Madison Medical Center

All Charges

Charge

Type

Setting

Price

INSERTION OF OSSEOUS NEEDLE

Professional

Both

$752.00

Service Code	CPT 36680
Hospital Charge Code	1836680
Hospital Revenue Code	981
Min. Negotiated Rate	$56.06
Max. Negotiated Rate	$263.20
Rate for Payer: Aetna Commercial/Medicare Advantage	$56.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$56.12
Rate for Payer: Cash Price	$676.80
Rate for Payer: Cash Price	$676.80
Rate for Payer: Cigna Commercial HMO & PPO	$56.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$56.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$61.73
Rate for Payer: Home State Health Plan Medicare Advantage	$56.06
Rate for Payer: Optum Medicare Advantage	$263.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$56.12

INSERTION OF SUPRAPUBIC CATHETER

Professional

Both

$610.00

Service Code	CPT 51102
Hospital Charge Code	1851010
Hospital Revenue Code	981
Min. Negotiated Rate	$121.90
Max. Negotiated Rate	$238.67
Rate for Payer: Aetna Commercial/Medicare Advantage	$121.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$216.97
Rate for Payer: Cash Price	$549.00
Rate for Payer: Cash Price	$549.00
Rate for Payer: Cigna Commercial HMO & PPO	$121.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$216.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$238.67
Rate for Payer: Home State Health Plan Medicare Advantage	$121.90
Rate for Payer: Optum Medicare Advantage	$213.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$216.97

INSERTION PACEMAKER

Professional

Both

$2,368.00

Service Code	CPT 33207
Hospital Charge Code	4133207
Hospital Revenue Code	975
Min. Negotiated Rate	$405.66
Max. Negotiated Rate	$828.80
Rate for Payer: Aetna Commercial/Medicare Advantage	$405.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$465.39
Rate for Payer: Cash Price	$2,131.20
Rate for Payer: Cash Price	$2,131.20
Rate for Payer: Cigna Commercial HMO & PPO	$405.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$465.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$511.93
Rate for Payer: Home State Health Plan Medicare Advantage	$405.66
Rate for Payer: Optum Medicare Advantage	$828.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$465.39

INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES

Facility

$17,501.14

Service Code	APR-DRG 1761
Min. Negotiated Rate	$17,501.14
Max. Negotiated Rate	$17,501.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,501.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,501.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,501.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,501.14

INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES

Facility

$41,248.34

Service Code	APR-DRG 1764
Min. Negotiated Rate	$41,248.34
Max. Negotiated Rate	$41,248.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$41,248.34
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$41,248.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$41,248.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$41,248.34

INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES

Facility

$23,910.83

Service Code	APR-DRG 1762
Min. Negotiated Rate	$23,910.83
Max. Negotiated Rate	$23,910.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,910.83
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,910.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,910.83
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,910.83

INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES

Facility

$34,381.01

Service Code	APR-DRG 1763
Min. Negotiated Rate	$34,381.01
Max. Negotiated Rate	$34,381.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$34,381.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$34,381.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$34,381.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$34,381.01

INSERT/REPLACE P'MAKER SINGLE CHAMBER

Professional

Both

$1,284.00

Service Code	CPT 33212
Hospital Charge Code	4133212
Hospital Revenue Code	975
Min. Negotiated Rate	$242.67
Max. Negotiated Rate	$449.40
Rate for Payer: Aetna Commercial/Medicare Advantage	$278.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$242.67
Rate for Payer: Cash Price	$1,155.60
Rate for Payer: Cash Price	$1,155.60
Rate for Payer: Cigna Commercial HMO & PPO	$278.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$242.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$266.94
Rate for Payer: Home State Health Plan Medicare Advantage	$278.76
Rate for Payer: Optum Medicare Advantage	$449.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$242.67

INSERTS-DOU RECTANG(DISP)

Facility

$15.00

Hospital Charge Code	289176
Hospital Revenue Code	271
Rate for Payer: Cash Price	$13.50

INSERTS-DOU RECTANG(DISP)

Facility

$15.00

Hospital Charge Code	289176
Hospital Revenue Code	271
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

INS OF NON INDWELLING BLADDER CATH

Facility

$230.00

Service Code	CPT 51798
Hospital Charge Code	9351701
Hospital Revenue Code	521
Rate for Payer: Cash Price	$207.00

INS OF NON INDWELLING BLADDER CATH

Facility

$230.00

Service Code	CPT 51798
Hospital Charge Code	9351701
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$136.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$164.22
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$153.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INS REG INJ 1 UNIT

Facility

$19.00

Service Code	HCPCS J1815
Hospital Charge Code	2697632
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

INS REG INJ 1 UNIT

Facility

$19.00

Service Code	HCPCS J1815
Hospital Charge Code	2697632
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$13.57
Rate for Payer: Cash Price	$17.10
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.84

INS REGULAR 10ML VIAL EMP

Facility

$245.00

Service Code	HCPCS J1815
Hospital Charge Code	2621935
Hospital Revenue Code	250
Rate for Payer: Cash Price	$220.50

INS REGULAR 10ML VIAL EMP

Facility

$245.00

Service Code	HCPCS J1815
Hospital Charge Code	2621935
Hospital Revenue Code	250
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$174.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$145.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.93
Rate for Payer: Cash Price	$220.50
Rate for Payer: UnitedHealthcare Commercial	$163.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$88.20

INSTRUMENT TRAY

Facility

$110.00

Hospital Charge Code	129108
Hospital Revenue Code	360
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$73.37
Rate for Payer: Cash Price	$99.00
Rate for Payer: UnitedHealthcare Commercial	$73.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

INSTRUMENT TRAY

Facility

$110.00

Hospital Charge Code	129108
Hospital Revenue Code	360
Rate for Payer: Cash Price	$99.00

INSUFFLATOR/CO2

Facility

$599.00

Hospital Charge Code	127803
Hospital Revenue Code	271
Min. Negotiated Rate	$215.64
Max. Negotiated Rate	$427.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$354.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$427.69
Rate for Payer: Cash Price	$539.10
Rate for Payer: UnitedHealthcare Commercial	$399.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$215.64

INSUFFLATOR/CO2

Facility

$599.00

Hospital Charge Code	127803
Hospital Revenue Code	271
Rate for Payer: Cash Price	$539.10

INSULATED BLADE #ES27521

Facility

$48.00

Service Code	CPT Y7506
Hospital Charge Code	127285
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

INSULATED BLADE #ES27521

Facility

$48.00

Service Code	CPT Y7506
Hospital Charge Code	127285
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

INSULIN

Facility

$93.00

Service Code	CPT 83525
Hospital Charge Code	229400
Hospital Revenue Code	301
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$66.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.29
Rate for Payer: Aetna Medicare Advantage	$11.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cigna Commercial HMO & PPO	$11.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.01
Rate for Payer: Home State Health Plan Medicare Advantage	$11.43
Rate for Payer: Humana Commercial	$22.86
Rate for Payer: Humana Medicare Advantage	$11.43
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

INSULIN

Facility

$93.00

Service Code	CPT 83525
Hospital Charge Code	229400
Hospital Revenue Code	301
Rate for Payer: Cash Price	$83.70

INSULIN 70/30 10ML VIAL (HUMULIN)

Facility

$822.00

Service Code	HCPCS J1815
Hospital Charge Code	2626402
Hospital Revenue Code	250
Min. Negotiated Rate	$295.92
Max. Negotiated Rate	$586.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$486.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$586.91
Rate for Payer: Cash Price	$739.80
Rate for Payer: UnitedHealthcare Commercial	$548.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$295.92

Know your out-of-pocket cost for care.

All Charges