Madison Medical Center

All Charges

Charge

Type

Setting

Price

INFLUENZA HIGH-DOSE VACC 65+ PFS

Facility

$335.00

Service Code	HCPCS 90653
Hospital Charge Code	2626501
Hospital Revenue Code	250
Rate for Payer: Cash Price	$301.50

INFLUENZA HIGH-DOSE VACC 65+ PFS

Facility

$335.00

Service Code	HCPCS 90653
Hospital Charge Code	2626501
Hospital Revenue Code	250
Min. Negotiated Rate	$120.60
Max. Negotiated Rate	$239.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$198.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$239.19
Rate for Payer: Cash Price	$301.50
Rate for Payer: UnitedHealthcare Commercial	$223.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.60

INFLUENZA VACCINE

Facility

$65.00

Service Code	CPT 90658
Hospital Charge Code	4190658
Hospital Revenue Code	636
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$43.35
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35

INFLUENZA VACCINE

Facility

$65.00

Service Code	CPT 90658
Hospital Charge Code	4190658
Hospital Revenue Code	636
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

INFLUENZA VAC (FLUZONE) I-D PFS 3YRS+

Facility

$153.00

Service Code	HCPCS 90656
Hospital Charge Code	2697577
Hospital Revenue Code	250
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$109.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: UnitedHealthcare Commercial	$102.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

INFLUENZA VAC (FLUZONE) I-D PFS 3YRS+

Facility

$153.00

Service Code	HCPCS 90656
Hospital Charge Code	2697577
Hospital Revenue Code	250
Rate for Payer: Cash Price	$137.70

INFLU VACC FLUBLOK 18-64Y PFS 0.5ML

Facility

$313.00

Service Code	HCPCS 90658
Hospital Charge Code	2622967
Hospital Revenue Code	250
Min. Negotiated Rate	$112.68
Max. Negotiated Rate	$223.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$185.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$223.48
Rate for Payer: Cash Price	$281.70
Rate for Payer: UnitedHealthcare Commercial	$208.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$112.68

INFLU VACC FLUBLOK 18-64Y PFS 0.5ML

Facility

$313.00

Service Code	HCPCS 90658
Hospital Charge Code	2622967
Hospital Revenue Code	250
Rate for Payer: Cash Price	$281.70

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC

Facility

$27,508.54

Service Code	MSDRG 351
Min. Negotiated Rate	$13,754.27
Max. Negotiated Rate	$27,508.54
Rate for Payer: Aetna Medicare Advantage	$13,754.27
Rate for Payer: Cigna Commercial HMO & PPO	$13,754.27
Rate for Payer: Home State Health Plan Medicare Advantage	$13,754.27
Rate for Payer: Humana Commercial	$27,508.54
Rate for Payer: Humana Medicare Advantage	$13,754.27

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC

Facility

$42,750.64

Service Code	MSDRG 350
Min. Negotiated Rate	$21,375.32
Max. Negotiated Rate	$42,750.64
Rate for Payer: Aetna Medicare Advantage	$21,375.32
Rate for Payer: Cigna Commercial HMO & PPO	$21,375.32
Rate for Payer: Home State Health Plan Medicare Advantage	$21,375.32
Rate for Payer: Humana Commercial	$42,750.64
Rate for Payer: Humana Medicare Advantage	$21,375.32

INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC

Facility

$21,919.82

Service Code	MSDRG 352
Min. Negotiated Rate	$10,959.91
Max. Negotiated Rate	$21,919.82
Rate for Payer: Aetna Medicare Advantage	$10,959.91
Rate for Payer: Cigna Commercial HMO & PPO	$10,959.91
Rate for Payer: Home State Health Plan Medicare Advantage	$10,959.91
Rate for Payer: Humana Commercial	$21,919.82
Rate for Payer: Humana Medicare Advantage	$10,959.91

INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES

Facility

$17,383.73

Service Code	APR-DRG 2283
Min. Negotiated Rate	$17,383.73
Max. Negotiated Rate	$17,383.73
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,383.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,383.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,383.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,383.73

INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES

Facility

$7,878.75

Service Code	APR-DRG 2281
Min. Negotiated Rate	$7,878.75
Max. Negotiated Rate	$7,878.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,878.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,878.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,878.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,878.75

INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES

Facility

$30,741.18

Service Code	APR-DRG 2284
Min. Negotiated Rate	$30,741.18
Max. Negotiated Rate	$30,741.18
Rate for Payer: Aetna Better Health Medicaid/QHP	$30,741.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30,741.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$30,741.18
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$30,741.18

INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES

Facility

$11,926.30

Service Code	APR-DRG 2282
Min. Negotiated Rate	$11,926.30
Max. Negotiated Rate	$11,926.30
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,926.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,926.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,926.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,926.30

INGUINAL HERNIA REPAIR

Professional

Both

$1,927.00

Service Code	CPT 49520
Hospital Charge Code	4149520
Hospital Revenue Code	975
Min. Negotiated Rate	$481.14
Max. Negotiated Rate	$674.45
Rate for Payer: Aetna Commercial/Medicare Advantage	$578.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$481.14
Rate for Payer: Cash Price	$1,734.30
Rate for Payer: Cash Price	$1,734.30
Rate for Payer: Cigna Commercial HMO & PPO	$578.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$481.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$529.25
Rate for Payer: Home State Health Plan Medicare Advantage	$578.77
Rate for Payer: Optum Medicare Advantage	$674.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$481.14

INHIBIN A

Facility

$367.00

Service Code	CPT 86336
Hospital Charge Code	2283520
Hospital Revenue Code	305
Min. Negotiated Rate	$14.03
Max. Negotiated Rate	$262.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.03
Rate for Payer: Aetna Medicare Advantage	$15.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$217.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$262.04
Rate for Payer: Cash Price	$330.30
Rate for Payer: Cash Price	$330.30
Rate for Payer: Cash Price	$330.30
Rate for Payer: Cigna Commercial HMO & PPO	$15.59
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.01
Rate for Payer: Home State Health Plan Medicare Advantage	$15.59
Rate for Payer: Humana Commercial	$31.18
Rate for Payer: Humana Medicare Advantage	$15.59
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$132.12

INHIBIN A

Facility

$367.00

Service Code	CPT 86336
Hospital Charge Code	2283520
Hospital Revenue Code	305
Rate for Payer: Cash Price	$330.30

INHIBIN B

Facility

$367.00

Service Code	CPT 83520
Hospital Charge Code	2283599
Hospital Revenue Code	305
Rate for Payer: Cash Price	$330.30

INHIBIN B

Facility

$367.00

Service Code	CPT 83520
Hospital Charge Code	2283599
Hospital Revenue Code	305
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$262.04
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	$217.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$262.04
Rate for Payer: Cash Price	$330.30
Rate for Payer: Cash Price	$330.30
Rate for Payer: Cash Price	$330.30
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	$132.12

INITAIL ACAPELLA EDU/ASSESMT

Facility

$391.00

Service Code	CPT 94667
Hospital Charge Code	4594015
Hospital Revenue Code	460
Min. Negotiated Rate	$119.94
Max. Negotiated Rate	$279.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$231.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$279.17
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$119.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$260.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$140.76

INITAIL ACAPELLA EDU/ASSESMT

Facility

$391.00

Service Code	CPT 94667
Hospital Charge Code	4594015
Hospital Revenue Code	460
Rate for Payer: Cash Price	$351.90

INITIAL CONSULTATION

Facility

$368.00

Service Code	CPT 99244
Hospital Charge Code	5499244
Hospital Revenue Code	521
Rate for Payer: Cash Price	$331.20

INITIAL CONSULTATION

Facility

$368.00

Service Code	CPT 99244
Hospital Charge Code	5499244
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$262.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$217.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$262.75
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: UnitedHealthcare Commercial	$245.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INITIAL HOSP CARE-HIGH COMPLEX

Professional

Both

$500.00

Service Code	CPT 99223
Hospital Charge Code	5299223
Hospital Revenue Code	987
Min. Negotiated Rate	$151.92
Max. Negotiated Rate	$178.83
Rate for Payer: Aetna Commercial/Medicare Advantage	$151.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$162.57
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cigna Commercial HMO & PPO	$151.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$178.83
Rate for Payer: Home State Health Plan Medicare Advantage	$151.92
Rate for Payer: Optum Medicare Advantage	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$162.57

Know your out-of-pocket cost for care.

All Charges