Madison Medical Center

All Charges

Charge

Type

Setting

Price

RECTAL TUBE

Facility

$112.00

Hospital Charge Code	2818613
Hospital Revenue Code	271
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$79.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: UnitedHealthcare Commercial	$74.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

RECTAL TUBE

Facility

$112.00

Hospital Charge Code	2818613
Hospital Revenue Code	271
Rate for Payer: Cash Price	$100.80

RED BLOOD CELL COUNT

Facility

$48.00

Service Code	CPT 85041
Hospital Charge Code	2218194
Hospital Revenue Code	305
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$34.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.72
Rate for Payer: Aetna Medicare Advantage	$3.02
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: Cigna Commercial HMO & PPO	$3.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2.91
Rate for Payer: Home State Health Plan Medicare Advantage	$3.02
Rate for Payer: Humana Commercial	$6.04
Rate for Payer: Humana Medicare Advantage	$3.02
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

RED BLOOD CELL COUNT

Facility

$48.00

Service Code	CPT 85041
Hospital Charge Code	2218194
Hospital Revenue Code	305
Rate for Payer: Cash Price	$43.20

RED BLOOD CELL DISORDERS WITH MCC

Facility

$25,622.98

Service Code	MSDRG 811
Min. Negotiated Rate	$12,811.49
Max. Negotiated Rate	$25,622.98
Rate for Payer: Aetna Medicare Advantage	$12,811.49
Rate for Payer: Cigna Commercial HMO & PPO	$12,811.49
Rate for Payer: Home State Health Plan Medicare Advantage	$12,811.49
Rate for Payer: Humana Commercial	$25,622.98
Rate for Payer: Humana Medicare Advantage	$12,811.49

RED BLOOD CELL DISORDERS WITHOUT MCC

Facility

$18,013.76

Service Code	MSDRG 812
Min. Negotiated Rate	$9,006.88
Max. Negotiated Rate	$18,013.76
Rate for Payer: Aetna Medicare Advantage	$9,006.88
Rate for Payer: Cigna Commercial HMO & PPO	$9,006.88
Rate for Payer: Home State Health Plan Medicare Advantage	$9,006.88
Rate for Payer: Humana Commercial	$18,013.76
Rate for Payer: Humana Medicare Advantage	$9,006.88

RED CELL PREP, EACH

Facility

$45.00

Service Code	CPT 86970
Hospital Charge Code	2286970
Hospital Revenue Code	302
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$120.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
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: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$53.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

RED CELL PREP, EACH

Facility

$45.00

Service Code	CPT 86970
Hospital Charge Code	2286970
Hospital Revenue Code	302
Rate for Payer: Cash Price	$40.50

REDUCING SUBSTANCES STOOL

Facility

$58.00

Service Code	CPT 84376
Hospital Charge Code	2284376
Hospital Revenue Code	306
Rate for Payer: Cash Price	$52.20

REDUCING SUBSTANCES STOOL

Facility

$58.00

Service Code	CPT 84376
Hospital Charge Code	2284376
Hospital Revenue Code	306
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$41.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.95
Rate for Payer: Aetna Medicare Advantage	$5.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cigna Commercial HMO & PPO	$5.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.30
Rate for Payer: Home State Health Plan Medicare Advantage	$5.50
Rate for Payer: Humana Commercial	$11.00
Rate for Payer: Humana Medicare Advantage	$5.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

REDUCTION OF FRACTURE W/ MANIPULATION

Professional

Both

$1,038.00

Service Code	CPT 24655
Hospital Charge Code	1824655
Hospital Revenue Code	981
Min. Negotiated Rate	$341.49
Max. Negotiated Rate	$405.51
Rate for Payer: Aetna Commercial/Medicare Advantage	$405.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$341.49
Rate for Payer: Cash Price	$934.20
Rate for Payer: Cash Price	$934.20
Rate for Payer: Cigna Commercial HMO & PPO	$405.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$341.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$375.64
Rate for Payer: Home State Health Plan Medicare Advantage	$405.51
Rate for Payer: Optum Medicare Advantage	$363.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$341.49

REDUCTION PATELLA

Professional

Both

$1,229.00

Service Code	CPT 27562
Hospital Charge Code	1827562
Hospital Revenue Code	981
Min. Negotiated Rate	$372.54
Max. Negotiated Rate	$442.12
Rate for Payer: Aetna Commercial/Medicare Advantage	$442.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$372.54
Rate for Payer: Cash Price	$1,106.10
Rate for Payer: Cash Price	$1,106.10
Rate for Payer: Cigna Commercial HMO & PPO	$442.12
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$372.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$409.79
Rate for Payer: Home State Health Plan Medicare Advantage	$442.12
Rate for Payer: Optum Medicare Advantage	$430.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$372.54

REGADENOSON (LEXISCAN) 0.4MG INJ 5ML

Facility

$1,486.00

Service Code	HCPCS J2785
Hospital Charge Code	2626441
Hospital Revenue Code	250
Min. Negotiated Rate	$534.96
Max. Negotiated Rate	$1,061.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$879.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,061.00
Rate for Payer: Cash Price	$1,337.40
Rate for Payer: UnitedHealthcare Commercial	$991.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$534.96

REGADENOSON (LEXISCAN) 0.4MG INJ 5ML

Facility

$1,486.00

Service Code	HCPCS J2785
Hospital Charge Code	2626441
Hospital Revenue Code	250
Rate for Payer: Cash Price	$1,337.40

REHABILITATION

Facility

$19,436.16

Service Code	APR-DRG 8604
Min. Negotiated Rate	$19,436.16
Max. Negotiated Rate	$19,436.16
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,436.16
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,436.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,436.16
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,436.16

REHABILITATION

Facility

$17,367.09

Service Code	APR-DRG 8603
Min. Negotiated Rate	$17,367.09
Max. Negotiated Rate	$17,367.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,367.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,367.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,367.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,367.09

REHABILITATION

Facility

$13,373.17

Service Code	APR-DRG 8602
Min. Negotiated Rate	$13,373.17
Max. Negotiated Rate	$13,373.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,373.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,373.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,373.17
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,373.17

REHABILITATION

Facility

$10,906.55

Service Code	APR-DRG 8601
Min. Negotiated Rate	$10,906.55
Max. Negotiated Rate	$10,906.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,906.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,906.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,906.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,906.55

REHABILITATION WITH CC/MCC

Facility

$27,888.16

Service Code	MSDRG 945
Min. Negotiated Rate	$935.00
Max. Negotiated Rate	$27,888.16
Rate for Payer: Aetna Medicare Advantage	$13,944.08
Rate for Payer: Cigna Commercial HMO & PPO	$13,944.08
Rate for Payer: Home State Health Plan Medicare Advantage	$13,944.08
Rate for Payer: Humana Commercial	$27,888.16
Rate for Payer: Humana Medicare Advantage	$13,944.08
Rate for Payer: UnitedHealthcare Commercial	$935.00

REHABILITATION WITHOUT CC/MCC

Facility

$21,591.18

Service Code	MSDRG 946
Min. Negotiated Rate	$935.00
Max. Negotiated Rate	$21,591.18
Rate for Payer: Aetna Medicare Advantage	$10,795.59
Rate for Payer: Cigna Commercial HMO & PPO	$10,795.59
Rate for Payer: Home State Health Plan Medicare Advantage	$10,795.59
Rate for Payer: Humana Commercial	$21,591.18
Rate for Payer: Humana Medicare Advantage	$10,795.59
Rate for Payer: UnitedHealthcare Commercial	$935.00

REMDESIVIR 100MG IVPB

Facility

$2,483.00

Service Code	NDC 6.1958E+10
Hospital Charge Code	2623686
Hospital Revenue Code	250
Min. Negotiated Rate	$893.88
Max. Negotiated Rate	$1,772.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,469.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,772.86
Rate for Payer: Cash Price	$2,234.70
Rate for Payer: UnitedHealthcare Commercial	$1,656.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$893.88

REMDESIVIR 100MG IVPB

Facility

$2,483.00

Service Code	NDC 6.1958E+10
Hospital Charge Code	2623686
Hospital Revenue Code	250
Rate for Payer: Cash Price	$2,234.70

REM F/B EAR W/GENERAL ANESTH

Professional

Both

$660.00

Service Code	CPT 69205
Hospital Charge Code	9369205
Hospital Revenue Code	975
Min. Negotiated Rate	$71.30
Max. Negotiated Rate	$231.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$81.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$71.30
Rate for Payer: Cash Price	$594.00
Rate for Payer: Cash Price	$594.00
Rate for Payer: Cigna Commercial HMO & PPO	$81.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$71.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$78.43
Rate for Payer: Home State Health Plan Medicare Advantage	$81.51
Rate for Payer: Optum Medicare Advantage	$231.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$71.30

REM F/B FROM EAR W/O ANESTH

Facility

$185.00

Service Code	CPT 69200
Hospital Charge Code	9869200
Hospital Revenue Code	521
Rate for Payer: Cash Price	$166.50

REM F/B FROM EAR W/O ANESTH

Facility

$185.00

Service Code	CPT 69200
Hospital Charge Code	9869200
Hospital Revenue Code	521
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$271.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
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: Cash Price	$166.50
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$123.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges