Madison Medical Center

All Charges

Charge

Type

Setting

Price

HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS

Facility

$9,013.15

Service Code	APR-DRG 8941
Min. Negotiated Rate	$9,013.15
Max. Negotiated Rate	$9,013.15
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,013.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,013.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,013.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,013.15

HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS

Facility

$14,454.72

Service Code	APR-DRG 8943
Min. Negotiated Rate	$14,454.72
Max. Negotiated Rate	$14,454.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,454.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,454.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,454.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,454.72

HIV WITH OR WITHOUT OTHER RELATED CONDITION

Facility

$23,952.68

Service Code	MSDRG 977
Min. Negotiated Rate	$11,976.34
Max. Negotiated Rate	$23,952.68
Rate for Payer: Aetna Medicare Advantage	$11,976.34
Rate for Payer: Cigna Commercial HMO & PPO	$11,976.34
Rate for Payer: Home State Health Plan Medicare Advantage	$11,976.34
Rate for Payer: Humana Commercial	$23,952.68
Rate for Payer: Humana Medicare Advantage	$11,976.34

HLA-A29

Facility

$581.00

Service Code	CPT 86812
Hospital Charge Code	2281381
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$414.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$23.23
Rate for Payer: Aetna Medicare Advantage	$25.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$343.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$414.83
Rate for Payer: Cash Price	$522.90
Rate for Payer: Cash Price	$522.90
Rate for Payer: Cash Price	$522.90
Rate for Payer: Cigna Commercial HMO & PPO	$25.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24.86
Rate for Payer: Home State Health Plan Medicare Advantage	$25.81
Rate for Payer: Humana Commercial	$51.62
Rate for Payer: Humana Medicare Advantage	$25.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$209.16

HLA-A29

Facility

$581.00

Service Code	CPT 86812
Hospital Charge Code	2281381
Hospital Revenue Code	301
Rate for Payer: Cash Price	$522.90

HLA-B27

Facility

$169.00

Service Code	CPT 86812
Hospital Charge Code	228900
Hospital Revenue Code	301
Rate for Payer: Cash Price	$152.10

HLA-B27

Facility

$169.00

Service Code	CPT 86812
Hospital Charge Code	228900
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$120.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$23.23
Rate for Payer: Aetna Medicare Advantage	$25.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$120.67
Rate for Payer: Cash Price	$152.10
Rate for Payer: Cash Price	$152.10
Rate for Payer: Cash Price	$152.10
Rate for Payer: Cigna Commercial HMO & PPO	$25.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24.86
Rate for Payer: Home State Health Plan Medicare Advantage	$25.81
Rate for Payer: Humana Commercial	$51.62
Rate for Payer: Humana Medicare Advantage	$25.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.84

.HLA-B27 DNA TYPING

Facility

$394.00

Service Code	CPT 81374
Hospital Charge Code	2281374
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$281.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$66.90
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$233.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$281.32
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cigna Commercial HMO & PPO	$74.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$66.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$71.58
Rate for Payer: Home State Health Plan Medicare Advantage	$74.33
Rate for Payer: Humana Commercial	$148.66
Rate for Payer: Humana Medicare Advantage	$74.33
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$66.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$141.84

.HLA-B27 DNA TYPING

Facility

$394.00

Service Code	CPT 81374
Hospital Charge Code	2281374
Hospital Revenue Code	302
Rate for Payer: Cash Price	$354.60

HLA-B51

Facility

$494.00

Service Code	CPT 81381
Hospital Charge Code	2233891
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$352.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$152.91
Rate for Payer: Aetna Medicare Advantage	$169.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$292.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$352.72
Rate for Payer: Cash Price	$444.60
Rate for Payer: Cash Price	$444.60
Rate for Payer: Cash Price	$444.60
Rate for Payer: Cigna Commercial HMO & PPO	$169.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$152.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$163.61
Rate for Payer: Home State Health Plan Medicare Advantage	$169.90
Rate for Payer: Humana Commercial	$339.80
Rate for Payer: Humana Medicare Advantage	$169.90
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$152.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$177.84

HLA-B51

Facility

$494.00

Service Code	CPT 81381
Hospital Charge Code	2233891
Hospital Revenue Code	302
Rate for Payer: Cash Price	$444.60

HLA B 57.01

Facility

$342.00

Service Code	CPT 81381
Hospital Charge Code	2281382
Hospital Revenue Code	301
Rate for Payer: Cash Price	$307.80

HLA B 57.01

Facility

$342.00

Service Code	CPT 81381
Hospital Charge Code	2281382
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$339.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$152.91
Rate for Payer: Aetna Medicare Advantage	$169.90
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	$169.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$152.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$163.61
Rate for Payer: Home State Health Plan Medicare Advantage	$169.90
Rate for Payer: Humana Commercial	$339.80
Rate for Payer: Humana Medicare Advantage	$169.90
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$152.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$123.12

HME, ADULT

Facility

$4.00

Hospital Charge Code	28251796
Hospital Revenue Code	271
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$2.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2.86
Rate for Payer: Cash Price	$3.60
Rate for Payer: UnitedHealthcare Commercial	$2.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

HME, ADULT

Facility

$4.00

Hospital Charge Code	28251796
Hospital Revenue Code	271
Rate for Payer: Cash Price	$3.60

H M E FILTER

Facility

$44.00

Hospital Charge Code	2024489
Hospital Revenue Code	370
Rate for Payer: Cash Price	$39.60

H M E FILTER

Facility

$44.00

Hospital Charge Code	2024489
Hospital Revenue Code	370
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

.H METAPNEUMOVIRUS (LC CHARGE)

Facility

$50.00

Service Code	CPT 87299
Hospital Charge Code	2287209
Hospital Revenue Code	305
Rate for Payer: Cash Price	$45.00

.H METAPNEUMOVIRUS (LC CHARGE)

Facility

$50.00

Service Code	CPT 87299
Hospital Charge Code	2287209
Hospital Revenue Code	305
Min. Negotiated Rate	$14.49
Max. Negotiated Rate	$35.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.49
Rate for Payer: Aetna Medicare Advantage	$16.10
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: Cigna Commercial HMO & PPO	$16.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.50
Rate for Payer: Home State Health Plan Medicare Advantage	$16.10
Rate for Payer: Humana Commercial	$32.20
Rate for Payer: Humana Medicare Advantage	$16.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

HOFFMAN II COMPACT PIN TO ROD

Facility

$980.00

Hospital Charge Code	123336
Hospital Revenue Code	271
Min. Negotiated Rate	$352.80
Max. Negotiated Rate	$699.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$580.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$699.72
Rate for Payer: Cash Price	$882.00
Rate for Payer: UnitedHealthcare Commercial	$653.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$352.80

HOFFMAN II COMPACT PIN TO ROD

Facility

$980.00

Hospital Charge Code	123336
Hospital Revenue Code	271
Rate for Payer: Cash Price	$882.00

HOFFMAN MICRO LENGTHENER ASSEMBLY

Facility

$7,138.00

Hospital Charge Code	129111
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,424.20

HOFFMAN MICRO LENGTHENER ASSEMBLY

Facility

$7,138.00

Hospital Charge Code	129111
Hospital Revenue Code	360
Min. Negotiated Rate	$2,569.68
Max. Negotiated Rate	$4,761.05
Rate for Payer: Cash Price	$6,424.20
Rate for Payer: UnitedHealthcare Commercial	$4,761.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,569.68

HOLTER HOOK UP AND DISCONNECT

Facility

$263.00

Service Code	CPT 93225
Hospital Charge Code	9293225
Hospital Revenue Code	521
Rate for Payer: Cash Price	$236.70

HOLTER HOOK UP AND DISCONNECT

Facility

$263.00

Service Code	CPT 93225
Hospital Charge Code	9493225
Hospital Revenue Code	521
Rate for Payer: Cash Price	$236.70

Know your out-of-pocket cost for care.

All Charges