Madison Medical Center

All Charges

Charge

Type

Setting

Price

SHOULDER XRAY LT

Facility

$465.00

Service Code	CPT 73030
Hospital Charge Code	3219115
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$332.01
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	$275.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$332.01
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
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	$167.40

SHOULDER XRAY LT

Facility

$465.00

Service Code	CPT 73030
Hospital Charge Code	3219115
Hospital Revenue Code	320
Rate for Payer: Cash Price	$418.50

SHOULDER XRAY RT

Facility

$465.00

Service Code	CPT 73030
Hospital Charge Code	3219116
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$332.01
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	$275.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$332.01
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
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	$167.40

SHOULDER XRAY RT

Facility

$465.00

Service Code	CPT 73030
Hospital Charge Code	3219116
Hospital Revenue Code	320
Rate for Payer: Cash Price	$418.50

SHRT LEG CAST TOES TO KNEE

Professional

Both

$663.00

Service Code	CPT 29405
Hospital Charge Code	1829405
Hospital Revenue Code	981
Min. Negotiated Rate	$52.16
Max. Negotiated Rate	$232.05
Rate for Payer: Aetna Commercial/Medicare Advantage	$52.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$59.25
Rate for Payer: Cash Price	$596.70
Rate for Payer: Cash Price	$596.70
Rate for Payer: Cigna Commercial HMO & PPO	$52.16
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$59.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$65.17
Rate for Payer: Home State Health Plan Medicare Advantage	$52.16
Rate for Payer: Optum Medicare Advantage	$232.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$59.25

SHRT SPLINT - CALF TO FOOT

Professional

Both

$448.00

Service Code	CPT 29515
Hospital Charge Code	1829515
Hospital Revenue Code	981
Min. Negotiated Rate	$46.62
Max. Negotiated Rate	$156.80
Rate for Payer: Aetna Commercial/Medicare Advantage	$46.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$52.90
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cigna Commercial HMO & PPO	$46.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$52.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$58.19
Rate for Payer: Home State Health Plan Medicare Advantage	$46.62
Rate for Payer: Optum Medicare Advantage	$156.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$52.90

SHUR-CLENS

Facility

$58.00

Hospital Charge Code	2819237
Hospital Revenue Code	271
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
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: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

SHUR-CLENS

Facility

$58.00

Hospital Charge Code	2819237
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

SICKLE CELL ANEMIA CRISIS

Facility

$11,993.72

Service Code	APR-DRG 6622
Min. Negotiated Rate	$11,993.72
Max. Negotiated Rate	$11,993.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,993.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,993.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,993.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,993.72

SICKLE CELL ANEMIA CRISIS

Facility

$52,729.74

Service Code	APR-DRG 6624
Min. Negotiated Rate	$52,729.74
Max. Negotiated Rate	$52,729.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$52,729.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$52,729.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$52,729.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$52,729.74

SICKLE CELL ANEMIA CRISIS

Facility

$23,570.82

Service Code	APR-DRG 6623
Min. Negotiated Rate	$23,570.82
Max. Negotiated Rate	$23,570.82
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,570.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,570.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,570.82
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,570.82

SICKLE CELL ANEMIA CRISIS

Facility

$8,651.03

Service Code	APR-DRG 6621
Min. Negotiated Rate	$8,651.03
Max. Negotiated Rate	$8,651.03
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,651.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,651.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,651.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,651.03

SICKLE CELL PREP

Facility

$22.00

Service Code	CPT 85660
Hospital Charge Code	4285660
Hospital Revenue Code	521
Rate for Payer: Cash Price	$19.80

SICKLE CELL PREP

Facility

$22.00

Service Code	CPT 85660
Hospital Charge Code	4285660
Hospital Revenue Code	521
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.96
Rate for Payer: Aetna Medicare Advantage	$5.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.31
Rate for Payer: Home State Health Plan Medicare Advantage	$5.51
Rate for Payer: Humana Commercial	$11.02
Rate for Payer: Humana Medicare Advantage	$5.51
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SICKLE CELL SCREEN

Facility

$63.00

Service Code	CPT 85660
Hospital Charge Code	2285018
Hospital Revenue Code	305
Rate for Payer: Cash Price	$56.70

SICKLE CELL SCREEN

Facility

$63.00

Service Code	CPT 85660
Hospital Charge Code	2285018
Hospital Revenue Code	305
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$44.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.96
Rate for Payer: Aetna Medicare Advantage	$5.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cigna Commercial HMO & PPO	$5.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.31
Rate for Payer: Home State Health Plan Medicare Advantage	$5.51
Rate for Payer: Humana Commercial	$11.02
Rate for Payer: Humana Medicare Advantage	$5.51
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

SIDEKICK LOW PROFILE WALKER

Facility

$225.00

Service Code	CPT L4386
Hospital Charge Code	5204386
Hospital Revenue Code	521
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$133.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$160.65
Rate for Payer: Cash Price	$202.50
Rate for Payer: Cash Price	$202.50
Rate for Payer: UnitedHealthcare Commercial	$150.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SIDEKICK LOW PROFILE WALKER

Facility

$225.00

Service Code	CPT L4386
Hospital Charge Code	5204386
Hospital Revenue Code	521
Rate for Payer: Cash Price	$202.50

SIGM'COPY FLEX,W/BIOPSY

Professional

Both

$341.00

Service Code	CPT 45331
Hospital Charge Code	4145331
Hospital Revenue Code	975
Min. Negotiated Rate	$63.22
Max. Negotiated Rate	$273.13
Rate for Payer: Aetna Commercial/Medicare Advantage	$63.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$248.30
Rate for Payer: Cash Price	$306.90
Rate for Payer: Cash Price	$306.90
Rate for Payer: Cigna Commercial HMO & PPO	$63.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$248.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$273.13
Rate for Payer: Home State Health Plan Medicare Advantage	$63.22
Rate for Payer: Optum Medicare Advantage	$119.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$248.30

SIGM'COPY FLEX,W/WO SPECIMAN BY BRUSH

Professional

Both

$240.00

Service Code	CPT 45330
Hospital Charge Code	4145330
Hospital Revenue Code	975
Min. Negotiated Rate	$50.58
Max. Negotiated Rate	$175.18
Rate for Payer: Aetna Commercial/Medicare Advantage	$50.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$159.25
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cigna Commercial HMO & PPO	$50.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$159.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$175.18
Rate for Payer: Home State Health Plan Medicare Advantage	$50.58
Rate for Payer: Optum Medicare Advantage	$84.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$159.25

SIGMOID COLECTOMY W/BAKERS ANASTAMOSIS

Facility

$974.00

Service Code	CPT 44140
Hospital Charge Code	5244140
Hospital Revenue Code	521
Rate for Payer: Cash Price	$876.60

SIGMOID COLECTOMY W/BAKERS ANASTAMOSIS

Facility

$974.00

Service Code	CPT 44140
Hospital Charge Code	5244140
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$695.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$576.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$695.44
Rate for Payer: Cash Price	$876.60
Rate for Payer: Cash Price	$876.60
Rate for Payer: UnitedHealthcare Commercial	$649.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SIGMOIDOSCOPY

Professional

Both

$550.00

Service Code	CPT 45330
Hospital Charge Code	9345330
Hospital Revenue Code	975
Min. Negotiated Rate	$50.58
Max. Negotiated Rate	$192.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$50.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$159.25
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cigna Commercial HMO & PPO	$50.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$159.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$175.18
Rate for Payer: Home State Health Plan Medicare Advantage	$50.58
Rate for Payer: Optum Medicare Advantage	$192.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$159.25

SIGMOIDOSCOPY, FLEXIBLE, W OR W/O COLLEC

Facility

$263.00

Service Code	CPT 45330
Hospital Charge Code	4445330
Hospital Revenue Code	521
Min. Negotiated Rate	$155.70
Max. Negotiated Rate	$1,900.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$838.31
Rate for Payer: Aetna Medicare Advantage	$950.10
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	$950.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$754.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$896.99
Rate for Payer: Home State Health Plan Medicare Advantage	$950.10
Rate for Payer: Humana Commercial	$1,900.20
Rate for Payer: Humana Medicare Advantage	$950.10
Rate for Payer: UnitedHealthcare Commercial	$175.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$838.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SIGMOIDOSCOPY, FLEXIBLE, W OR W/O COLLEC

Facility

$263.00

Service Code	CPT 45330
Hospital Charge Code	4445330
Hospital Revenue Code	521
Rate for Payer: Cash Price	$236.70

Know your out-of-pocket cost for care.

All Charges