Madison Medical Center

All Charges

Charge

Type

Setting

Price

HGE AB IGG IGM PANEL (LABCORP 164672)

Facility

$207.00

Service Code	CPT 86666
Hospital Charge Code	2287791
Hospital Revenue Code	305
Rate for Payer: Cash Price	$186.30

HGE AB IGG IGM PANEL (LABCORP 164672)

Facility

$207.00

Service Code	CPT 86666
Hospital Charge Code	2287791
Hospital Revenue Code	305
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$147.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.16
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$122.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$147.80
Rate for Payer: Cash Price	$186.30
Rate for Payer: Cash Price	$186.30
Rate for Payer: Cash Price	$186.30
Rate for Payer: Cigna Commercial HMO & PPO	$10.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.80
Rate for Payer: Home State Health Plan Medicare Advantage	$10.18
Rate for Payer: Humana Commercial	$20.36
Rate for Payer: Humana Medicare Advantage	$10.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$74.52

H&H SPECIMEN COLLECTION

Facility

$35.00

Hospital Charge Code	221115
Hospital Revenue Code	300
Rate for Payer: Cash Price	$31.50

H&H SPECIMEN COLLECTION

Facility

$35.00

Hospital Charge Code	221115
Hospital Revenue Code	300
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
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: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

HIB

Facility

$25.00

Service Code	CPT 90647
Hospital Charge Code	9290647
Hospital Revenue Code	636
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

HIB

Facility

$25.00

Service Code	CPT 90647
Hospital Charge Code	9290647
Hospital Revenue Code	636
Min. Negotiated Rate	$16.68
Max. Negotiated Rate	$16.68
Rate for Payer: Cash Price	$22.50
Rate for Payer: UnitedHealthcare Commercial	$16.68

HIGH FLOW NC, ADULT

Facility

$10.00

Hospital Charge Code	4500425
Hospital Revenue Code	271
Rate for Payer: Cash Price	$9.00

HIGH FLOW NC, ADULT

Facility

$10.00

Hospital Charge Code	4500425
Hospital Revenue Code	271
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$7.14
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: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.60

HIGH SEVERITY ADM AND DISCHARGE SAME DAY

Facility

$550.00

Service Code	CPT 99236
Hospital Charge Code	9699236
Hospital Revenue Code	521
Rate for Payer: Cash Price	$495.00

HIGH SEVERITY ADM AND DISCHARGE SAME DAY

Facility

$550.00

Service Code	CPT 99236
Hospital Charge Code	9699236
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$392.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$325.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$392.70
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: UnitedHealthcare Commercial	$366.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

H INFLUENZA AB

Facility

$134.00

Service Code	CPT 86684
Hospital Charge Code	2286684
Hospital Revenue Code	301
Rate for Payer: Cash Price	$120.60

H INFLUENZA AB

Facility

$134.00

Service Code	CPT 86684
Hospital Charge Code	2286684
Hospital Revenue Code	301
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$95.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.26
Rate for Payer: Aetna Medicare Advantage	$15.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$95.68
Rate for Payer: Cash Price	$120.60
Rate for Payer: Cash Price	$120.60
Rate for Payer: Cash Price	$120.60
Rate for Payer: Cigna Commercial HMO & PPO	$15.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.26
Rate for Payer: Home State Health Plan Medicare Advantage	$15.84
Rate for Payer: Humana Commercial	$31.68
Rate for Payer: Humana Medicare Advantage	$15.84
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$48.24

H INFLUENZA B IGG

Facility

$342.00

Service Code	CPT 86317
Hospital Charge Code	2286043
Hospital Revenue Code	302
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$244.19
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.49
Rate for Payer: Aetna Medicare Advantage	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$202.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$244.19
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cigna Commercial HMO & PPO	$14.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.43
Rate for Payer: Home State Health Plan Medicare Advantage	$14.99
Rate for Payer: Humana Commercial	$29.98
Rate for Payer: Humana Medicare Advantage	$14.99
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$123.12

H INFLUENZA B IGG

Facility

$342.00

Service Code	CPT 86317
Hospital Charge Code	2286043
Hospital Revenue Code	302
Rate for Payer: Cash Price	$307.80

HIP AND FEMUR FRACTURE REPAIR

Facility

$10,761.40

Service Code	APR-DRG 3081
Min. Negotiated Rate	$10,761.40
Max. Negotiated Rate	$10,761.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,761.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,761.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,761.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,761.40

HIP AND FEMUR FRACTURE REPAIR

Facility

$14,669.34

Service Code	APR-DRG 3082
Min. Negotiated Rate	$14,669.34
Max. Negotiated Rate	$14,669.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,669.34
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,669.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,669.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,669.34

HIP AND FEMUR FRACTURE REPAIR

Facility

$23,185.09

Service Code	APR-DRG 3083
Min. Negotiated Rate	$23,185.09
Max. Negotiated Rate	$23,185.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,185.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,185.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,185.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,185.09

HIP AND FEMUR FRACTURE REPAIR

Facility

$39,681.28

Service Code	APR-DRG 3084
Min. Negotiated Rate	$39,681.28
Max. Negotiated Rate	$39,681.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$39,681.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$39,681.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$39,681.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$39,681.28

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC

Facility

$36,488.14

Service Code	MSDRG 481
Min. Negotiated Rate	$18,244.07
Max. Negotiated Rate	$36,488.14
Rate for Payer: Aetna Medicare Advantage	$18,244.07
Rate for Payer: Cigna Commercial HMO & PPO	$18,244.07
Rate for Payer: Home State Health Plan Medicare Advantage	$18,244.07
Rate for Payer: Humana Commercial	$36,488.14
Rate for Payer: Humana Medicare Advantage	$18,244.07

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC

Facility

$49,399.88

Service Code	MSDRG 480
Min. Negotiated Rate	$24,699.94
Max. Negotiated Rate	$49,399.88
Rate for Payer: Aetna Medicare Advantage	$24,699.94
Rate for Payer: Cigna Commercial HMO & PPO	$24,699.94
Rate for Payer: Home State Health Plan Medicare Advantage	$24,699.94
Rate for Payer: Humana Commercial	$49,399.88
Rate for Payer: Humana Medicare Advantage	$24,699.94

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC

Facility

$29,186.28

Service Code	MSDRG 482
Min. Negotiated Rate	$14,593.14
Max. Negotiated Rate	$29,186.28
Rate for Payer: Aetna Medicare Advantage	$14,593.14
Rate for Payer: Cigna Commercial HMO & PPO	$14,593.14
Rate for Payer: Home State Health Plan Medicare Advantage	$14,593.14
Rate for Payer: Humana Commercial	$29,186.28
Rate for Payer: Humana Medicare Advantage	$14,593.14

HIP NAILING PROSTH LT

Facility

$1,061.00

Service Code	CPT 27130
Hospital Charge Code	328167
Hospital Revenue Code	320
Rate for Payer: Cash Price	$954.90

HIP NAILING PROSTH LT

Facility

$1,061.00

Service Code	CPT 27130
Hospital Charge Code	328167
Hospital Revenue Code	320
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$26,233.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,573.41
Rate for Payer: Aetna Medicare Advantage	$13,116.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$628.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$757.55
Rate for Payer: Cash Price	$954.90
Rate for Payer: Cash Price	$954.90
Rate for Payer: Cash Price	$954.90
Rate for Payer: Cigna Commercial HMO & PPO	$13,116.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,573.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,383.55
Rate for Payer: Home State Health Plan Medicare Advantage	$13,116.76
Rate for Payer: Humana Commercial	$26,233.52
Rate for Payer: Humana Medicare Advantage	$13,116.76
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,573.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$381.96

HIP NAILING PROSTH RT

Facility

$1,061.00

Service Code	CPT 27130
Hospital Charge Code	328166
Hospital Revenue Code	320
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$26,233.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,573.41
Rate for Payer: Aetna Medicare Advantage	$13,116.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$628.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$757.55
Rate for Payer: Cash Price	$954.90
Rate for Payer: Cash Price	$954.90
Rate for Payer: Cash Price	$954.90
Rate for Payer: Cigna Commercial HMO & PPO	$13,116.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,573.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,383.55
Rate for Payer: Home State Health Plan Medicare Advantage	$13,116.76
Rate for Payer: Humana Commercial	$26,233.52
Rate for Payer: Humana Medicare Advantage	$13,116.76
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,573.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$381.96

HIP NAILING PROSTH RT

Facility

$1,061.00

Service Code	CPT 27130
Hospital Charge Code	328166
Hospital Revenue Code	320
Rate for Payer: Cash Price	$954.90

Know your out-of-pocket cost for care.

All Charges