Madison Medical Center

All Charges

Charge

Type

Setting

Price

OCCULT BLOOD

Facility

$25.00

Service Code	CPT 82270
Hospital Charge Code	9682270
Hospital Revenue Code	301
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.94
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.85
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna Commercial HMO & PPO	$4.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.22
Rate for Payer: Home State Health Plan Medicare Advantage	$4.38
Rate for Payer: Humana Commercial	$8.76
Rate for Payer: Humana Medicare Advantage	$4.38
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.00

OCCULT BLOOD

Facility

$25.00

Service Code	CPT 82270
Hospital Charge Code	4182270
Hospital Revenue Code	521
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.94
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.85
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna Commercial HMO & PPO	$4.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.22
Rate for Payer: Home State Health Plan Medicare Advantage	$4.38
Rate for Payer: Humana Commercial	$8.76
Rate for Payer: Humana Medicare Advantage	$4.38
Rate for Payer: UnitedHealthcare Commercial	$16.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OCCULT BLOOD

Facility

$25.00

Service Code	CPT 82270
Hospital Charge Code	4182270
Hospital Revenue Code	521
Rate for Payer: Cash Price	$22.50

OCCULT BLOOD #1 STOOL

Facility

$75.00

Service Code	CPT 82274
Hospital Charge Code	2219153
Hospital Revenue Code	301
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.33
Rate for Payer: Aetna Medicare Advantage	$15.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$15.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.33
Rate for Payer: Home State Health Plan Medicare Advantage	$15.92
Rate for Payer: Humana Commercial	$31.84
Rate for Payer: Humana Medicare Advantage	$15.92
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

OCCULT BLOOD #1 STOOL

Facility

$75.00

Service Code	CPT 82274
Hospital Charge Code	2219153
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

OCCULT BLOOD #2 STOOL

Facility

$75.00

Service Code	CPT 82274
Hospital Charge Code	2219156
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

OCCULT BLOOD #2 STOOL

Facility

$75.00

Service Code	CPT 82274
Hospital Charge Code	2219156
Hospital Revenue Code	301
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.33
Rate for Payer: Aetna Medicare Advantage	$15.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$15.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.33
Rate for Payer: Home State Health Plan Medicare Advantage	$15.92
Rate for Payer: Humana Commercial	$31.84
Rate for Payer: Humana Medicare Advantage	$15.92
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

OCCULT BLOOD #3 STOOL

Facility

$75.00

Service Code	CPT 82274
Hospital Charge Code	2219155
Hospital Revenue Code	301
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.33
Rate for Payer: Aetna Medicare Advantage	$15.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$15.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.33
Rate for Payer: Home State Health Plan Medicare Advantage	$15.92
Rate for Payer: Humana Commercial	$31.84
Rate for Payer: Humana Medicare Advantage	$15.92
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

OCCULT BLOOD #3 STOOL

Facility

$75.00

Service Code	CPT 82274
Hospital Charge Code	2219155
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

.OCCULT BLOOD DIAGNOSTIC

Facility

$38.00

Service Code	CPT 82270
Hospital Charge Code	2219150
Hospital Revenue Code	306
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$27.13
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.94
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$22.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.13
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cigna Commercial HMO & PPO	$4.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.22
Rate for Payer: Home State Health Plan Medicare Advantage	$4.38
Rate for Payer: Humana Commercial	$8.76
Rate for Payer: Humana Medicare Advantage	$4.38
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.68

.OCCULT BLOOD DIAGNOSTIC

Facility

$38.00

Service Code	CPT 82270
Hospital Charge Code	2219150
Hospital Revenue Code	306
Rate for Payer: Cash Price	$34.20

OCCULT BLOOD GASTRIC CONTENTS

Facility

$75.00

Service Code	CPT 82271
Hospital Charge Code	2219157
Hospital Revenue Code	306
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.79
Rate for Payer: Aetna Medicare Advantage	$5.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$5.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.13
Rate for Payer: Home State Health Plan Medicare Advantage	$5.32
Rate for Payer: Humana Commercial	$10.64
Rate for Payer: Humana Medicare Advantage	$5.32
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

OCCULT BLOOD GASTRIC CONTENTS

Facility

$75.00

Service Code	CPT 82271
Hospital Charge Code	2219157
Hospital Revenue Code	306
Rate for Payer: Cash Price	$67.50

OCCULT BLOOD, IMMUNOASSAY (COLOFIT - LC)

Facility

$87.00

Service Code	CPT 82274
Hospital Charge Code	221354
Hospital Revenue Code	301
Rate for Payer: Cash Price	$78.30

OCCULT BLOOD, IMMUNOASSAY (COLOFIT - LC)

Facility

$87.00

Service Code	CPT 82274
Hospital Charge Code	221354
Hospital Revenue Code	301
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$62.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.33
Rate for Payer: Aetna Medicare Advantage	$15.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$51.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.12
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cigna Commercial HMO & PPO	$15.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.33
Rate for Payer: Home State Health Plan Medicare Advantage	$15.92
Rate for Payer: Humana Commercial	$31.84
Rate for Payer: Humana Medicare Advantage	$15.92
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.32

.OCCULT BLOOD SCREENING

Facility

$57.00

Service Code	CPT 82274
Hospital Charge Code	2219152
Hospital Revenue Code	306
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$40.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.33
Rate for Payer: Aetna Medicare Advantage	$15.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$33.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$40.70
Rate for Payer: Cash Price	$51.30
Rate for Payer: Cash Price	$51.30
Rate for Payer: Cash Price	$51.30
Rate for Payer: Cigna Commercial HMO & PPO	$15.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.33
Rate for Payer: Home State Health Plan Medicare Advantage	$15.92
Rate for Payer: Humana Commercial	$31.84
Rate for Payer: Humana Medicare Advantage	$15.92
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.52

.OCCULT BLOOD SCREENING

Facility

$57.00

Service Code	CPT 82274
Hospital Charge Code	2219152
Hospital Revenue Code	306
Rate for Payer: Cash Price	$51.30

OCL SPLINT 2 SR215

Facility

$12.00

Hospital Charge Code	2819423
Hospital Revenue Code	271
Rate for Payer: Cash Price	$10.80

OCL SPLINT 2 SR215

Facility

$12.00

Hospital Charge Code	2819423
Hospital Revenue Code	271
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$8.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$8.57
Rate for Payer: Cash Price	$10.80
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.32

O ETHIBOND EXCEL (SUTURE) 8 NEEDLE W/PKG

Facility

$463.00

Service Code	CPT Y7506
Hospital Charge Code	127282
Hospital Revenue Code	271
Rate for Payer: Cash Price	$416.70

O ETHIBOND EXCEL (SUTURE) 8 NEEDLE W/PKG

Facility

$463.00

Service Code	CPT Y7506
Hospital Charge Code	127282
Hospital Revenue Code	271
Min. Negotiated Rate	$166.68
Max. Negotiated Rate	$330.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$274.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$330.58
Rate for Payer: Cash Price	$416.70
Rate for Payer: UnitedHealthcare Commercial	$308.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$166.68

OFFICE CONS.(NEW) 30 MIN.

Facility

$230.00

Service Code	CPT 99242
Hospital Charge Code	4199242
Hospital Revenue Code	521
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$136.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$164.22
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: UnitedHealthcare Commercial	$153.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE CONS.(NEW) 30 MIN.

Facility

$230.00

Service Code	CPT 99242
Hospital Charge Code	4199242
Hospital Revenue Code	521
Rate for Payer: Cash Price	$207.00

OFFICE CONS.(NEW) 40 MIN.

Facility

$300.00

Service Code	CPT 99243
Hospital Charge Code	4199243
Hospital Revenue Code	521
Rate for Payer: Cash Price	$270.00

OFFICE CONS.(NEW) 40 MIN.

Facility

$300.00

Service Code	CPT 99243
Hospital Charge Code	4199243
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$214.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$177.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.20
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: UnitedHealthcare Commercial	$200.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges