Madison Medical Center

All Charges

Charge

Type

Setting

Price

REMOVAL OF SKIN TAG

Facility

$115.00

Service Code	CPT 11200
Hospital Charge Code	4411200
Hospital Revenue Code	521
Rate for Payer: Cash Price	$103.50

REMOVAL OF SKIN TAGS UP TO 15

Facility

$115.00

Service Code	CPT 11200
Hospital Charge Code	9611200
Hospital Revenue Code	521
Rate for Payer: Cash Price	$103.50

REMOVAL OF SKIN TAGS UP TO 15

Facility

$115.00

Service Code	CPT 11200
Hospital Charge Code	9611200
Hospital Revenue Code	521
Min. Negotiated Rate	$68.08
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$68.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$82.11
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$76.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REMOVAL OF TUNNELED CENTRAL VEN CATHETER

Professional

Both

$735.00

Service Code	CPT 36589
Hospital Charge Code	5436589
Hospital Revenue Code	975
Min. Negotiated Rate	$119.51
Max. Negotiated Rate	$257.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$119.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$126.07
Rate for Payer: Cash Price	$661.50
Rate for Payer: Cash Price	$661.50
Rate for Payer: Cigna Commercial HMO & PPO	$119.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$126.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$138.68
Rate for Payer: Home State Health Plan Medicare Advantage	$119.51
Rate for Payer: Optum Medicare Advantage	$257.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$126.07

REMOVE FRGN BODY-EYE,CONJ SUPE

Professional

Both

$441.00

Service Code	CPT 65205
Hospital Charge Code	1865205
Hospital Revenue Code	981
Min. Negotiated Rate	$23.31
Max. Negotiated Rate	$154.35
Rate for Payer: Aetna Commercial/Medicare Advantage	$23.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$31.22
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cigna Commercial HMO & PPO	$23.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$34.34
Rate for Payer: Home State Health Plan Medicare Advantage	$23.31
Rate for Payer: Optum Medicare Advantage	$154.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.22

REMOVE FRGN BODY-FOOT DEEP

Professional

Both

$2,230.00

Service Code	CPT 28192
Hospital Charge Code	1828192
Hospital Revenue Code	981
Min. Negotiated Rate	$276.28
Max. Negotiated Rate	$780.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$276.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$346.75
Rate for Payer: Cash Price	$2,007.00
Rate for Payer: Cash Price	$2,007.00
Rate for Payer: Cigna Commercial HMO & PPO	$276.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$346.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$381.43
Rate for Payer: Home State Health Plan Medicare Advantage	$276.28
Rate for Payer: Optum Medicare Advantage	$780.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$346.75

REMOVE FRGN BODY-FOOT SUBSEQUENT

Professional

Both

$1,171.00

Service Code	CPT 28190
Hospital Charge Code	1828190
Hospital Revenue Code	981
Min. Negotiated Rate	$119.80
Max. Negotiated Rate	$409.85
Rate for Payer: Aetna Commercial/Medicare Advantage	$119.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$183.95
Rate for Payer: Cash Price	$1,053.90
Rate for Payer: Cash Price	$1,053.90
Rate for Payer: Cigna Commercial HMO & PPO	$119.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$183.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$202.34
Rate for Payer: Home State Health Plan Medicare Advantage	$119.80
Rate for Payer: Optum Medicare Advantage	$409.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$183.95

REMOVE FRGN BODY-FOREARM

Professional

Both

$3,006.00

Service Code	CPT 25248
Hospital Charge Code	1825248
Hospital Revenue Code	981
Min. Negotiated Rate	$318.76
Max. Negotiated Rate	$1,052.10
Rate for Payer: Aetna Commercial/Medicare Advantage	$379.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$318.76
Rate for Payer: Cash Price	$2,705.40
Rate for Payer: Cash Price	$2,705.40
Rate for Payer: Cigna Commercial HMO & PPO	$379.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$318.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$350.64
Rate for Payer: Home State Health Plan Medicare Advantage	$379.90
Rate for Payer: Optum Medicare Advantage	$1,052.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$318.76

RENAL CAPS (VIRT-CAPS) CAP

Facility

$16.00

Service Code	NDC 6.9543E+10
Hospital Charge Code	2626506
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

RENAL CAPS (VIRT-CAPS) CAP

Facility

$16.00

Service Code	NDC 6.9543E+10
Hospital Charge Code	2626506
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

RENAL DIALYSIS ACCESS DEVICE PROCEDURES

Facility

$18,078.04

Service Code	APR-DRG 4442
Min. Negotiated Rate	$18,078.04
Max. Negotiated Rate	$18,078.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$18,078.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18,078.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18,078.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18,078.04

RENAL DIALYSIS ACCESS DEVICE PROCEDURES

Facility

$23,007.58

Service Code	APR-DRG 4443
Min. Negotiated Rate	$23,007.58
Max. Negotiated Rate	$23,007.58
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,007.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,007.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,007.58
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,007.58

RENAL DIALYSIS ACCESS DEVICE PROCEDURES

Facility

$42,893.98

Service Code	APR-DRG 4444
Min. Negotiated Rate	$42,893.98
Max. Negotiated Rate	$42,893.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$42,893.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$42,893.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$42,893.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$42,893.98

RENAL DIALYSIS ACCESS DEVICE PROCEDURES

Facility

$15,080.75

Service Code	APR-DRG 4441
Min. Negotiated Rate	$15,080.75
Max. Negotiated Rate	$15,080.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,080.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,080.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,080.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,080.75

RENAL FAILURE WITH CC

Facility

$17,350.24

Service Code	MSDRG 683
Min. Negotiated Rate	$8,675.12
Max. Negotiated Rate	$17,350.24
Rate for Payer: Aetna Medicare Advantage	$8,675.12
Rate for Payer: Cigna Commercial HMO & PPO	$8,675.12
Rate for Payer: Home State Health Plan Medicare Advantage	$8,675.12
Rate for Payer: Humana Commercial	$17,350.24
Rate for Payer: Humana Medicare Advantage	$8,675.12

RENAL FAILURE WITH MCC

Facility

$26,826.16

Service Code	MSDRG 682
Min. Negotiated Rate	$13,413.08
Max. Negotiated Rate	$26,826.16
Rate for Payer: Aetna Medicare Advantage	$13,413.08
Rate for Payer: Cigna Commercial HMO & PPO	$13,413.08
Rate for Payer: Home State Health Plan Medicare Advantage	$13,413.08
Rate for Payer: Humana Commercial	$26,826.16
Rate for Payer: Humana Medicare Advantage	$13,413.08

RENAL FAILURE WITHOUT CC/MCC

Facility

$13,051.06

Service Code	MSDRG 684
Min. Negotiated Rate	$6,525.53
Max. Negotiated Rate	$13,051.06
Rate for Payer: Aetna Medicare Advantage	$6,525.53
Rate for Payer: Cigna Commercial HMO & PPO	$6,525.53
Rate for Payer: Home State Health Plan Medicare Advantage	$6,525.53
Rate for Payer: Humana Commercial	$13,051.06
Rate for Payer: Humana Medicare Advantage	$6,525.53

RENAL PANEL

Facility

$306.00

Service Code	CPT 80069
Hospital Charge Code	2280069
Hospital Revenue Code	301
Rate for Payer: Cash Price	$275.40

RENAL PANEL

Facility

$306.00

Service Code	CPT 80069
Hospital Charge Code	2280069
Hospital Revenue Code	301
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$218.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.81
Rate for Payer: Aetna Medicare Advantage	$8.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$181.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$218.48
Rate for Payer: Cash Price	$275.40
Rate for Payer: Cash Price	$275.40
Rate for Payer: Cash Price	$275.40
Rate for Payer: Cigna Commercial HMO & PPO	$8.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.36
Rate for Payer: Home State Health Plan Medicare Advantage	$8.68
Rate for Payer: Humana Commercial	$17.36
Rate for Payer: Humana Medicare Advantage	$8.68
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$110.16

RENIN ACTIVITY

Facility

$138.00

Service Code	CPT 84244
Hospital Charge Code	2219198
Hospital Revenue Code	302
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$98.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.79
Rate for Payer: Aetna Medicare Advantage	$21.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$81.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$98.53
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cigna Commercial HMO & PPO	$21.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21.18
Rate for Payer: Home State Health Plan Medicare Advantage	$21.99
Rate for Payer: Humana Commercial	$43.98
Rate for Payer: Humana Medicare Advantage	$21.99
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$49.68

RENIN ACTIVITY

Facility

$138.00

Service Code	CPT 84244
Hospital Charge Code	2219198
Hospital Revenue Code	302
Rate for Payer: Cash Price	$124.20

REPAGLINIDE (PRANDIN) 1MG TAB

Facility

$21.00

Service Code	NDC 5.7664E+10
Hospital Charge Code	2621503
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

REPAGLINIDE (PRANDIN) 1MG TAB

Facility

$21.00

Service Code	NDC 5.7664E+10
Hospital Charge Code	2621503
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

REPAIR

Facility

$518.00

Service Code	CPT 13131
Hospital Charge Code	4113131
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
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	$306.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$369.85
Rate for Payer: Cash Price	$466.20
Rate for Payer: Cash Price	$466.20
Rate for Payer: Cash Price	$466.20
Rate for Payer: Cash Price	$466.20
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	$345.51
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REPAIR

Facility

$518.00

Service Code	CPT 13131
Hospital Charge Code	4113131
Hospital Revenue Code	521
Rate for Payer: Cash Price	$466.20

Know your out-of-pocket cost for care.

All Charges