Madison Medical Center

All Charges

Charge

Type

Setting

Price

AMYLASE ISOENZYMES

Facility

$185.00

Service Code	CPT 82150
Hospital Charge Code	2284990
Hospital Revenue Code	305
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$132.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.83
Rate for Payer: Aetna Medicare Advantage	$6.48
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: Cigna Commercial HMO & PPO	$6.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.24
Rate for Payer: Home State Health Plan Medicare Advantage	$6.48
Rate for Payer: Humana Commercial	$12.96
Rate for Payer: Humana Medicare Advantage	$6.48
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.60

AMYL/LIPA/PROT (CREON) 3000U CAP EMP

Facility

$5.00

Service Code	NDC 32004570
Hospital Charge Code	2626950
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$3.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3.57
Rate for Payer: Cash Price	$4.50
Rate for Payer: UnitedHealthcare Commercial	$3.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.80

AMYL/LIPA/PROT (CREON) 3000U CAP EMP

Facility

$5.00

Service Code	NDC 32004570
Hospital Charge Code	2626950
Hospital Revenue Code	250
Rate for Payer: Cash Price	$4.50

AMYL/LIPA/PROT (CREON DR) 36000U CAP EMP

Facility

$17.00

Service Code	NDC 32301613
Hospital Charge Code	2626994
Hospital Revenue Code	250
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$12.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.14
Rate for Payer: Cash Price	$15.30
Rate for Payer: UnitedHealthcare Commercial	$11.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.12

AMYL/LIPA/PROT (CREON DR) 36000U CAP EMP

Facility

$17.00

Service Code	NDC 32301613
Hospital Charge Code	2626994
Hospital Revenue Code	250
Rate for Payer: Cash Price	$15.30

ANA

Facility

$46.00

Service Code	CPT 86038
Hospital Charge Code	4286038
Hospital Revenue Code	521
Rate for Payer: Cash Price	$41.40

ANA

Facility

$46.00

Service Code	CPT 86038
Hospital Charge Code	4286038
Hospital Revenue Code	521
Min. Negotiated Rate	$9.79
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.88
Rate for Payer: Aetna Medicare Advantage	$12.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$27.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.84
Rate for Payer: Cash Price	$41.40
Rate for Payer: Cash Price	$41.40
Rate for Payer: Cash Price	$41.40
Rate for Payer: Cash Price	$41.40
Rate for Payer: Cigna Commercial HMO & PPO	$12.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.64
Rate for Payer: Home State Health Plan Medicare Advantage	$12.09
Rate for Payer: Humana Commercial	$24.18
Rate for Payer: Humana Medicare Advantage	$12.09
Rate for Payer: UnitedHealthcare Commercial	$30.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ANA BY IFA RFX TO 11 MULTIPLEX

Facility

$55.00

Service Code	CPT 86038
Hospital Charge Code	2286050
Hospital Revenue Code	302
Min. Negotiated Rate	$10.88
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.88
Rate for Payer: Aetna Medicare Advantage	$12.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$12.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.64
Rate for Payer: Home State Health Plan Medicare Advantage	$12.09
Rate for Payer: Humana Commercial	$24.18
Rate for Payer: Humana Medicare Advantage	$12.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

ANA BY IFA RFX TO 11 MULTIPLEX

Facility

$55.00

Service Code	CPT 86038
Hospital Charge Code	2286050
Hospital Revenue Code	302
Rate for Payer: Cash Price	$49.50

ANAESTHESIA VENTILATOR

Facility

$89.00

Hospital Charge Code	2024466
Hospital Revenue Code	370
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$63.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.55
Rate for Payer: Cash Price	$80.10
Rate for Payer: UnitedHealthcare Commercial	$59.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

ANAESTHESIA VENTILATOR

Facility

$89.00

Hospital Charge Code	2024466
Hospital Revenue Code	370
Rate for Payer: Cash Price	$80.10

ANAL AND PERINEAL PROCEDURES

Facility

$7,171.49

Service Code	APR-DRG 2262
Min. Negotiated Rate	$7,171.49
Max. Negotiated Rate	$7,171.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,171.49
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,171.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,171.49
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,171.49

ANAL AND PERINEAL PROCEDURES

Facility

$16,155.05

Service Code	APR-DRG 2263
Min. Negotiated Rate	$16,155.05
Max. Negotiated Rate	$16,155.05
Rate for Payer: Aetna Better Health Medicaid/QHP	$16,155.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16,155.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16,155.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16,155.05

ANAL AND PERINEAL PROCEDURES

Facility

$7,171.49

Service Code	APR-DRG 2261
Min. Negotiated Rate	$7,171.49
Max. Negotiated Rate	$7,171.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,171.49
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,171.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,171.49
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,171.49

ANAL AND PERINEAL PROCEDURES

Facility

$30,030.23

Service Code	APR-DRG 2264
Min. Negotiated Rate	$30,030.23
Max. Negotiated Rate	$30,030.23
Rate for Payer: Aetna Better Health Medicaid/QHP	$30,030.23
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30,030.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$30,030.23
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$30,030.23

ANAL AND STOMAL PROCEDURES WITH CC

Facility

$24,126.40

Service Code	MSDRG 348
Min. Negotiated Rate	$12,063.20
Max. Negotiated Rate	$24,126.40
Rate for Payer: Aetna Medicare Advantage	$12,063.20
Rate for Payer: Cigna Commercial HMO & PPO	$12,063.20
Rate for Payer: Home State Health Plan Medicare Advantage	$12,063.20
Rate for Payer: Humana Commercial	$24,126.40
Rate for Payer: Humana Medicare Advantage	$12,063.20

ANAL AND STOMAL PROCEDURES WITH MCC

Facility

$39,656.22

Service Code	MSDRG 347
Min. Negotiated Rate	$19,828.11
Max. Negotiated Rate	$39,656.22
Rate for Payer: Aetna Medicare Advantage	$19,828.11
Rate for Payer: Cigna Commercial HMO & PPO	$19,828.11
Rate for Payer: Home State Health Plan Medicare Advantage	$19,828.11
Rate for Payer: Humana Commercial	$39,656.22
Rate for Payer: Humana Medicare Advantage	$19,828.11

ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC

Facility

$17,268.84

Service Code	MSDRG 349
Min. Negotiated Rate	$8,634.42
Max. Negotiated Rate	$17,268.84
Rate for Payer: Aetna Medicare Advantage	$8,634.42
Rate for Payer: Cigna Commercial HMO & PPO	$8,634.42
Rate for Payer: Home State Health Plan Medicare Advantage	$8,634.42
Rate for Payer: Humana Commercial	$17,268.84
Rate for Payer: Humana Medicare Advantage	$8,634.42

Anaplasma phagocytophilum IgG

Facility

$156.00

Service Code	CPT 86666
Hospital Charge Code	2286600
Hospital Revenue Code	302
Rate for Payer: Cash Price	$140.40

Anaplasma phagocytophilum IgG

Facility

$156.00

Service Code	CPT 86666
Hospital Charge Code	2286600
Hospital Revenue Code	302
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$111.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.16
Rate for Payer: Aetna Medicare Advantage	$10.18
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	$10.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.80
Rate for Payer: Home State Health Plan Medicare Advantage	$10.18
Rate for Payer: Humana Commercial	$20.36
Rate for Payer: Humana Medicare Advantage	$10.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.16

..ANA SCREEN AEL

Facility

$55.00

Service Code	CPT 86038
Hospital Charge Code	2286037
Hospital Revenue Code	302
Rate for Payer: Cash Price	$49.50

..ANA SCREEN AEL

Facility

$55.00

Service Code	CPT 86038
Hospital Charge Code	2286037
Hospital Revenue Code	302
Min. Negotiated Rate	$10.88
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.88
Rate for Payer: Aetna Medicare Advantage	$12.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$12.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.64
Rate for Payer: Home State Health Plan Medicare Advantage	$12.09
Rate for Payer: Humana Commercial	$24.18
Rate for Payer: Humana Medicare Advantage	$12.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

ANA SCREEN, DIRECT

Facility

$55.00

Service Code	CPT 86038
Hospital Charge Code	221233
Hospital Revenue Code	302
Min. Negotiated Rate	$10.88
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.88
Rate for Payer: Aetna Medicare Advantage	$12.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$12.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.64
Rate for Payer: Home State Health Plan Medicare Advantage	$12.09
Rate for Payer: Humana Commercial	$24.18
Rate for Payer: Humana Medicare Advantage	$12.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

ANA SCREEN, DIRECT

Facility

$55.00

Service Code	CPT 86038
Hospital Charge Code	221233
Hospital Revenue Code	302
Rate for Payer: Cash Price	$49.50

ANA SCREEN, IFA PATTERN IF POS

Facility

$55.00

Service Code	CPT 86038
Hospital Charge Code	2286038
Hospital Revenue Code	302
Min. Negotiated Rate	$10.88
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.88
Rate for Payer: Aetna Medicare Advantage	$12.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$12.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.64
Rate for Payer: Home State Health Plan Medicare Advantage	$12.09
Rate for Payer: Humana Commercial	$24.18
Rate for Payer: Humana Medicare Advantage	$12.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

Know your out-of-pocket cost for care.

All Charges