Madison Medical Center

All Charges

Charge

Type

Setting

Price

NM RENAL WITH FLOW

Facility

$1,385.00

Service Code	CPT 78701
Hospital Charge Code	3478701
Hospital Revenue Code	341
Min. Negotiated Rate	$360.38
Max. Negotiated Rate	$988.89
Rate for Payer: Aetna Better Health Medicaid/QHP	$360.38
Rate for Payer: Aetna Medicare Advantage	$408.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$819.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$988.89
Rate for Payer: Cash Price	$1,246.50
Rate for Payer: Cash Price	$1,246.50
Rate for Payer: Cash Price	$1,246.50
Rate for Payer: Cigna Commercial HMO & PPO	$408.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$360.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$385.61
Rate for Payer: Home State Health Plan Medicare Advantage	$408.43
Rate for Payer: Humana Commercial	$816.86
Rate for Payer: Humana Medicare Advantage	$408.43
Rate for Payer: UnitedHealthcare Commercial	$923.79
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$360.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$498.60

NM RENAL WITH FLOW

Facility

$1,385.00

Service Code	CPT 78701
Hospital Charge Code	3478701
Hospital Revenue Code	341
Rate for Payer: Cash Price	$1,246.50

NM SINGLE-MYOCARDIAL PERFUSION SPECT

Facility

$1,046.00

Service Code	CPT 78466
Hospital Charge Code	3478464
Hospital Revenue Code	341
Rate for Payer: Cash Price	$941.40

NM SINGLE-MYOCARDIAL PERFUSION SPECT

Facility

$1,046.00

Service Code	CPT 78466
Hospital Charge Code	3478464
Hospital Revenue Code	341
Min. Negotiated Rate	$360.38
Max. Negotiated Rate	$816.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$360.38
Rate for Payer: Aetna Medicare Advantage	$408.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$619.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$746.84
Rate for Payer: Cash Price	$941.40
Rate for Payer: Cash Price	$941.40
Rate for Payer: Cash Price	$941.40
Rate for Payer: Cigna Commercial HMO & PPO	$408.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$360.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$385.61
Rate for Payer: Home State Health Plan Medicare Advantage	$408.43
Rate for Payer: Humana Commercial	$816.86
Rate for Payer: Humana Medicare Advantage	$408.43
Rate for Payer: UnitedHealthcare Commercial	$697.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$360.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$376.56

NM STRESS THALLIUM (ISO KIT)

Facility

$468.00

Service Code	CPT A4641
Hospital Charge Code	3400019
Hospital Revenue Code	341
Rate for Payer: Cash Price	$421.20

NM STRESS THALLIUM (ISO KIT)

Facility

$468.00

Service Code	CPT A4641
Hospital Charge Code	3400019
Hospital Revenue Code	341
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$334.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$277.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$334.15
Rate for Payer: Cash Price	$421.20
Rate for Payer: UnitedHealthcare Commercial	$312.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$168.48

NM SULFUR COLLOID

Facility

$234.00

Service Code	CPT A9541
Hospital Charge Code	3400213
Hospital Revenue Code	342
Min. Negotiated Rate	$84.24
Max. Negotiated Rate	$167.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$138.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.08
Rate for Payer: Cash Price	$210.60
Rate for Payer: UnitedHealthcare Commercial	$156.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.24

NM SULFUR COLLOID

Facility

$234.00

Service Code	CPT A9541
Hospital Charge Code	3400213
Hospital Revenue Code	342
Rate for Payer: Cash Price	$210.60

NM THYROID SCAN

Facility

$1,466.00

Service Code	CPT 78013
Hospital Charge Code	3478010
Hospital Revenue Code	341
Rate for Payer: Cash Price	$1,319.40

NM THYROID SCAN

Facility

$1,466.00

Service Code	CPT 78013
Hospital Charge Code	3478010
Hospital Revenue Code	341
Min. Negotiated Rate	$360.38
Max. Negotiated Rate	$1,046.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$360.38
Rate for Payer: Aetna Medicare Advantage	$408.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$867.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,046.72
Rate for Payer: Cash Price	$1,319.40
Rate for Payer: Cash Price	$1,319.40
Rate for Payer: Cash Price	$1,319.40
Rate for Payer: Cigna Commercial HMO & PPO	$408.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$360.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$385.61
Rate for Payer: Home State Health Plan Medicare Advantage	$408.43
Rate for Payer: Humana Commercial	$816.86
Rate for Payer: Humana Medicare Advantage	$408.43
Rate for Payer: UnitedHealthcare Commercial	$977.82
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$360.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$527.76

NM THYROID SCAN ISOTOPE KIT

Facility

$184.00

Service Code	CPT A4641
Hospital Charge Code	3400222
Hospital Revenue Code	342
Min. Negotiated Rate	$66.24
Max. Negotiated Rate	$131.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$108.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$131.38
Rate for Payer: Cash Price	$165.60
Rate for Payer: UnitedHealthcare Commercial	$122.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.24

NM THYROID SCAN ISOTOPE KIT

Facility

$184.00

Service Code	CPT A4641
Hospital Charge Code	3400222
Hospital Revenue Code	342
Rate for Payer: Cash Price	$165.60

NM THYROID UPTAKE SINGLE OR MULTIPLE

Facility

$1,543.00

Service Code	CPT 78012
Hospital Charge Code	3478012
Hospital Revenue Code	341
Min. Negotiated Rate	$360.38
Max. Negotiated Rate	$1,101.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$360.38
Rate for Payer: Aetna Medicare Advantage	$408.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$913.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,101.70
Rate for Payer: Cash Price	$1,388.70
Rate for Payer: Cash Price	$1,388.70
Rate for Payer: Cash Price	$1,388.70
Rate for Payer: Cigna Commercial HMO & PPO	$408.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$360.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$385.61
Rate for Payer: Home State Health Plan Medicare Advantage	$408.43
Rate for Payer: Humana Commercial	$816.86
Rate for Payer: Humana Medicare Advantage	$408.43
Rate for Payer: UnitedHealthcare Commercial	$1,029.18
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$360.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$555.48

NM THYROID UPTAKE SINGLE OR MULTIPLE

Facility

$1,543.00

Service Code	CPT 78012
Hospital Charge Code	3478012
Hospital Revenue Code	341
Rate for Payer: Cash Price	$1,388.70

NM ULTRA TAG RED BLOOD CELL KIT

Facility

$294.00

Hospital Charge Code	3400022
Hospital Revenue Code	342
Min. Negotiated Rate	$105.84
Max. Negotiated Rate	$209.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$174.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$209.92
Rate for Payer: Cash Price	$264.60
Rate for Payer: UnitedHealthcare Commercial	$196.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$105.84

NM ULTRA TAG RED BLOOD CELL KIT

Facility

$294.00

Hospital Charge Code	3400022
Hospital Revenue Code	342
Rate for Payer: Cash Price	$264.60

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

$39,645.20

Service Code	MSDRG 098
Min. Negotiated Rate	$19,822.60
Max. Negotiated Rate	$39,645.20
Rate for Payer: Aetna Medicare Advantage	$19,822.60
Rate for Payer: Cigna Commercial HMO & PPO	$19,822.60
Rate for Payer: Home State Health Plan Medicare Advantage	$19,822.60
Rate for Payer: Humana Commercial	$39,645.20
Rate for Payer: Humana Medicare Advantage	$19,822.60

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$60,478.44

Service Code	MSDRG 097
Min. Negotiated Rate	$30,239.22
Max. Negotiated Rate	$60,478.44
Rate for Payer: Aetna Medicare Advantage	$30,239.22
Rate for Payer: Cigna Commercial HMO & PPO	$30,239.22
Rate for Payer: Home State Health Plan Medicare Advantage	$30,239.22
Rate for Payer: Humana Commercial	$60,478.44
Rate for Payer: Humana Medicare Advantage	$30,239.22

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$24,965.68

Service Code	MSDRG 099
Min. Negotiated Rate	$12,482.84
Max. Negotiated Rate	$24,965.68
Rate for Payer: Aetna Medicare Advantage	$12,482.84
Rate for Payer: Cigna Commercial HMO & PPO	$12,482.84
Rate for Payer: Home State Health Plan Medicare Advantage	$12,482.84
Rate for Payer: Humana Commercial	$24,965.68
Rate for Payer: Humana Medicare Advantage	$12,482.84

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$18,595.53

Service Code	APR-DRG 0502
Min. Negotiated Rate	$18,595.53
Max. Negotiated Rate	$18,595.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$18,595.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18,595.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18,595.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18,595.53

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$28,893.69

Service Code	APR-DRG 0503
Min. Negotiated Rate	$28,893.69
Max. Negotiated Rate	$28,893.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$28,893.69
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28,893.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28,893.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28,893.69

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$10,896.45

Service Code	APR-DRG 0501
Min. Negotiated Rate	$10,896.45
Max. Negotiated Rate	$10,896.45
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,896.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,896.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,896.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,896.45

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$64,960.84

Service Code	APR-DRG 0504
Min. Negotiated Rate	$64,960.84
Max. Negotiated Rate	$64,960.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$64,960.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64,960.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$64,960.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64,960.84

NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$45,764.62

Service Code	APR-DRG 3234
Min. Negotiated Rate	$45,764.62
Max. Negotiated Rate	$45,764.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$45,764.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$45,764.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$45,764.62
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$45,764.62

NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$19,349.26

Service Code	APR-DRG 3232
Min. Negotiated Rate	$19,349.26
Max. Negotiated Rate	$19,349.26
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,349.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,349.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,349.26
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,349.26

Know your out-of-pocket cost for care.

All Charges