Madison Medical Center

All Charges

Charge

Type

Setting

Price

ANTIMULLERIAN

Facility

$382.00

Service Code	CPT 82397
Hospital Charge Code	2203520
Hospital Revenue Code	301
Rate for Payer: Cash Price	$343.80

ANTIPARIENTAL CELL ANTIBODY

Facility

$187.00

Service Code	CPT 83516
Hospital Charge Code	2286253
Hospital Revenue Code	301
Rate for Payer: Cash Price	$168.30

ANTIPARIENTAL CELL ANTIBODY

Facility

$187.00

Service Code	CPT 83516
Hospital Charge Code	2286253
Hospital Revenue Code	301
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$133.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$110.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$133.52
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cigna Commercial HMO & PPO	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.32

ANTIPHOSPHOLIPID SYNDROME PROF

Facility

$258.00

Hospital Charge Code	2225055
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$184.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$152.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$184.21
Rate for Payer: Cash Price	$232.20
Rate for Payer: Cash Price	$232.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$92.88

ANTIPHOSPHOLIPID SYNDROME PROF

Facility

$258.00

Hospital Charge Code	2225055
Hospital Revenue Code	302
Rate for Payer: Cash Price	$232.20

ANTISKIN AUTOANTIBODIES

Facility

$152.00

Service Code	CPT 86255
Hospital Charge Code	2282545
Hospital Revenue Code	305
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$108.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.85
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$108.53
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cigna Commercial HMO & PPO	$12.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.61
Rate for Payer: Home State Health Plan Medicare Advantage	$12.05
Rate for Payer: Humana Commercial	$24.10
Rate for Payer: Humana Medicare Advantage	$12.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.72

ANTISKIN AUTOANTIBODIES

Facility

$152.00

Service Code	CPT 86255
Hospital Charge Code	2282545
Hospital Revenue Code	305
Rate for Payer: Cash Price	$136.80

ANTITHROMBIN III ACTIVITY

Facility

$196.00

Service Code	CPT 85300
Hospital Charge Code	2285300
Hospital Revenue Code	305
Min. Negotiated Rate	$10.67
Max. Negotiated Rate	$139.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.67
Rate for Payer: Aetna Medicare Advantage	$11.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$116.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$139.94
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cigna Commercial HMO & PPO	$11.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.42
Rate for Payer: Home State Health Plan Medicare Advantage	$11.85
Rate for Payer: Humana Commercial	$23.70
Rate for Payer: Humana Medicare Advantage	$11.85
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.56

ANTITHROMBIN III ACTIVITY

Facility

$196.00

Service Code	CPT 85300
Hospital Charge Code	2285300
Hospital Revenue Code	305
Rate for Payer: Cash Price	$176.40

ANTITHROM III ANTIGEN

Facility

$210.00

Service Code	CPT 85301
Hospital Charge Code	2285301
Hospital Revenue Code	305
Min. Negotiated Rate	$9.73
Max. Negotiated Rate	$149.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.73
Rate for Payer: Aetna Medicare Advantage	$10.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$124.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.94
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cigna Commercial HMO & PPO	$10.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10.41
Rate for Payer: Home State Health Plan Medicare Advantage	$10.81
Rate for Payer: Humana Commercial	$21.62
Rate for Payer: Humana Medicare Advantage	$10.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$75.60

ANTITHROM III ANTIGEN

Facility

$210.00

Service Code	CPT 85301
Hospital Charge Code	2285301
Hospital Revenue Code	305
Rate for Payer: Cash Price	$189.00

ANZEMET 12.5 MG DOLASETRON

Facility

$210.00

Hospital Charge Code	2024479
Hospital Revenue Code	250
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$149.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$124.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.94
Rate for Payer: Cash Price	$189.00
Rate for Payer: UnitedHealthcare Commercial	$140.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$75.60

ANZEMET 12.5 MG DOLASETRON

Facility

$210.00

Hospital Charge Code	2024479
Hospital Revenue Code	250
Rate for Payer: Cash Price	$189.00

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC

Facility

$112,318.76

Service Code	MSDRG 268
Min. Negotiated Rate	$56,159.38
Max. Negotiated Rate	$112,318.76
Rate for Payer: Aetna Medicare Advantage	$56,159.38
Rate for Payer: Cigna Commercial HMO & PPO	$56,159.38
Rate for Payer: Home State Health Plan Medicare Advantage	$56,159.38
Rate for Payer: Humana Commercial	$112,318.76
Rate for Payer: Humana Medicare Advantage	$56,159.38

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC

Facility

$70,176.30

Service Code	MSDRG 269
Min. Negotiated Rate	$35,088.15
Max. Negotiated Rate	$70,176.30
Rate for Payer: Aetna Medicare Advantage	$35,088.15
Rate for Payer: Cigna Commercial HMO & PPO	$35,088.15
Rate for Payer: Home State Health Plan Medicare Advantage	$35,088.15
Rate for Payer: Humana Commercial	$70,176.30
Rate for Payer: Humana Medicare Advantage	$35,088.15

A PHAGOCYTOPHILUM PCR

Facility

$387.00

Service Code	CPT 87798
Hospital Charge Code	2259100
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$276.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.58
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$229.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$276.32
Rate for Payer: Cash Price	$348.30
Rate for Payer: Cash Price	$348.30
Rate for Payer: Cash Price	$348.30
Rate for Payer: Cigna Commercial HMO & PPO	$35.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33.79
Rate for Payer: Home State Health Plan Medicare Advantage	$35.09
Rate for Payer: Humana Commercial	$70.18
Rate for Payer: Humana Medicare Advantage	$35.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$139.32

A PHAGOCYTOPHILUM PCR

Facility

$387.00

Service Code	CPT 87798
Hospital Charge Code	2259100
Hospital Revenue Code	302
Rate for Payer: Cash Price	$348.30

APIXABAN (ELIQUIS) 2.5MG TAB

Facility

$44.00

Service Code	NDC 3089331
Hospital Charge Code	2698428
Hospital Revenue Code	250
Rate for Payer: Cash Price	$39.60

APIXABAN (ELIQUIS) 2.5MG TAB

Facility

$44.00

Service Code	NDC 3089331
Hospital Charge Code	2698428
Hospital Revenue Code	250
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

APIXABAN (ELIQUIS) 2.5 MG TAB EMP

Facility

$28.00

Service Code	NDC 3089321
Hospital Charge Code	2623572
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

APIXABAN (ELIQUIS) 2.5 MG TAB EMP

Facility

$28.00

Service Code	NDC 3089321
Hospital Charge Code	2623572
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

APIXABAN (ELIQUIS) 5 MG TAB EMP

Facility

$28.00

Service Code	NDC 3089321
Hospital Charge Code	2622415
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

APIXABAN (ELIQUIS) 5 MG TAB EMP

Facility

$28.00

Service Code	NDC 3089321
Hospital Charge Code	2622415
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

.APOLIPOPROTEIN A-1 CPT 82172

Facility

$55.00

Service Code	CPT 82172
Hospital Charge Code	22282172
Hospital Revenue Code	307
Min. Negotiated Rate	$18.98
Max. Negotiated Rate	$42.18
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.98
Rate for Payer: Aetna Medicare Advantage	$21.09
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	$21.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.31
Rate for Payer: Home State Health Plan Medicare Advantage	$21.09
Rate for Payer: Humana Commercial	$42.18
Rate for Payer: Humana Medicare Advantage	$21.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

.APOLIPOPROTEIN A-1 CPT 82172

Facility

$55.00

Service Code	CPT 82172
Hospital Charge Code	22282172
Hospital Revenue Code	307
Rate for Payer: Cash Price	$49.50

Know your out-of-pocket cost for care.

All Charges