Madison Medical Center

All Charges

Charge

Type

Setting

Price

HSV CULTURE

Facility

$117.00

Service Code	CPT 87255
Hospital Charge Code	3087255
Hospital Revenue Code	306
Rate for Payer: Cash Price	$105.30

HUMALOG 75/25 KWIK PEN 5X3ML EMP

Facility

$648.00

Service Code	HCPCS J1817
Hospital Charge Code	2623795
Hospital Revenue Code	250
Rate for Payer: Cash Price	$583.20

HUMALOG 75/25 KWIK PEN 5X3ML EMP

Facility

$648.00

Service Code	HCPCS J1817
Hospital Charge Code	2623795
Hospital Revenue Code	250
Min. Negotiated Rate	$233.28
Max. Negotiated Rate	$462.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$383.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$462.67
Rate for Payer: Cash Price	$583.20
Rate for Payer: UnitedHealthcare Commercial	$432.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$233.28

HUMALOG INS VIAL 10ML EMP

Facility

$648.00

Service Code	HCPCS J1817
Hospital Charge Code	2622566
Hospital Revenue Code	250
Rate for Payer: Cash Price	$583.20

HUMALOG INS VIAL 10ML EMP

Facility

$648.00

Service Code	HCPCS J1817
Hospital Charge Code	2622566
Hospital Revenue Code	250
Min. Negotiated Rate	$233.28
Max. Negotiated Rate	$462.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$383.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$462.67
Rate for Payer: Cash Price	$583.20
Rate for Payer: UnitedHealthcare Commercial	$432.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$233.28

HUMALOG KWIK PEN 5X3ML EMP

Facility

$648.00

Service Code	HCPCS J1817
Hospital Charge Code	2623216
Hospital Revenue Code	250
Rate for Payer: Cash Price	$583.20

HUMALOG KWIK PEN 5X3ML EMP

Facility

$648.00

Service Code	HCPCS J1817
Hospital Charge Code	2623216
Hospital Revenue Code	250
Min. Negotiated Rate	$233.28
Max. Negotiated Rate	$462.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$383.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$462.67
Rate for Payer: Cash Price	$583.20
Rate for Payer: UnitedHealthcare Commercial	$432.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$233.28

HUMERUS XRAY LT

Facility

$465.00

Service Code	CPT 73060
Hospital Charge Code	328127
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$332.01
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	$275.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$332.01
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
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	$167.40

HUMERUS XRAY LT

Facility

$465.00

Service Code	CPT 73060
Hospital Charge Code	328127
Hospital Revenue Code	320
Rate for Payer: Cash Price	$418.50

HUMERUS XRAY RT

Facility

$465.00

Service Code	CPT 73060
Hospital Charge Code	328126
Hospital Revenue Code	320
Rate for Payer: Cash Price	$418.50

HUMERUS XRAY RT

Facility

$465.00

Service Code	CPT 73060
Hospital Charge Code	328126
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$332.01
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	$275.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$332.01
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
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	$167.40

HUNTINGTON DISEASE GENETIC TESTING

Facility

$491.00

Service Code	CPT 81271
Hospital Charge Code	2281271
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$350.57
Rate for Payer: Aetna Better Health Medicaid/QHP	$123.30
Rate for Payer: Aetna Medicare Advantage	$137.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$290.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$350.57
Rate for Payer: Cash Price	$441.90
Rate for Payer: Cash Price	$441.90
Rate for Payer: Cash Price	$441.90
Rate for Payer: Cigna Commercial HMO & PPO	$137.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$123.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$131.93
Rate for Payer: Home State Health Plan Medicare Advantage	$137.00
Rate for Payer: Humana Commercial	$274.00
Rate for Payer: Humana Medicare Advantage	$137.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$123.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$176.76

HUNTINGTON DISEASE GENETIC TESTING

Facility

$491.00

Service Code	CPT 81271
Hospital Charge Code	2281271
Hospital Revenue Code	301
Rate for Payer: Cash Price	$441.90

HYALGAN ORTHOVISC

Facility

$250.00

Service Code	HCPCS J7315
Hospital Charge Code	9107315
Hospital Revenue Code	521
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$178.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HYALGAN ORTHOVISC

Facility

$250.00

Service Code	HCPCS J7315
Hospital Charge Code	9107315
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

HYALURONIC ACID

Facility

$417.00

Service Code	CPT 83520
Hospital Charge Code	2233520
Hospital Revenue Code	301
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$297.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.54
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$246.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$297.74
Rate for Payer: Cash Price	$375.30
Rate for Payer: Cash Price	$375.30
Rate for Payer: Cash Price	$375.30
Rate for Payer: Cigna Commercial HMO & PPO	$17.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.63
Rate for Payer: Home State Health Plan Medicare Advantage	$17.27
Rate for Payer: Humana Commercial	$34.54
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$150.12

HYALURONIC ACID

Facility

$417.00

Service Code	CPT 83520
Hospital Charge Code	2233520
Hospital Revenue Code	301
Rate for Payer: Cash Price	$375.30

HYC NEW PT AGES 12 - 17

Facility

$290.00

Service Code	CPT 99384
Hospital Charge Code	9799384
Hospital Revenue Code	521
Min. Negotiated Rate	$171.68
Max. Negotiated Rate	$207.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$171.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$207.06
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: UnitedHealthcare Commercial	$193.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HYC NEW PT AGES 12 - 17

Facility

$290.00

Service Code	CPT 99384
Hospital Charge Code	9799384
Hospital Revenue Code	521
Rate for Payer: Cash Price	$261.00

HYC NEW PT AGES 5 - 11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	9799383
Hospital Revenue Code	521
Min. Negotiated Rate	$153.92
Max. Negotiated Rate	$185.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: UnitedHealthcare Commercial	$173.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HYC NEW PT AGES 5 - 11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	9799383
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.00

HYD-CROUPETTE/DAY

Facility

$147.00

Service Code	CPT 94680
Hospital Charge Code	4500280
Hospital Revenue Code	412
Min. Negotiated Rate	$52.92
Max. Negotiated Rate	$262.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$116.00
Rate for Payer: Aetna Medicare Advantage	$131.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$87.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$104.96
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cigna Commercial HMO & PPO	$131.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$116.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$124.12
Rate for Payer: Home State Health Plan Medicare Advantage	$131.46
Rate for Payer: Humana Commercial	$262.92
Rate for Payer: Humana Medicare Advantage	$131.46
Rate for Payer: UnitedHealthcare Commercial	$98.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$116.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$52.92

HYD-CROUPETTE/DAY

Facility

$147.00

Service Code	CPT 94680
Hospital Charge Code	4500280
Hospital Revenue Code	412
Rate for Payer: Cash Price	$132.30

HYD-CROUPETTE SETUP

Facility

$183.00

Service Code	CPT 94680
Hospital Charge Code	4500270
Hospital Revenue Code	271
Rate for Payer: Cash Price	$164.70

HYD-CROUPETTE SETUP

Facility

$183.00

Service Code	CPT 94680
Hospital Charge Code	4500270
Hospital Revenue Code	271
Min. Negotiated Rate	$65.88
Max. Negotiated Rate	$262.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$116.00
Rate for Payer: Aetna Medicare Advantage	$131.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$108.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$130.66
Rate for Payer: Cash Price	$164.70
Rate for Payer: Cash Price	$164.70
Rate for Payer: Cash Price	$164.70
Rate for Payer: Cigna Commercial HMO & PPO	$131.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$116.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$124.12
Rate for Payer: Home State Health Plan Medicare Advantage	$131.46
Rate for Payer: Humana Commercial	$262.92
Rate for Payer: Humana Medicare Advantage	$131.46
Rate for Payer: UnitedHealthcare Commercial	$122.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$116.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.88

Know your out-of-pocket cost for care.

All Charges