Madison Medical Center

All Charges

Charge

Type

Setting

Price

I & D SIMPLE

Facility

$104.00

Service Code	CPT 10060
Hospital Charge Code	9410060
Hospital Revenue Code	521
Min. Negotiated Rate	$61.57
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	$61.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.26
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
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	$69.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I & D SIMPLE ABCESS

Facility

$104.00

Service Code	CPT 10060
Hospital Charge Code	3910060
Hospital Revenue Code	521
Rate for Payer: Cash Price	$93.60

I & D SIMPLE ABCESS

Facility

$104.00

Service Code	CPT 10060
Hospital Charge Code	3910060
Hospital Revenue Code	521
Min. Negotiated Rate	$61.57
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	$61.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.26
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
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	$69.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I & D SIMPLE ABSCESS

Facility

$104.00

Service Code	CPT 10060
Hospital Charge Code	9710060
Hospital Revenue Code	521
Rate for Payer: Cash Price	$93.60

I & D SIMPLE ABSCESS

Facility

$104.00

Service Code	CPT 10060
Hospital Charge Code	9610060
Hospital Revenue Code	521
Min. Negotiated Rate	$61.57
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	$61.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.26
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
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	$69.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I & D SIMPLE ABSCESS

Facility

$104.00

Service Code	CPT 10060
Hospital Charge Code	9710060
Hospital Revenue Code	521
Min. Negotiated Rate	$61.57
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	$61.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.26
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
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	$69.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I & D SIMPLE ABSCESS

Facility

$104.00

Service Code	CPT 10060
Hospital Charge Code	9610060
Hospital Revenue Code	521
Rate for Payer: Cash Price	$93.60

I&D SIMPLE ABSCESS

Facility

$185.00

Service Code	CPT 10060
Hospital Charge Code	9810060
Hospital Revenue Code	521
Min. Negotiated Rate	$109.52
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	$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: Cash Price	$166.50
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	$123.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I&D SIMPLE ABSCESS

Facility

$185.00

Service Code	CPT 10060
Hospital Charge Code	9810060
Hospital Revenue Code	521
Rate for Payer: Cash Price	$166.50

I & D SIMPLE CYST

Facility

$185.00

Service Code	CPT 10060
Hospital Charge Code	4210060
Hospital Revenue Code	521
Min. Negotiated Rate	$109.52
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	$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: Cash Price	$166.50
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	$123.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I & D SIMPLE CYST

Facility

$185.00

Service Code	CPT 10060
Hospital Charge Code	4210060
Hospital Revenue Code	521
Rate for Payer: Cash Price	$166.50

I&D VULVAR/PERNINAL ABCESS

Facility

$129.00

Service Code	CPT 56405
Hospital Charge Code	4256405
Hospital Revenue Code	521
Rate for Payer: Cash Price	$116.10

I&D VULVAR/PERNINAL ABCESS

Facility

$129.00

Service Code	CPT 56405
Hospital Charge Code	4256405
Hospital Revenue Code	521
Min. Negotiated Rate	$76.37
Max. Negotiated Rate	$622.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$274.70
Rate for Payer: Aetna Medicare Advantage	$311.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cigna Commercial HMO & PPO	$311.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$247.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$293.93
Rate for Payer: Home State Health Plan Medicare Advantage	$311.33
Rate for Payer: Humana Commercial	$622.66
Rate for Payer: Humana Medicare Advantage	$311.33
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$274.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

.IFE URINE (CHARGE)

Facility

$30.00

Service Code	CPT 86335
Hospital Charge Code	221959
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

.IFE URINE (CHARGE)

Facility

$30.00

Service Code	CPT 86335
Hospital Charge Code	221959
Hospital Revenue Code	301
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$58.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$26.42
Rate for Payer: Aetna Medicare Advantage	$29.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$29.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28.27
Rate for Payer: Home State Health Plan Medicare Advantage	$29.35
Rate for Payer: Humana Commercial	$58.70
Rate for Payer: Humana Medicare Advantage	$29.35
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

IGA

Facility

$70.00

Service Code	CPT 82784
Hospital Charge Code	229272
Hospital Revenue Code	301
Min. Negotiated Rate	$8.37
Max. Negotiated Rate	$49.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.37
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$9.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.96
Rate for Payer: Home State Health Plan Medicare Advantage	$9.30
Rate for Payer: Humana Commercial	$18.60
Rate for Payer: Humana Medicare Advantage	$9.30
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

IGA

Facility

$70.00

Service Code	CPT 82784
Hospital Charge Code	229272
Hospital Revenue Code	301
Rate for Payer: Cash Price	$63.00

IGD (IMMUNOGLOBULIN D)

Facility

$171.00

Service Code	CPT 82784
Hospital Charge Code	229301
Hospital Revenue Code	301
Min. Negotiated Rate	$8.37
Max. Negotiated Rate	$122.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.37
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$101.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$122.09
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cigna Commercial HMO & PPO	$9.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.96
Rate for Payer: Home State Health Plan Medicare Advantage	$9.30
Rate for Payer: Humana Commercial	$18.60
Rate for Payer: Humana Medicare Advantage	$9.30
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.56

IGD (IMMUNOGLOBULIN D)

Facility

$171.00

Service Code	CPT 82784
Hospital Charge Code	229301
Hospital Revenue Code	301
Rate for Payer: Cash Price	$153.90

IGE (IMMUNOGLOBULIN E)

Facility

$125.00

Service Code	CPT 82785
Hospital Charge Code	229300
Hospital Revenue Code	301
Rate for Payer: Cash Price	$112.50

IGE (IMMUNOGLOBULIN E)

Facility

$125.00

Service Code	CPT 82785
Hospital Charge Code	229300
Hospital Revenue Code	301
Min. Negotiated Rate	$14.81
Max. Negotiated Rate	$89.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.81
Rate for Payer: Aetna Medicare Advantage	$16.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna Commercial HMO & PPO	$16.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.85
Rate for Payer: Home State Health Plan Medicare Advantage	$16.46
Rate for Payer: Humana Commercial	$32.92
Rate for Payer: Humana Medicare Advantage	$16.46
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

IGF-2

Facility

$179.00

Service Code	CPT 83519
Hospital Charge Code	2283550
Hospital Revenue Code	301
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$127.81
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.56
Rate for Payer: Aetna Medicare Advantage	$18.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.81
Rate for Payer: Cash Price	$161.10
Rate for Payer: Cash Price	$161.10
Rate for Payer: Cash Price	$161.10
Rate for Payer: Cigna Commercial HMO & PPO	$18.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.72
Rate for Payer: Home State Health Plan Medicare Advantage	$18.40
Rate for Payer: Humana Commercial	$36.80
Rate for Payer: Humana Medicare Advantage	$18.40
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.44

IGF-2

Facility

$179.00

Service Code	CPT 83519
Hospital Charge Code	2283550
Hospital Revenue Code	301
Rate for Payer: Cash Price	$161.10

IGF-I

Facility

$156.00

Service Code	CPT 84305
Hospital Charge Code	2284399
Hospital Revenue Code	301
Rate for Payer: Cash Price	$140.40

IGF-I

Facility

$156.00

Service Code	CPT 84305
Hospital Charge Code	2284399
Hospital Revenue Code	301
Min. Negotiated Rate	$19.13
Max. Negotiated Rate	$111.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.13
Rate for Payer: Aetna Medicare Advantage	$21.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial HMO & PPO	$21.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.47
Rate for Payer: Home State Health Plan Medicare Advantage	$21.26
Rate for Payer: Humana Commercial	$42.52
Rate for Payer: Humana Medicare Advantage	$21.26
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.16

Know your out-of-pocket cost for care.

All Charges