Madison Medical Center

All Charges

Charge

Type

Setting

Price

ANKLE XRAY RT

Facility

$486.00

Service Code	CPT 73610
Hospital Charge Code	321137
Hospital Revenue Code	320
Rate for Payer: Cash Price	$437.40

ANORECTAL EXAM,SURG,UNDER ANESTH

Professional

Both

$420.00

Service Code	CPT 45990
Hospital Charge Code	5445990
Hospital Revenue Code	975
Min. Negotiated Rate	$78.95
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$95.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$78.95
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cigna Commercial HMO & PPO	$95.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$86.84
Rate for Payer: Home State Health Plan Medicare Advantage	$95.22
Rate for Payer: Optum Medicare Advantage	$147.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.95

ANORO ELLIPTA 62.5/25MCG INH 30 DOSE EMP

Facility

$367.00

Service Code	NDC 173086910
Hospital Charge Code	2623384
Hospital Revenue Code	250
Min. Negotiated Rate	$132.12
Max. Negotiated Rate	$262.04
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: UnitedHealthcare Commercial	$244.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$132.12

ANORO ELLIPTA 62.5/25MCG INH 30 DOSE EMP

Facility

$367.00

Service Code	NDC 173086910
Hospital Charge Code	2623384
Hospital Revenue Code	250
Rate for Payer: Cash Price	$330.30

ANOSCOPY

Facility

$78.00

Service Code	CPT 46600
Hospital Charge Code	4246600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$70.20

ANOSCOPY

Facility

$78.00

Service Code	CPT 46600
Hospital Charge Code	4446600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$70.20

ANOSCOPY

Facility

$78.00

Service Code	CPT 46600
Hospital Charge Code	4446600
Hospital Revenue Code	521
Min. Negotiated Rate	$46.18
Max. Negotiated Rate	$271.86
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	$46.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$55.69
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.95
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	$52.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ANOSCOPY

Professional

Both

$78.00

Service Code	CPT 46600
Hospital Charge Code	4146600
Hospital Revenue Code	975
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$102.14
Rate for Payer: Aetna Commercial/Medicare Advantage	$37.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$92.85
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna Commercial HMO & PPO	$37.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$92.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$102.14
Rate for Payer: Home State Health Plan Medicare Advantage	$37.63
Rate for Payer: Optum Medicare Advantage	$27.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$92.85

ANOSCOPY

Facility

$78.00

Service Code	CPT 46600
Hospital Charge Code	4246600
Hospital Revenue Code	521
Min. Negotiated Rate	$46.18
Max. Negotiated Rate	$271.86
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	$46.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$55.69
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.95
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	$52.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ANOSCOPY/DIAGNOSTIC

Professional

Both

$394.00

Service Code	CPT 46600
Hospital Charge Code	1846600
Hospital Revenue Code	981
Min. Negotiated Rate	$37.63
Max. Negotiated Rate	$137.90
Rate for Payer: Aetna Commercial/Medicare Advantage	$37.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$92.85
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cigna Commercial HMO & PPO	$37.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$92.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$102.14
Rate for Payer: Home State Health Plan Medicare Advantage	$37.63
Rate for Payer: Optum Medicare Advantage	$137.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$92.85

ANOSCOPY WITH DILATION, ANY METHOD

Professional

Both

$152.00

Service Code	CPT 46604
Hospital Charge Code	4146604
Hospital Revenue Code	975
Min. Negotiated Rate	$53.20
Max. Negotiated Rate	$583.73
Rate for Payer: Aetna Commercial/Medicare Advantage	$59.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$530.66
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cigna Commercial HMO & PPO	$59.12
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$530.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$583.73
Rate for Payer: Home State Health Plan Medicare Advantage	$59.12
Rate for Payer: Optum Medicare Advantage	$53.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$530.66

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$26,554.96

Service Code	APR-DRG 0594
Min. Negotiated Rate	$26,554.96
Max. Negotiated Rate	$26,554.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$26,554.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26,554.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26,554.96
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26,554.96

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$19,566.52

Service Code	APR-DRG 0593
Min. Negotiated Rate	$19,566.52
Max. Negotiated Rate	$19,566.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,566.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,566.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,566.52
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,566.52

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$5,846.66

Service Code	APR-DRG 0591
Min. Negotiated Rate	$5,846.66
Max. Negotiated Rate	$5,846.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,846.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,846.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,846.66
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,846.66

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$10,153.99

Service Code	APR-DRG 0592
Min. Negotiated Rate	$10,153.99
Max. Negotiated Rate	$10,153.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,153.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,153.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,153.99
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,153.99

ANSTH SPEC PR 1/2 HR

Facility

$437.00

Hospital Charge Code	201004
Hospital Revenue Code	370
Rate for Payer: Cash Price	$393.30

ANSTH SPEC PR 1/2 HR

Facility

$437.00

Hospital Charge Code	201004
Hospital Revenue Code	370
Min. Negotiated Rate	$157.32
Max. Negotiated Rate	$312.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$258.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$312.02
Rate for Payer: Cash Price	$393.30
Rate for Payer: UnitedHealthcare Commercial	$291.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$157.32

ANTEPARTUM CARE 4-6 VISITS

Facility

$313.00

Service Code	CPT 59425
Hospital Charge Code	4259425
Rate for Payer: Cash Price	$281.70

ANTEPARTUM CARE 7+ VISITS

Facility

$932.00

Service Code	CPT 59426
Hospital Charge Code	4259426
Rate for Payer: Cash Price	$838.80

ANTEPARTUM CARE ONLY 7+VISITS

Facility

$608.00

Service Code	CPT 59426
Hospital Charge Code	5259426
Hospital Revenue Code	521
Rate for Payer: Cash Price	$547.20

ANTEPARTUM CARE ONLY 7+VISITS

Facility

$608.00

Service Code	CPT 59426
Hospital Charge Code	5259426
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$434.11
Rate for Payer: Cash Price	$547.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$359.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$434.11
Rate for Payer: Cash Price	$547.20
Rate for Payer: UnitedHealthcare Commercial	$405.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$6,080.87

Service Code	APR-DRG 5471
Min. Negotiated Rate	$6,080.87
Max. Negotiated Rate	$6,080.87
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,080.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,080.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,080.87
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,080.87

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$39,176.33

Service Code	APR-DRG 5474
Min. Negotiated Rate	$39,176.33
Max. Negotiated Rate	$39,176.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$39,176.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$39,176.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$39,176.33
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$39,176.33

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$19,643.35

Service Code	APR-DRG 5473
Min. Negotiated Rate	$19,643.35
Max. Negotiated Rate	$19,643.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,643.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,643.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,643.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,643.35

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$7,779.85

Service Code	APR-DRG 5472
Min. Negotiated Rate	$7,779.85
Max. Negotiated Rate	$7,779.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,779.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,779.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,779.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,779.85

Know your out-of-pocket cost for care.

All Charges