Madison Medical Center

All Charges

Charge

Type

Setting

Price

HYPERTENSION WITHOUT MCC

Facility

$15,461.36

Service Code	MSDRG 305
Min. Negotiated Rate	$7,730.68
Max. Negotiated Rate	$15,461.36
Rate for Payer: Aetna Medicare Advantage	$7,730.68
Rate for Payer: Cigna Commercial HMO & PPO	$7,730.68
Rate for Payer: Home State Health Plan Medicare Advantage	$7,730.68
Rate for Payer: Humana Commercial	$15,461.36
Rate for Payer: Humana Medicare Advantage	$7,730.68

HYPOTHYROID PANEL (84443)

Facility

$61.00

Service Code	CPT 84443
Hospital Charge Code	4280093
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.90

HYPOTHYROID PANEL (84443)

Facility

$61.00

Service Code	CPT 84443
Hospital Charge Code	4280093
Hospital Revenue Code	521
Min. Negotiated Rate	$13.61
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.12
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$43.55
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cigna Commercial HMO & PPO	$16.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.18
Rate for Payer: Home State Health Plan Medicare Advantage	$16.80
Rate for Payer: Humana Commercial	$33.60
Rate for Payer: Humana Medicare Advantage	$16.80
Rate for Payer: UnitedHealthcare Commercial	$40.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS

Facility

$18,458.68

Service Code	APR-DRG 4224
Min. Negotiated Rate	$18,458.68
Max. Negotiated Rate	$18,458.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$18,458.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18,458.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18,458.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18,458.68

HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS

Facility

$5,580.84

Service Code	APR-DRG 4222
Min. Negotiated Rate	$5,580.84
Max. Negotiated Rate	$5,580.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,580.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,580.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,580.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,580.84

HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS

Facility

$4,297.05

Service Code	APR-DRG 4221
Min. Negotiated Rate	$4,297.05
Max. Negotiated Rate	$4,297.05
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,297.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,297.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,297.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,297.05

HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS

Facility

$12,156.01

Service Code	APR-DRG 4223
Min. Negotiated Rate	$12,156.01
Max. Negotiated Rate	$12,156.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,156.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,156.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,156.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,156.01

HYPROCOTISONE INJ

Facility

$65.00

Service Code	HCPCS J1700
Hospital Charge Code	2058058
Hospital Revenue Code	370
Rate for Payer: Cash Price	$58.50

HYPROCOTISONE INJ

Facility

$65.00

Service Code	HCPCS J1700
Hospital Charge Code	2058058
Hospital Revenue Code	370
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

HYSTERECTOMY

Professional

Both

$2,663.00

Service Code	CPT 58150-80
Hospital Charge Code	4158150
Hospital Revenue Code	975
Min. Negotiated Rate	$932.05
Max. Negotiated Rate	$932.05
Rate for Payer: Cash Price	$2,396.70
Rate for Payer: Optum Medicare Advantage	$932.05

HYSTERECTOMY DRAIN

Facility

$199.00

Hospital Charge Code	288825
Hospital Revenue Code	271
Rate for Payer: Cash Price	$179.10

HYSTERECTOMY DRAIN

Facility

$199.00

Hospital Charge Code	288825
Hospital Revenue Code	271
Min. Negotiated Rate	$71.64
Max. Negotiated Rate	$142.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$117.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.09
Rate for Payer: Cash Price	$179.10
Rate for Payer: UnitedHealthcare Commercial	$132.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.64

HYSTEROSCOPY DIAGNOSTIC

Facility

$1,100.00

Service Code	CPT 58555
Hospital Charge Code	5256350
Hospital Revenue Code	521
Rate for Payer: Cash Price	$990.00

HYSTEROSCOPY DIAGNOSTIC

Facility

$1,100.00

Service Code	CPT 58555
Hospital Charge Code	5256350
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$6,614.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,918.10
Rate for Payer: Aetna Medicare Advantage	$3,307.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$651.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$785.40
Rate for Payer: Cash Price	$990.00
Rate for Payer: Cash Price	$990.00
Rate for Payer: Cash Price	$990.00
Rate for Payer: Cash Price	$990.00
Rate for Payer: Cigna Commercial HMO & PPO	$3,307.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,626.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,122.37
Rate for Payer: Home State Health Plan Medicare Advantage	$3,307.24
Rate for Payer: Humana Commercial	$6,614.48
Rate for Payer: Humana Medicare Advantage	$3,307.24
Rate for Payer: UnitedHealthcare Commercial	$733.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,918.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HYSTERSCOPE

Facility

$1,027.00

Hospital Charge Code	127391
Hospital Revenue Code	270
Rate for Payer: Cash Price	$924.30

HYSTERSCOPE

Facility

$1,027.00

Hospital Charge Code	127391
Hospital Revenue Code	270
Min. Negotiated Rate	$369.72
Max. Negotiated Rate	$733.28
Rate for Payer: Cash Price	$924.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$607.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$733.28
Rate for Payer: UnitedHealthcare Commercial	$685.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$369.72

IA2 AUTO AB (LC141531)

Facility

$96.00

Service Code	CPT 86341
Hospital Charge Code	2286337
Hospital Revenue Code	301
Rate for Payer: Cash Price	$86.40

IA2 AUTO AB (LC141531)

Facility

$96.00

Service Code	CPT 86341
Hospital Charge Code	2286337
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$68.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.21
Rate for Payer: Aetna Medicare Advantage	$23.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$68.54
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna Commercial HMO & PPO	$23.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22.69
Rate for Payer: Home State Health Plan Medicare Advantage	$23.57
Rate for Payer: Humana Commercial	$47.14
Rate for Payer: Humana Medicare Advantage	$23.57
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.56

I AND D ABSCESS

Facility

$151.00

Service Code	CPT 26010
Hospital Charge Code	4126010
Hospital Revenue Code	521
Min. Negotiated Rate	$89.39
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.81
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$100.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I AND D ABSCESS

Facility

$151.00

Service Code	CPT 26010
Hospital Charge Code	4126010
Hospital Revenue Code	521
Rate for Payer: Cash Price	$135.90

I AND D UPPER ARM/ELBOW/BURSA

Professional

Both

$2,007.00

Service Code	CPT 23930
Hospital Charge Code	1823931
Hospital Revenue Code	981
Min. Negotiated Rate	$192.52
Max. Negotiated Rate	$702.45
Rate for Payer: Aetna Commercial/Medicare Advantage	$192.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$276.83
Rate for Payer: Cash Price	$1,806.30
Rate for Payer: Cash Price	$1,806.30
Rate for Payer: Cigna Commercial HMO & PPO	$192.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$276.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$304.51
Rate for Payer: Home State Health Plan Medicare Advantage	$192.52
Rate for Payer: Optum Medicare Advantage	$702.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.83

IBANDRONATE (BONIVA) 150MG TAB 3 EMP

Facility

$110.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2624866
Hospital Revenue Code	250
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$78.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: UnitedHealthcare Commercial	$73.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

IBANDRONATE (BONIVA) 150MG TAB 3 EMP

Facility

$110.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2624866
Hospital Revenue Code	250
Rate for Payer: Cash Price	$99.00

IBUPROFEN 800MG TAB EMP

Facility

$20.00

Service Code	NDC 904585561
Hospital Charge Code	2620261
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

IBUPROFEN 800MG TAB EMP

Facility

$20.00

Service Code	NDC 904585561
Hospital Charge Code	2620261
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

Know your out-of-pocket cost for care.

All Charges