Madison Medical Center

All Charges

Charge

Type

Setting

Price

INTRODUCTION CATHETER

Professional

Both

$547.00

Service Code	CPT 36010
Hospital Charge Code	4136010
Hospital Revenue Code	975
Min. Negotiated Rate	$93.41
Max. Negotiated Rate	$471.16
Rate for Payer: Aetna Commercial/Medicare Advantage	$93.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$428.33
Rate for Payer: Cash Price	$492.30
Rate for Payer: Cash Price	$492.30
Rate for Payer: Cigna Commercial HMO & PPO	$93.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$428.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$471.16
Rate for Payer: Home State Health Plan Medicare Advantage	$93.41
Rate for Payer: Optum Medicare Advantage	$191.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$428.33

INTRO OF NEEDLE OR CATH, VAIN

Professional

Both

$250.00

Service Code	CPT 36000
Hospital Charge Code	1836000
Hospital Revenue Code	981
Min. Negotiated Rate	$22.15
Max. Negotiated Rate	$87.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$22.15
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24.36
Rate for Payer: Optum Medicare Advantage	$87.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22.15

INTUBATION

Facility

$931.00

Service Code	CPT 31500
Hospital Charge Code	451805
Hospital Revenue Code	412
Rate for Payer: Cash Price	$837.90

INTUBATION

Facility

$931.00

Service Code	CPT 31500
Hospital Charge Code	451805
Hospital Revenue Code	412
Min. Negotiated Rate	$213.51
Max. Negotiated Rate	$664.73
Rate for Payer: Aetna Better Health Medicaid/QHP	$213.51
Rate for Payer: Aetna Medicare Advantage	$241.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$551.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$664.73
Rate for Payer: Cash Price	$837.90
Rate for Payer: Cash Price	$837.90
Rate for Payer: Cash Price	$837.90
Rate for Payer: Cigna Commercial HMO & PPO	$241.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$213.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$228.46
Rate for Payer: Home State Health Plan Medicare Advantage	$241.98
Rate for Payer: Humana Commercial	$483.96
Rate for Payer: Humana Medicare Advantage	$241.98
Rate for Payer: UnitedHealthcare Commercial	$620.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$213.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$335.16

INTUBATION, ENDOTRACHEAL, EMERGENCY

Facility

$303.00

Service Code	CPT 31500
Hospital Charge Code	4431500
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$483.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$213.51
Rate for Payer: Aetna Medicare Advantage	$241.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$179.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$216.34
Rate for Payer: Cash Price	$272.70
Rate for Payer: Cash Price	$272.70
Rate for Payer: Cash Price	$272.70
Rate for Payer: Cash Price	$272.70
Rate for Payer: Cigna Commercial HMO & PPO	$241.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$192.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$228.46
Rate for Payer: Home State Health Plan Medicare Advantage	$241.98
Rate for Payer: Humana Commercial	$483.96
Rate for Payer: Humana Medicare Advantage	$241.98
Rate for Payer: UnitedHealthcare Commercial	$202.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$213.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INTUBATION, ENDOTRACHEAL, EMERGENCY

Facility

$303.00

Service Code	CPT 31500
Hospital Charge Code	4431500
Hospital Revenue Code	521
Rate for Payer: Cash Price	$272.70

IODINE

Facility

$200.00

Service Code	CPT 83789
Hospital Charge Code	2283789
Hospital Revenue Code	301
Rate for Payer: Cash Price	$180.00

IODINE

Facility

$200.00

Service Code	CPT 83789
Hospital Charge Code	2283789
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$142.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.70
Rate for Payer: Aetna Medicare Advantage	$24.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$118.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.80
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cigna Commercial HMO & PPO	$24.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.22
Rate for Payer: Home State Health Plan Medicare Advantage	$24.11
Rate for Payer: Humana Commercial	$48.22
Rate for Payer: Humana Medicare Advantage	$24.11
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$72.00

IOHEXOL (OMNIPAQUE) 240MGI/ML INJ 10ML

Facility

$457.00

Service Code	NDC 407141210
Hospital Charge Code	2697060
Hospital Revenue Code	250
Min. Negotiated Rate	$164.52
Max. Negotiated Rate	$326.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$270.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$326.30
Rate for Payer: Cash Price	$411.30
Rate for Payer: UnitedHealthcare Commercial	$304.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$164.52

IOHEXOL (OMNIPAQUE) 240MGI/ML INJ 10ML

Facility

$457.00

Service Code	NDC 407141210
Hospital Charge Code	2697060
Hospital Revenue Code	250
Rate for Payer: Cash Price	$411.30

IOHEXOL (OMNIPAQUE) 240MGI/ML INJ 20ML

Facility

$457.00

Service Code	NDC 407141210
Hospital Charge Code	2620940
Hospital Revenue Code	250
Rate for Payer: Cash Price	$411.30

IOHEXOL (OMNIPAQUE) 240MGI/ML INJ 20ML

Facility

$457.00

Service Code	NDC 407141210
Hospital Charge Code	2620940
Hospital Revenue Code	250
Min. Negotiated Rate	$164.52
Max. Negotiated Rate	$326.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$270.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$326.30
Rate for Payer: Cash Price	$411.30
Rate for Payer: UnitedHealthcare Commercial	$304.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$164.52

IONTOPHORESIS EACH 15 MIN

Facility

$65.00

Service Code	CPT 97033
Hospital Charge Code	9897033
Hospital Revenue Code	521
Min. Negotiated Rate	$15.03
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.70
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: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.87
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

IONTOPHORESIS EACH 15 MIN

Facility

$65.00

Service Code	CPT 97033
Hospital Charge Code	9897033
Hospital Revenue Code	521
Rate for Payer: Cash Price	$58.50

IP ADMISSIONS LEVEL 3

Facility

$471.00

Service Code	CPT 99223
Hospital Charge Code	5499223
Rate for Payer: Cash Price	$423.90

IP CONSULT INTERMEDIATE

Facility

$240.00

Service Code	CPT 99252
Hospital Charge Code	4299252
Rate for Payer: Cash Price	$216.00

IP CRITICAL CARE FIRST HOUR

Facility

$700.00

Service Code	CPT 99291
Hospital Charge Code	9899291
Rate for Payer: Cash Price	$630.00

IP CRITICAL CARE SECOND HOUR

Facility

$355.00

Service Code	CPT 99292
Hospital Charge Code	9899292
Rate for Payer: Cash Price	$319.50

IP DISCHARGE < 30 MIN

Facility

$205.00

Service Code	CPT 99238
Hospital Charge Code	9899238
Rate for Payer: Cash Price	$184.50

IP DISCHARGE <30 MIN

Professional

Both

$205.00

Service Code	CPT 99238
Hospital Charge Code	9799238
Hospital Revenue Code	987
Min. Negotiated Rate	$58.97
Max. Negotiated Rate	$71.86
Rate for Payer: Aetna Commercial/Medicare Advantage	$71.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$58.97
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$71.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$64.87
Rate for Payer: Home State Health Plan Medicare Advantage	$71.86
Rate for Payer: Optum Medicare Advantage	$71.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$58.97

IP DISCHARGE > 30 MIN

Facility

$290.00

Service Code	CPT 99239
Hospital Charge Code	9899239
Rate for Payer: Cash Price	$261.00

IP DISCHARGE >30 MIN

Professional

Both

$290.00

Service Code	CPT 99239
Hospital Charge Code	9799239
Hospital Revenue Code	987
Min. Negotiated Rate	$86.23
Max. Negotiated Rate	$102.35
Rate for Payer: Aetna Commercial/Medicare Advantage	$102.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$86.23
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cigna Commercial HMO & PPO	$102.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$86.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$94.85
Rate for Payer: Home State Health Plan Medicare Advantage	$102.35
Rate for Payer: Optum Medicare Advantage	$101.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$86.23

IP DISCHARGE OVER 30 MIN

Facility

$285.00

Service Code	CPT 99239
Hospital Charge Code	4299239
Rate for Payer: Cash Price	$256.50

IP DISCHARGE UNDER 30 MIN

Facility

$202.00

Service Code	CPT 99238
Hospital Charge Code	4299238
Rate for Payer: Cash Price	$181.80

IP INITIAL ADMIT BRIEF

Facility

$270.00

Service Code	CPT 99221
Hospital Charge Code	9899221
Rate for Payer: Cash Price	$243.00

Know your out-of-pocket cost for care.

All Charges