Madison Medical Center

All Charges

Charge

Type

Setting

Price

.ASPERGILLUS FLAVUS AB

Facility

$36.00

Service Code	CPT 86606
Hospital Charge Code	2286603
Hospital Revenue Code	305
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$30.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.55
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$25.70
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial HMO & PPO	$15.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.50
Rate for Payer: Home State Health Plan Medicare Advantage	$15.05
Rate for Payer: Humana Commercial	$30.10
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.96

ASPERGILLUS FUMIGATUS AB IGE

Facility

$110.00

Service Code	CPT 86603
Hospital Charge Code	2286607
Hospital Revenue Code	305
Rate for Payer: Cash Price	$99.00

ASPERGILLUS FUMIGATUS AB IGE

Facility

$110.00

Service Code	CPT 86603
Hospital Charge Code	2286607
Hospital Revenue Code	305
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$78.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.58
Rate for Payer: Aetna Medicare Advantage	$12.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$12.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.39
Rate for Payer: Home State Health Plan Medicare Advantage	$12.87
Rate for Payer: Humana Commercial	$25.74
Rate for Payer: Humana Medicare Advantage	$12.87
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

.ASPERGILLUS FUMIGATUS AB IGG

Facility

$36.00

Service Code	CPT 86606
Hospital Charge Code	2286640
Hospital Revenue Code	305
Rate for Payer: Cash Price	$32.40

.ASPERGILLUS FUMIGATUS AB IGG

Facility

$36.00

Service Code	CPT 86606
Hospital Charge Code	2286640
Hospital Revenue Code	305
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$30.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.55
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$25.70
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial HMO & PPO	$15.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.50
Rate for Payer: Home State Health Plan Medicare Advantage	$15.05
Rate for Payer: Humana Commercial	$30.10
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.96

ASPERGILLUS FUMIGATUS AB IGG

Facility

$127.00

Service Code	CPT 86606
Hospital Charge Code	22286606
Hospital Revenue Code	305
Min. Negotiated Rate	$13.55
Max. Negotiated Rate	$90.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.55
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$90.68
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cigna Commercial HMO & PPO	$15.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.50
Rate for Payer: Home State Health Plan Medicare Advantage	$15.05
Rate for Payer: Humana Commercial	$30.10
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.72

ASPERGILLUS FUMIGATUS AB IGG

Facility

$127.00

Service Code	CPT 86606
Hospital Charge Code	22286606
Hospital Revenue Code	305
Rate for Payer: Cash Price	$114.30

ASPERGILLUS GLAUCUS AB

Facility

$151.00

Service Code	CPT 86606
Hospital Charge Code	2286604
Hospital Revenue Code	305
Rate for Payer: Cash Price	$135.90

ASPERGILLUS GLAUCUS AB

Facility

$151.00

Service Code	CPT 86606
Hospital Charge Code	2286604
Hospital Revenue Code	305
Min. Negotiated Rate	$13.55
Max. Negotiated Rate	$107.81
Rate for Payer: Cigna Commercial HMO & PPO	$15.05
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.55
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.81
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cash Price	$135.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.50
Rate for Payer: Home State Health Plan Medicare Advantage	$15.05
Rate for Payer: Humana Commercial	$30.10
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.36

ASPERGILLUS NIDULANS AB

Facility

$37.00

Service Code	CPT 86606
Hospital Charge Code	2286605
Hospital Revenue Code	305
Rate for Payer: Cash Price	$33.30

ASPERGILLUS NIDULANS AB

Facility

$37.00

Service Code	CPT 86606
Hospital Charge Code	2286605
Hospital Revenue Code	305
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$30.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.55
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$26.42
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cigna Commercial HMO & PPO	$15.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.50
Rate for Payer: Home State Health Plan Medicare Advantage	$15.05
Rate for Payer: Humana Commercial	$30.10
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.32

ASPIRATION AND OR INJECTION

Facility

$358.00

Service Code	CPT 20612
Hospital Charge Code	9120612
Hospital Revenue Code	521
Rate for Payer: Cash Price	$322.20

ASPIRATION AND OR INJECTION

Facility

$358.00

Service Code	CPT 20612
Hospital Charge Code	9120612
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$211.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$255.61
Rate for Payer: Cash Price	$322.20
Rate for Payer: Cash Price	$322.20
Rate for Payer: Cash Price	$322.20
Rate for Payer: Cash Price	$322.20
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$238.79
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ASPIRATION/INJ GANGLION CYST

Facility

$181.00

Service Code	CPT 20612
Hospital Charge Code	9820612
Hospital Revenue Code	521
Min. Negotiated Rate	$107.15
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$107.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$129.23
Rate for Payer: Cash Price	$162.90
Rate for Payer: Cash Price	$162.90
Rate for Payer: Cash Price	$162.90
Rate for Payer: Cash Price	$162.90
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$120.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ASPIRATION/INJ GANGLION CYST

Facility

$210.00

Service Code	CPT 20612
Hospital Charge Code	9320612
Hospital Revenue Code	521
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
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: Cash Price	$189.00
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$140.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ASPIRATION/INJ GANGLION CYST

Facility

$181.00

Service Code	CPT 20612
Hospital Charge Code	9820612
Hospital Revenue Code	521
Rate for Payer: Cash Price	$162.90

ASPIRATION/INJ GANGLION CYST

Facility

$210.00

Service Code	CPT 20612
Hospital Charge Code	9320612
Hospital Revenue Code	521
Rate for Payer: Cash Price	$189.00

ASPIRATION/NEEDLE BIOPSY BREAST

Facility

$263.00

Service Code	CPT 19000
Hospital Charge Code	4419000
Hospital Revenue Code	521
Min. Negotiated Rate	$155.70
Max. Negotiated Rate	$1,446.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$638.34
Rate for Payer: Aetna Medicare Advantage	$723.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$155.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$187.78
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cigna Commercial HMO & PPO	$723.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$574.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$683.02
Rate for Payer: Home State Health Plan Medicare Advantage	$723.47
Rate for Payer: Humana Commercial	$1,446.94
Rate for Payer: Humana Medicare Advantage	$723.47
Rate for Payer: UnitedHealthcare Commercial	$175.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ASPIRATION/NEEDLE BIOPSY BREAST

Facility

$263.00

Service Code	CPT 19000
Hospital Charge Code	4419000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$236.70

ASPIRATION, PUNCTURE-ABSCESS,HEMA,CYST

Facility

$104.00

Service Code	CPT 10160
Hospital Charge Code	4410160
Hospital Revenue Code	521
Min. Negotiated Rate	$61.57
Max. Negotiated Rate	$830.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$366.45
Rate for Payer: Aetna Medicare Advantage	$415.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$61.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.26
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cigna Commercial HMO & PPO	$415.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$329.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$392.10
Rate for Payer: Home State Health Plan Medicare Advantage	$415.32
Rate for Payer: Humana Commercial	$830.64
Rate for Payer: Humana Medicare Advantage	$415.32
Rate for Payer: UnitedHealthcare Commercial	$69.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ASPIRATION, PUNCTURE-ABSCESS,HEMA,CYST

Facility

$104.00

Service Code	CPT 10160
Hospital Charge Code	4410160
Hospital Revenue Code	521
Rate for Payer: Cash Price	$93.60

ASPIRATOR, NASAL INF

Facility

$45.00

Hospital Charge Code	281215
Hospital Revenue Code	271
Rate for Payer: Cash Price	$40.50

ASPIRATOR, NASAL INF

Facility

$45.00

Hospital Charge Code	281215
Hospital Revenue Code	271
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

ASPIRIN 300MG (5 GRAINS) SUPP

Facility

$25.00

Service Code	NDC 574703412
Hospital Charge Code	2697143
Hospital Revenue Code	250
Rate for Payer: Cash Price	$22.50

ASPIRIN 300MG (5 GRAINS) SUPP

Facility

$25.00

Service Code	NDC 574703412
Hospital Charge Code	2697143
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$17.85
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: UnitedHealthcare Commercial	$16.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.00

Know your out-of-pocket cost for care.

All Charges