Madison Medical Center

All Charges

Charge

Type

Setting

Price

PORPHOBILINOGEN URINE 24 HOUR

Facility

$153.00

Service Code	CPT 84110
Hospital Charge Code	223177
Hospital Revenue Code	301
Rate for Payer: Cash Price	$137.70

PORPHYRINS, FECAL

Facility

$385.00

Service Code	CPT 84126
Hospital Charge Code	2284126
Hospital Revenue Code	307
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$274.89
Rate for Payer: Aetna Better Health Medicaid/QHP	$35.20
Rate for Payer: Aetna Medicare Advantage	$39.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$227.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$274.89
Rate for Payer: Cash Price	$346.50
Rate for Payer: Cash Price	$346.50
Rate for Payer: Cash Price	$346.50
Rate for Payer: Cigna Commercial HMO & PPO	$39.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$35.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37.66
Rate for Payer: Home State Health Plan Medicare Advantage	$39.11
Rate for Payer: Humana Commercial	$78.22
Rate for Payer: Humana Medicare Advantage	$39.11
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$35.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$138.60

PORPHYRINS, FECAL

Facility

$385.00

Service Code	CPT 84126
Hospital Charge Code	2284126
Hospital Revenue Code	307
Rate for Payer: Cash Price	$346.50

PORPHYRINS, FRAC PLASMA

Facility

$421.00

Service Code	CPT 82542
Hospital Charge Code	222492
Hospital Revenue Code	307
Rate for Payer: Cash Price	$378.90

PORPHYRINS, FRAC PLASMA

Facility

$421.00

Service Code	CPT 82542
Hospital Charge Code	222492
Hospital Revenue Code	307
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$300.59
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.68
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$249.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$300.59
Rate for Payer: Cash Price	$378.90
Rate for Payer: Cash Price	$378.90
Rate for Payer: Cash Price	$378.90
Rate for Payer: Cigna Commercial HMO & PPO	$24.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.20
Rate for Payer: Home State Health Plan Medicare Advantage	$24.09
Rate for Payer: Humana Commercial	$48.18
Rate for Payer: Humana Medicare Advantage	$24.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$151.56

PORPHYRINS, TOTAL PLASMA

Facility

$209.00

Service Code	CPT 82542
Hospital Charge Code	222491
Hospital Revenue Code	307
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$149.23
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.68
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$123.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.23
Rate for Payer: Cash Price	$188.10
Rate for Payer: Cash Price	$188.10
Rate for Payer: Cash Price	$188.10
Rate for Payer: Cigna Commercial HMO & PPO	$24.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.20
Rate for Payer: Home State Health Plan Medicare Advantage	$24.09
Rate for Payer: Humana Commercial	$48.18
Rate for Payer: Humana Medicare Advantage	$24.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$75.24

PORPHYRINS, TOTAL PLASMA

Facility

$209.00

Service Code	CPT 82542
Hospital Charge Code	222491
Hospital Revenue Code	307
Rate for Payer: Cash Price	$188.10

PORPHYRINS URINE 24 HOUR FRACTIONATED

Facility

$185.00

Service Code	CPT 84120
Hospital Charge Code	2284120
Hospital Revenue Code	307
Rate for Payer: Cash Price	$166.50

PORPHYRINS URINE 24 HOUR FRACTIONATED

Facility

$185.00

Service Code	CPT 84120
Hospital Charge Code	2284120
Hospital Revenue Code	307
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$132.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.24
Rate for Payer: Aetna Medicare Advantage	$14.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$109.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.09
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cigna Commercial HMO & PPO	$14.71
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.17
Rate for Payer: Home State Health Plan Medicare Advantage	$14.71
Rate for Payer: Humana Commercial	$29.42
Rate for Payer: Humana Medicare Advantage	$14.71
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.60

PORPHYRINS URINE RANDOM

Facility

$187.00

Service Code	CPT 84120
Hospital Charge Code	2221218
Hospital Revenue Code	307
Rate for Payer: Cash Price	$168.30

PORPHYRINS URINE RANDOM

Facility

$187.00

Service Code	CPT 84120
Hospital Charge Code	2221218
Hospital Revenue Code	307
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$133.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.24
Rate for Payer: Aetna Medicare Advantage	$14.71
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	$14.71
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.17
Rate for Payer: Home State Health Plan Medicare Advantage	$14.71
Rate for Payer: Humana Commercial	$29.42
Rate for Payer: Humana Medicare Advantage	$14.71
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.32

PORTABLE CHEST

Facility

$389.00

Service Code	CPT 71045
Hospital Charge Code	323191
Hospital Revenue Code	320
Rate for Payer: Cash Price	$350.10

PORTABLE CHEST

Facility

$389.00

Service Code	CPT 71045
Hospital Charge Code	323191
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$277.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$230.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$277.75
Rate for Payer: Cash Price	$350.10
Rate for Payer: Cash Price	$350.10
Rate for Payer: Cash Price	$350.10
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$140.04

POST COITAL TEST/INSERTION

Facility

$48.00

Service Code	CPT 89300
Hospital Charge Code	4289300
Hospital Revenue Code	521
Rate for Payer: Cash Price	$43.20

POST COITAL TEST/INSERTION

Facility

$48.00

Service Code	CPT 89300
Hospital Charge Code	4289300
Hospital Revenue Code	521
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.86
Rate for Payer: Aetna Medicare Advantage	$9.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cigna Commercial HMO & PPO	$9.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.48
Rate for Payer: Home State Health Plan Medicare Advantage	$9.84
Rate for Payer: Humana Commercial	$19.68
Rate for Payer: Humana Medicare Advantage	$9.84
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

POSTERIOR COLPORRHAPHY

Facility

$1,389.00

Service Code	CPT 57250
Hospital Charge Code	5257250
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$10,221.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,509.45
Rate for Payer: Aetna Medicare Advantage	$5,110.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$822.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$991.75
Rate for Payer: Cash Price	$1,250.10
Rate for Payer: Cash Price	$1,250.10
Rate for Payer: Cash Price	$1,250.10
Rate for Payer: Cash Price	$1,250.10
Rate for Payer: Cigna Commercial HMO & PPO	$5,110.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,058.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,825.11
Rate for Payer: Home State Health Plan Medicare Advantage	$5,110.80
Rate for Payer: Humana Commercial	$10,221.60
Rate for Payer: Humana Medicare Advantage	$5,110.80
Rate for Payer: UnitedHealthcare Commercial	$926.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,509.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

POSTERIOR COLPORRHAPHY

Facility

$1,389.00

Service Code	CPT 57250
Hospital Charge Code	5257250
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,250.10

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC

Facility

$32,222.04

Service Code	MSDRG 862
Min. Negotiated Rate	$16,111.02
Max. Negotiated Rate	$32,222.04
Rate for Payer: Aetna Medicare Advantage	$16,111.02
Rate for Payer: Cigna Commercial HMO & PPO	$16,111.02
Rate for Payer: Home State Health Plan Medicare Advantage	$16,111.02
Rate for Payer: Humana Commercial	$32,222.04
Rate for Payer: Humana Medicare Advantage	$16,111.02

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC

Facility

$19,261.00

Service Code	MSDRG 863
Min. Negotiated Rate	$9,630.50
Max. Negotiated Rate	$19,261.00
Rate for Payer: Aetna Medicare Advantage	$9,630.50
Rate for Payer: Cigna Commercial HMO & PPO	$9,630.50
Rate for Payer: Home State Health Plan Medicare Advantage	$9,630.50
Rate for Payer: Humana Commercial	$19,261.00
Rate for Payer: Humana Medicare Advantage	$9,630.50

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC

Facility

$37,228.58

Service Code	MSDRG 857
Min. Negotiated Rate	$18,614.29
Max. Negotiated Rate	$37,228.58
Rate for Payer: Aetna Medicare Advantage	$18,614.29
Rate for Payer: Cigna Commercial HMO & PPO	$18,614.29
Rate for Payer: Home State Health Plan Medicare Advantage	$18,614.29
Rate for Payer: Humana Commercial	$37,228.58
Rate for Payer: Humana Medicare Advantage	$18,614.29

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC

Facility

$75,343.48

Service Code	MSDRG 856
Min. Negotiated Rate	$37,671.74
Max. Negotiated Rate	$75,343.48
Rate for Payer: Aetna Medicare Advantage	$37,671.74
Rate for Payer: Cigna Commercial HMO & PPO	$37,671.74
Rate for Payer: Home State Health Plan Medicare Advantage	$37,671.74
Rate for Payer: Humana Commercial	$75,343.48
Rate for Payer: Humana Medicare Advantage	$37,671.74

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$25,444.14

Service Code	MSDRG 858
Min. Negotiated Rate	$12,722.07
Max. Negotiated Rate	$25,444.14
Rate for Payer: Aetna Medicare Advantage	$12,722.07
Rate for Payer: Cigna Commercial HMO & PPO	$12,722.07
Rate for Payer: Home State Health Plan Medicare Advantage	$12,722.07
Rate for Payer: Humana Commercial	$25,444.14
Rate for Payer: Humana Medicare Advantage	$12,722.07

POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE

Facility

$9,794.35

Service Code	APR-DRG 7111
Min. Negotiated Rate	$9,794.35
Max. Negotiated Rate	$9,794.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,794.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,794.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,794.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,794.35

POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE

Facility

$59,731.32

Service Code	APR-DRG 7114
Min. Negotiated Rate	$59,731.32
Max. Negotiated Rate	$59,731.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$59,731.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$59,731.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$59,731.32
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$59,731.32

POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE

Facility

$24,106.83

Service Code	APR-DRG 7113
Min. Negotiated Rate	$24,106.83
Max. Negotiated Rate	$24,106.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$24,106.83
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24,106.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24,106.83
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24,106.83

Know your out-of-pocket cost for care.

All Charges