Madison Medical Center

All Charges

Charge

Type

Setting

Price

SPECIAL HANDLING-PHY.

Facility

$29.00

Service Code	CPT 88302
Hospital Charge Code	4188302
Hospital Revenue Code	521
Rate for Payer: Cash Price	$26.10

SPECIAL STAINS GP. III

Facility

$127.00

Service Code	CPT 88313
Hospital Charge Code	2288313
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
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	$75.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$90.68
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$119.94
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	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.72

SPECIAL STAINS GP. III

Facility

$127.00

Service Code	CPT 88313
Hospital Charge Code	2288313
Hospital Revenue Code	305
Rate for Payer: Cash Price	$114.30

SPECIAL STAINS GPS. I & II

Facility

$479.00

Service Code	CPT 88312
Hospital Charge Code	2288312
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$342.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$46.98
Rate for Payer: Aetna Medicare Advantage	$53.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$283.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$342.01
Rate for Payer: Cash Price	$431.10
Rate for Payer: Cash Price	$431.10
Rate for Payer: Cash Price	$431.10
Rate for Payer: Cigna Commercial HMO & PPO	$53.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$46.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$50.27
Rate for Payer: Home State Health Plan Medicare Advantage	$53.24
Rate for Payer: Humana Commercial	$106.48
Rate for Payer: Humana Medicare Advantage	$53.24
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$46.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$172.44

SPECIAL STAINS GPS. I & II

Facility

$479.00

Service Code	CPT 88312
Hospital Charge Code	2288312
Hospital Revenue Code	305
Rate for Payer: Cash Price	$431.10

SPECIFIC GRAVITY FLUID

Facility

$101.00

Service Code	CPT 81003
Hospital Charge Code	2281003
Hospital Revenue Code	301
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$72.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.03
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cigna Commercial HMO & PPO	$2.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2.17
Rate for Payer: Home State Health Plan Medicare Advantage	$2.25
Rate for Payer: Humana Commercial	$4.50
Rate for Payer: Humana Medicare Advantage	$2.25
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

SPECIFIC GRAVITY FLUID

Facility

$101.00

Service Code	CPT 81003
Hospital Charge Code	2281003
Hospital Revenue Code	301
Rate for Payer: Cash Price	$90.90

SPECIMAN JAR

Facility

$15.00

Hospital Charge Code	2819411
Hospital Revenue Code	271
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

SPECIMAN JAR

Facility

$15.00

Hospital Charge Code	2819411
Hospital Revenue Code	271
Rate for Payer: Cash Price	$13.50

SPECIMAN TRAP/40CC(SUCTION)

Facility

$67.00

Hospital Charge Code	2819397
Hospital Revenue Code	271
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

SPECIMAN TRAP/40CC(SUCTION)

Facility

$67.00

Hospital Charge Code	2819397
Hospital Revenue Code	271
Rate for Payer: Cash Price	$60.30

SPECIMEN COLLECTION

Facility

$48.00

Hospital Charge Code	226666
Hospital Revenue Code	305
Rate for Payer: Cash Price	$43.20

SPECIMEN COLLECTION

Facility

$48.00

Hospital Charge Code	226666
Hospital Revenue Code	305
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
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: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

SPECULUM

Facility

$16.00

Hospital Charge Code	2819412
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

SPECULUM

Facility

$16.00

Hospital Charge Code	2819412
Hospital Revenue Code	271
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

SPERM CHECK SLIDE ONLY

Facility

$129.00

Service Code	CPT 89321
Hospital Charge Code	2227103
Hospital Revenue Code	306
Rate for Payer: Cash Price	$116.10

SPERM CHECK SLIDE ONLY

Facility

$129.00

Service Code	CPT 89321
Hospital Charge Code	2227103
Hospital Revenue Code	306
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$92.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.85
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cigna Commercial HMO & PPO	$12.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.61
Rate for Payer: Home State Health Plan Medicare Advantage	$12.05
Rate for Payer: Humana Commercial	$24.10
Rate for Payer: Humana Medicare Advantage	$12.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

SPHINCTEROTOMY, ANAL DIV OF SPINCTER

Professional

Both

$549.00

Service Code	CPT 46080
Hospital Charge Code	4146080
Hospital Revenue Code	975
Min. Negotiated Rate	$142.45
Max. Negotiated Rate	$243.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$142.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$221.59
Rate for Payer: Cash Price	$494.10
Rate for Payer: Cash Price	$494.10
Rate for Payer: Cigna Commercial HMO & PPO	$142.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$221.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$243.75
Rate for Payer: Home State Health Plan Medicare Advantage	$142.45
Rate for Payer: Optum Medicare Advantage	$192.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$221.59

SPINAL BLOCK TRAY

Facility

$65.00

Hospital Charge Code	2819456
Hospital Revenue Code	272
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

SPINAL BLOCK TRAY

Facility

$65.00

Hospital Charge Code	2819456
Hospital Revenue Code	272
Rate for Payer: Cash Price	$58.50

SPINAL DISORDERS AND INJURIES

Facility

$29,220.35

Service Code	APR-DRG 0404
Min. Negotiated Rate	$29,220.35
Max. Negotiated Rate	$29,220.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$29,220.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29,220.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29,220.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29,220.35

SPINAL DISORDERS AND INJURIES

Facility

$20,055.59

Service Code	APR-DRG 0403
Min. Negotiated Rate	$20,055.59
Max. Negotiated Rate	$20,055.59
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,055.59
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,055.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,055.59
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,055.59

SPINAL DISORDERS AND INJURIES

Facility

$10,690.21

Service Code	APR-DRG 0401
Min. Negotiated Rate	$10,690.21
Max. Negotiated Rate	$10,690.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,690.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,690.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,690.21
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,690.21

SPINAL DISORDERS AND INJURIES

Facility

$17,619.48

Service Code	APR-DRG 0402
Min. Negotiated Rate	$17,619.48
Max. Negotiated Rate	$17,619.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,619.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,619.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,619.48
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,619.48

SPINAL DISORDERS AND INJURIES WITH CC/MCC

Facility

$32,026.68

Service Code	MSDRG 052
Min. Negotiated Rate	$16,013.34
Max. Negotiated Rate	$32,026.68
Rate for Payer: Aetna Medicare Advantage	$16,013.34
Rate for Payer: Cigna Commercial HMO & PPO	$16,013.34
Rate for Payer: Home State Health Plan Medicare Advantage	$16,013.34
Rate for Payer: Humana Commercial	$32,026.68
Rate for Payer: Humana Medicare Advantage	$16,013.34

Know your out-of-pocket cost for care.

All Charges