Madison Medical Center

All Charges

Charge

Type

Setting

Price

PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC

Facility

$31,320.90

Service Code	MSDRG 542
Min. Negotiated Rate	$15,660.45
Max. Negotiated Rate	$31,320.90
Rate for Payer: Aetna Medicare Advantage	$15,660.45
Rate for Payer: Cigna Commercial HMO & PPO	$15,660.45
Rate for Payer: Home State Health Plan Medicare Advantage	$15,660.45
Rate for Payer: Humana Commercial	$31,320.90
Rate for Payer: Humana Medicare Advantage	$15,660.45

PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC

Facility

$15,453.54

Service Code	MSDRG 544
Min. Negotiated Rate	$7,726.77
Max. Negotiated Rate	$15,453.54
Rate for Payer: Cigna Commercial HMO & PPO	$7,726.77
Rate for Payer: Aetna Medicare Advantage	$7,726.77
Rate for Payer: Home State Health Plan Medicare Advantage	$7,726.77
Rate for Payer: Humana Commercial	$15,453.54
Rate for Payer: Humana Medicare Advantage	$7,726.77

PCA MINIBORE EXTENSION SET

Facility

$40.00

Hospital Charge Code	2816443
Hospital Revenue Code	271
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

PCA MINIBORE EXTENSION SET

Facility

$40.00

Hospital Charge Code	2816443
Hospital Revenue Code	271
Rate for Payer: Cash Price	$36.00

PCA PUMP USAGE

Facility

$119.00

Hospital Charge Code	2816445
Hospital Revenue Code	271
Rate for Payer: Cash Price	$107.10

PCA PUMP USAGE

Facility

$119.00

Hospital Charge Code	2816445
Hospital Revenue Code	271
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$84.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$70.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$84.97
Rate for Payer: Cash Price	$107.10
Rate for Payer: UnitedHealthcare Commercial	$79.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84

.PCP REFLEX CONFIRMATION

Facility

$110.00

Service Code	CPT 83992
Hospital Charge Code	221302
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$78.54
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: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

.PCP REFLEX CONFIRMATION

Facility

$110.00

Service Code	CPT 83992
Hospital Charge Code	221302
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

PCR COVID TEST IN OFFICE

Facility

$197.00

Service Code	CPT 87635
Hospital Charge Code	4487635
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$140.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$46.18
Rate for Payer: Aetna Medicare Advantage	$51.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$116.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$140.66
Rate for Payer: Cash Price	$177.30
Rate for Payer: Cash Price	$177.30
Rate for Payer: Cash Price	$177.30
Rate for Payer: Cigna Commercial HMO & PPO	$51.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$46.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$49.41
Rate for Payer: Home State Health Plan Medicare Advantage	$51.31
Rate for Payer: Humana Commercial	$102.62
Rate for Payer: Humana Medicare Advantage	$51.31
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$46.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.92

PCR COVID TEST IN OFFICE

Facility

$197.00

Service Code	CPT 87635
Hospital Charge Code	4487635
Hospital Revenue Code	301
Rate for Payer: Cash Price	$177.30

PDGFRA MUTATION ANALYSIS

Facility

$810.00

Service Code	CPT 81404
Hospital Charge Code	2283995
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$578.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$247.35
Rate for Payer: Aetna Medicare Advantage	$274.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$479.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$578.34
Rate for Payer: Cash Price	$729.00
Rate for Payer: Cash Price	$729.00
Rate for Payer: Cash Price	$729.00
Rate for Payer: Cigna Commercial HMO & PPO	$274.83
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$247.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$264.66
Rate for Payer: Home State Health Plan Medicare Advantage	$274.83
Rate for Payer: Humana Commercial	$549.66
Rate for Payer: Humana Medicare Advantage	$274.83
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$247.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$291.60

PDGFRA MUTATION ANALYSIS

Facility

$810.00

Service Code	CPT 81404
Hospital Charge Code	2283995
Hospital Revenue Code	302
Rate for Payer: Cash Price	$729.00

PEAK FLO METER

Facility

$95.00

Hospital Charge Code	4500333
Hospital Revenue Code	271
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$67.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$67.83
Rate for Payer: Cash Price	$85.50
Rate for Payer: UnitedHealthcare Commercial	$63.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.20

PEAK FLO METER

Facility

$95.00

Hospital Charge Code	4500333
Hospital Revenue Code	271
Rate for Payer: Cash Price	$85.50

PEAK FLOW METER SET-UP

Facility

$247.00

Service Code	CPT 94150
Hospital Charge Code	4500482
Hospital Revenue Code	460
Rate for Payer: Cash Price	$222.30

PEAK FLOW METER SET-UP

Facility

$247.00

Service Code	CPT 94150
Hospital Charge Code	4500482
Hospital Revenue Code	460
Min. Negotiated Rate	$88.92
Max. Negotiated Rate	$262.92
Rate for Payer: Cash Price	$222.30
Rate for Payer: Aetna Better Health Medicaid/QHP	$116.00
Rate for Payer: Aetna Medicare Advantage	$131.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$146.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$176.36
Rate for Payer: Cash Price	$222.30
Rate for Payer: Cash Price	$222.30
Rate for Payer: Cigna Commercial HMO & PPO	$131.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$116.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$124.12
Rate for Payer: Home State Health Plan Medicare Advantage	$131.46
Rate for Payer: Humana Commercial	$262.92
Rate for Payer: Humana Medicare Advantage	$131.46
Rate for Payer: UnitedHealthcare Commercial	$164.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$116.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$88.92

PEAK FLOW TEST

Facility

$468.00

Service Code	CPT 94726
Hospital Charge Code	4500484
Hospital Revenue Code	460
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$762.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$336.38
Rate for Payer: Aetna Medicare Advantage	$381.24
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: Cash Price	$421.20
Rate for Payer: Cash Price	$421.20
Rate for Payer: Cigna Commercial HMO & PPO	$381.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$336.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$359.93
Rate for Payer: Home State Health Plan Medicare Advantage	$381.24
Rate for Payer: Humana Commercial	$762.48
Rate for Payer: Humana Medicare Advantage	$381.24
Rate for Payer: UnitedHealthcare Commercial	$312.16
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$336.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$168.48

PEAK FLOW TEST

Facility

$468.00

Service Code	CPT 94726
Hospital Charge Code	4500484
Hospital Revenue Code	460
Rate for Payer: Cash Price	$421.20

PED.ANESTHESIA CIRCUIT

Facility

$81.00

Hospital Charge Code	281272
Hospital Revenue Code	270
Rate for Payer: Cash Price	$72.90

PED.ANESTHESIA CIRCUIT

Facility

$81.00

Hospital Charge Code	281272
Hospital Revenue Code	270
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$57.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

PEDIALYTE/ELECTROLYTE

Facility

$13.00

Hospital Charge Code	2819481
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

PEDIALYTE/ELECTROLYTE

Facility

$13.00

Hospital Charge Code	2819481
Hospital Revenue Code	271
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

PEDIALYTE ORAL SOL

Facility

$20.00

Hospital Charge Code	2816390
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

PEDIALYTE ORAL SOL

Facility

$20.00

Hospital Charge Code	2816390
Hospital Revenue Code	271
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

PEDIATRIC AMBU BAG

Facility

$52.00

Hospital Charge Code	4500228
Hospital Revenue Code	271
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$37.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.13
Rate for Payer: Cash Price	$46.80
Rate for Payer: UnitedHealthcare Commercial	$34.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.72

Know your out-of-pocket cost for care.

All Charges