$4.50

HF GLUCOSE

Facility

$5.00

Hospital Charge Code	22111125
Hospital Revenue Code	302
Rate for Payer: Cash Price	$4.50

HF GLUCOSE

Facility

$5.00

Hospital Charge Code	22111125
Hospital Revenue Code	302
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$21.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3.57
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cash Price	$4.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.80

HF GLUCOSE SPOUSE

Facility

$5.00

Hospital Charge Code	22111128
Hospital Revenue Code	302
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$21.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3.57
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cash Price	$4.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.80

HF GLUCOSE SPOUSE

Facility

$5.00

Hospital Charge Code	22111128
Hospital Revenue Code	302
Rate for Payer: Cash Price	$4.50

HF H&H

Facility

$5.00

Hospital Charge Code	22111120
Hospital Revenue Code	305
Rate for Payer: Cash Price	$4.50

HF H&H

Facility

$5.00

Hospital Charge Code	22111120
Hospital Revenue Code	305
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$21.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3.57
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cash Price	$4.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.80

HF LIPID PANEL

Facility

$10.00

Hospital Charge Code	22111121
Hospital Revenue Code	301
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$21.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.14
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.60

Know your out-of-pocket cost for care.

All Charges