Madison Medical Center

All Charges

Charge

Type

Setting

Price

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$48,733.84

Service Code	MSDRG 521
Min. Negotiated Rate	$24,366.92
Max. Negotiated Rate	$48,733.84
Rate for Payer: Aetna Medicare Advantage	$24,366.92
Rate for Payer: Cigna Commercial HMO & PPO	$24,366.92
Rate for Payer: Home State Health Plan Medicare Advantage	$24,366.92
Rate for Payer: Humana Commercial	$48,733.84
Rate for Payer: Humana Medicare Advantage	$24,366.92

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$36,853.62

Service Code	MSDRG 522
Min. Negotiated Rate	$18,426.81
Max. Negotiated Rate	$36,853.62
Rate for Payer: Aetna Medicare Advantage	$18,426.81
Rate for Payer: Cigna Commercial HMO & PPO	$18,426.81
Rate for Payer: Home State Health Plan Medicare Advantage	$18,426.81
Rate for Payer: Humana Commercial	$36,853.62
Rate for Payer: Humana Medicare Advantage	$18,426.81

HIP XRAY, BILAT

Facility

$810.00

Service Code	CPT 73522
Hospital Charge Code	3273522
Hospital Revenue Code	320
Rate for Payer: Cash Price	$729.00

HIP XRAY, BILAT

Facility

$810.00

Service Code	CPT 73522
Hospital Charge Code	3273522
Hospital Revenue Code	320
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$578.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$479.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$578.34
Rate for Payer: Cash Price	$729.00
Rate for Payer: Cash Price	$729.00
Rate for Payer: Cash Price	$729.00
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$291.60

HIP XRAY LT

Facility

$460.00

Service Code	CPT 73502
Hospital Charge Code	328114
Hospital Revenue Code	320
Rate for Payer: Cash Price	$414.00

HIP XRAY LT

Facility

$460.00

Service Code	CPT 73502
Hospital Charge Code	328114
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$328.44
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	$272.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$328.44
Rate for Payer: Cash Price	$414.00
Rate for Payer: Cash Price	$414.00
Rate for Payer: Cash Price	$414.00
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	$165.60

HIP XRAY ONE VIEW RT

Facility

$441.00

Service Code	CPT 73501
Hospital Charge Code	3273500
Hospital Revenue Code	320
Rate for Payer: Cash Price	$396.90

HIP XRAY ONE VIEW RT

Facility

$441.00

Service Code	CPT 73501
Hospital Charge Code	3273500
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$314.87
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	$261.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$314.87
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cash Price	$396.90
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	$158.76

HIP XRAY, RT

Facility

$460.00

Service Code	CPT 73502
Hospital Charge Code	328113
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$328.44
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	$272.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$328.44
Rate for Payer: Cash Price	$414.00
Rate for Payer: Cash Price	$414.00
Rate for Payer: Cash Price	$414.00
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	$165.60

HIP XRAY, RT

Facility

$460.00

Service Code	CPT 73502
Hospital Charge Code	328113
Hospital Revenue Code	320
Rate for Payer: Cash Price	$414.00

HISTAMINE

Facility

$326.00

Service Code	CPT 83088
Hospital Charge Code	2286343
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$232.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$26.58
Rate for Payer: Aetna Medicare Advantage	$29.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$192.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$232.76
Rate for Payer: Cash Price	$293.40
Rate for Payer: Cash Price	$293.40
Rate for Payer: Cash Price	$293.40
Rate for Payer: Cigna Commercial HMO & PPO	$29.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28.44
Rate for Payer: Home State Health Plan Medicare Advantage	$29.53
Rate for Payer: Humana Commercial	$59.06
Rate for Payer: Humana Medicare Advantage	$29.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$117.36

HISTAMINE

Facility

$326.00

Service Code	CPT 83088
Hospital Charge Code	2286343
Hospital Revenue Code	301
Rate for Payer: Cash Price	$293.40

HISTONE AB

Facility

$226.00

Service Code	CPT 83516
Hospital Charge Code	2286656
Hospital Revenue Code	301
Rate for Payer: Cash Price	$203.40

HISTONE AB

Facility

$226.00

Service Code	CPT 83516
Hospital Charge Code	2286656
Hospital Revenue Code	301
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$161.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$133.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$161.36
Rate for Payer: Cash Price	$203.40
Rate for Payer: Cash Price	$203.40
Rate for Payer: Cash Price	$203.40
Rate for Payer: Cigna Commercial HMO & PPO	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$81.36

HISTOPLASMA AB

Facility

$185.00

Service Code	CPT 86698
Hospital Charge Code	2286698
Hospital Revenue Code	305
Rate for Payer: Cash Price	$166.50

HISTOPLASMA AB

Facility

$185.00

Service Code	CPT 86698
Hospital Charge Code	2286698
Hospital Revenue Code	305
Min. Negotiated Rate	$12.41
Max. Negotiated Rate	$132.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.41
Rate for Payer: Aetna Medicare Advantage	$13.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$109.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.09
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cigna Commercial HMO & PPO	$13.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.28
Rate for Payer: Home State Health Plan Medicare Advantage	$13.79
Rate for Payer: Humana Commercial	$27.58
Rate for Payer: Humana Medicare Advantage	$13.79
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.60

HISTOPLASMA AG QUANT

Facility

$220.00

Service Code	CPT 87385
Hospital Charge Code	2287385
Hospital Revenue Code	305
Rate for Payer: Cash Price	$198.00

HISTOPLASMA AG QUANT

Facility

$220.00

Service Code	CPT 87385
Hospital Charge Code	2287385
Hospital Revenue Code	305
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$157.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.93
Rate for Payer: Aetna Medicare Advantage	$13.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$130.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$157.08
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cigna Commercial HMO & PPO	$13.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.77
Rate for Payer: Home State Health Plan Medicare Advantage	$13.25
Rate for Payer: Humana Commercial	$26.50
Rate for Payer: Humana Medicare Advantage	$13.25
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$79.20

HISTOPLASMA ANTIGEN URINE

Facility

$473.00

Service Code	CPT 87385
Hospital Charge Code	227385
Hospital Revenue Code	302
Rate for Payer: Cash Price	$425.70

HISTOPLASMA ANTIGEN URINE

Facility

$473.00

Service Code	CPT 87385
Hospital Charge Code	227385
Hospital Revenue Code	302
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$337.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.93
Rate for Payer: Aetna Medicare Advantage	$13.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$280.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$337.72
Rate for Payer: Cash Price	$425.70
Rate for Payer: Cash Price	$425.70
Rate for Payer: Cash Price	$425.70
Rate for Payer: Cigna Commercial HMO & PPO	$13.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.77
Rate for Payer: Home State Health Plan Medicare Advantage	$13.25
Rate for Payer: Humana Commercial	$26.50
Rate for Payer: Humana Medicare Advantage	$13.25
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$170.28

HIV

Facility

$50.00

Service Code	CPT 86687
Hospital Charge Code	4286687
Hospital Revenue Code	521
Rate for Payer: Cash Price	$45.00

HIV

Facility

$50.00

Service Code	CPT 86687
Hospital Charge Code	4286687
Hospital Revenue Code	521
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.18
Rate for Payer: Aetna Medicare Advantage	$9.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$9.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.75
Rate for Payer: Home State Health Plan Medicare Advantage	$9.09
Rate for Payer: Humana Commercial	$18.18
Rate for Payer: Humana Medicare Advantage	$9.09
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HIV 4TH GENERATION ANTIGEN/ANTIBODY

Facility

$133.00

Service Code	CPT 87389
Hospital Charge Code	2287389
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$94.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.67
Rate for Payer: Aetna Medicare Advantage	$24.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$78.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$94.96
Rate for Payer: Cash Price	$119.70
Rate for Payer: Cash Price	$119.70
Rate for Payer: Cash Price	$119.70
Rate for Payer: Cigna Commercial HMO & PPO	$24.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.19
Rate for Payer: Home State Health Plan Medicare Advantage	$24.08
Rate for Payer: Humana Commercial	$48.16
Rate for Payer: Humana Medicare Advantage	$24.08
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.88

HIV 4TH GENERATION ANTIGEN/ANTIBODY

Facility

$133.00

Service Code	CPT 87389
Hospital Charge Code	2287389
Hospital Revenue Code	301
Rate for Payer: Cash Price	$119.70

HIV AG/AB W/RFX

Facility

$178.00

Service Code	CPT 87389
Hospital Charge Code	228950
Hospital Revenue Code	301
Rate for Payer: Cash Price	$160.20

Know your out-of-pocket cost for care.

All Charges