Madison Medical Center

All Charges

Charge

Type

Setting

Price

BETHANECHOL (URECHOLINE) 10MG TAB

Facility

$21.00

Hospital Charge Code	2654276
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

BETHANECHOL (URECHOLINE) 10MG TAB

Facility

$21.00

Hospital Charge Code	2654276
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

B HENSELEA IGG

Facility

$59.00

Service Code	CPT 86611
Hospital Charge Code	2286614
Hospital Revenue Code	302
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$42.13
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.16
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.13
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cigna Commercial HMO & PPO	$10.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.80
Rate for Payer: Home State Health Plan Medicare Advantage	$10.18
Rate for Payer: Humana Commercial	$20.36
Rate for Payer: Humana Medicare Advantage	$10.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.24

B HENSELEA IGG

Facility

$59.00

Service Code	CPT 86611
Hospital Charge Code	2286614
Hospital Revenue Code	302
Rate for Payer: Cash Price	$53.10

B HENSELEA IGM

Facility

$54.00

Service Code	CPT 86611
Hospital Charge Code	2286613
Hospital Revenue Code	302
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$38.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.16
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$31.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$38.56
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cigna Commercial HMO & PPO	$10.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.80
Rate for Payer: Home State Health Plan Medicare Advantage	$10.18
Rate for Payer: Humana Commercial	$20.36
Rate for Payer: Humana Medicare Advantage	$10.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.44

B HENSELEA IGM

Facility

$54.00

Service Code	CPT 86611
Hospital Charge Code	2286613
Hospital Revenue Code	302
Rate for Payer: Cash Price	$48.60

BICARBONATE

Facility

$347.00

Service Code	CPT 82374
Hospital Charge Code	2282374
Hospital Revenue Code	301
Rate for Payer: Cash Price	$312.30

BICARBONATE

Facility

$347.00

Service Code	CPT 82374
Hospital Charge Code	2282374
Hospital Revenue Code	301
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$247.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.39
Rate for Payer: Aetna Medicare Advantage	$4.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$205.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$247.76
Rate for Payer: Cash Price	$312.30
Rate for Payer: Cash Price	$312.30
Rate for Payer: Cash Price	$312.30
Rate for Payer: Cigna Commercial HMO & PPO	$4.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicare Advantage	$4.88
Rate for Payer: Humana Commercial	$9.76
Rate for Payer: Humana Medicare Advantage	$4.88
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.92

BICARBONATE URINE RANDOM

Facility

$128.00

Service Code	CPT 82374
Hospital Charge Code	2221212
Hospital Revenue Code	307
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$91.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.39
Rate for Payer: Aetna Medicare Advantage	$4.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$91.39
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cigna Commercial HMO & PPO	$4.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicare Advantage	$4.88
Rate for Payer: Humana Commercial	$9.76
Rate for Payer: Humana Medicare Advantage	$4.88
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.08

BICARBONATE URINE RANDOM

Facility

$128.00

Service Code	CPT 82374
Hospital Charge Code	2221212
Hospital Revenue Code	307
Rate for Payer: Cash Price	$115.20

BICITRA

Facility

$20.00

Hospital Charge Code	2058079
Hospital Revenue Code	370
Rate for Payer: Cash Price	$18.00

BICITRA

Facility

$20.00

Hospital Charge Code	2058079
Hospital Revenue Code	370
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

BILATERAL BONE MARROW ASPIRATION

Facility

$980.00

Service Code	CPT 38220
Hospital Charge Code	538250
Hospital Revenue Code	360
Rate for Payer: Cash Price	$882.00

BILATERAL BONE MARROW ASPIRATION

Facility

$980.00

Service Code	CPT 38220
Hospital Charge Code	538250
Hospital Revenue Code	360
Min. Negotiated Rate	$352.80
Max. Negotiated Rate	$3,374.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,488.83
Rate for Payer: Aetna Medicare Advantage	$1,687.37
Rate for Payer: Cash Price	$882.00
Rate for Payer: Cash Price	$882.00
Rate for Payer: Cash Price	$882.00
Rate for Payer: Cigna Commercial HMO & PPO	$1,687.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,488.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,593.05
Rate for Payer: Home State Health Plan Medicare Advantage	$1,687.37
Rate for Payer: Humana Commercial	$3,374.74
Rate for Payer: Humana Medicare Advantage	$1,687.37
Rate for Payer: UnitedHealthcare Commercial	$947.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$352.80

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC

Facility

$90,810.16

Service Code	MSDRG 461
Min. Negotiated Rate	$45,405.08
Max. Negotiated Rate	$90,810.16
Rate for Payer: Aetna Medicare Advantage	$45,405.08
Rate for Payer: Cigna Commercial HMO & PPO	$45,405.08
Rate for Payer: Home State Health Plan Medicare Advantage	$45,405.08
Rate for Payer: Humana Commercial	$90,810.16
Rate for Payer: Humana Medicare Advantage	$45,405.08

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC

Facility

$45,408.46

Service Code	MSDRG 462
Min. Negotiated Rate	$22,704.23
Max. Negotiated Rate	$45,408.46
Rate for Payer: Aetna Medicare Advantage	$22,704.23
Rate for Payer: Cigna Commercial HMO & PPO	$22,704.23
Rate for Payer: Home State Health Plan Medicare Advantage	$22,704.23
Rate for Payer: Humana Commercial	$45,408.46
Rate for Payer: Humana Medicare Advantage	$22,704.23

BILE ACIDS, FRACTIONATED

Facility

$492.00

Service Code	CPT 82542
Hospital Charge Code	2282239
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$351.29
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	$291.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$351.29
Rate for Payer: Cash Price	$442.80
Rate for Payer: Cash Price	$442.80
Rate for Payer: Cash Price	$442.80
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	$177.12

BILE ACIDS, FRACTIONATED

Facility

$492.00

Service Code	CPT 82542
Hospital Charge Code	2282239
Hospital Revenue Code	301
Rate for Payer: Cash Price	$442.80

BILEBAG

Facility

$183.00

Hospital Charge Code	282727
Hospital Revenue Code	271
Min. Negotiated Rate	$65.88
Max. Negotiated Rate	$130.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$108.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$130.66
Rate for Payer: Cash Price	$164.70
Rate for Payer: UnitedHealthcare Commercial	$122.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.88

BILEBAG

Facility

$183.00

Hospital Charge Code	282727
Hospital Revenue Code	271
Rate for Payer: Cash Price	$164.70

BI LEVEL CIRCUIT W/TUBING AND FILTER

Facility

$79.00

Hospital Charge Code	4500224
Hospital Revenue Code	271
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$56.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$46.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$56.41
Rate for Payer: Cash Price	$71.10
Rate for Payer: UnitedHealthcare Commercial	$52.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.44

BI LEVEL CIRCUIT W/TUBING AND FILTER

Facility

$79.00

Hospital Charge Code	4500224
Hospital Revenue Code	271
Rate for Payer: Cash Price	$71.10

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC

Facility

$37,792.56

Service Code	MSDRG 409
Min. Negotiated Rate	$18,896.28
Max. Negotiated Rate	$37,792.56
Rate for Payer: Aetna Medicare Advantage	$18,896.28
Rate for Payer: Cigna Commercial HMO & PPO	$18,896.28
Rate for Payer: Home State Health Plan Medicare Advantage	$18,896.28
Rate for Payer: Humana Commercial	$37,792.56
Rate for Payer: Humana Medicare Advantage	$18,896.28

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC

Facility

$59,745.68

Service Code	MSDRG 408
Min. Negotiated Rate	$29,872.84
Max. Negotiated Rate	$59,745.68
Rate for Payer: Aetna Medicare Advantage	$29,872.84
Rate for Payer: Cigna Commercial HMO & PPO	$29,872.84
Rate for Payer: Home State Health Plan Medicare Advantage	$29,872.84
Rate for Payer: Humana Commercial	$59,745.68
Rate for Payer: Humana Medicare Advantage	$29,872.84

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$28,504.12

Service Code	MSDRG 410
Min. Negotiated Rate	$14,252.06
Max. Negotiated Rate	$28,504.12
Rate for Payer: Aetna Medicare Advantage	$14,252.06
Rate for Payer: Cigna Commercial HMO & PPO	$14,252.06
Rate for Payer: Home State Health Plan Medicare Advantage	$14,252.06
Rate for Payer: Humana Commercial	$28,504.12
Rate for Payer: Humana Medicare Advantage	$14,252.06

Know your out-of-pocket cost for care.

All Charges