Madison Medical Center

All Charges

Charge

Type

Setting

Price

US LIMITED OB (AFI & ECT.)

Facility

$744.00

Service Code	CPT 76815
Hospital Charge Code	3576815
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$531.22
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$440.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$531.22
Rate for Payer: Cash Price	$669.60
Rate for Payer: Cash Price	$669.60
Rate for Payer: Cash Price	$669.60
Rate for Payer: Cash Price	$669.60
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$267.84

US MASS SOFT TISSUE

Facility

$744.00

Service Code	CPT 76882
Hospital Charge Code	3576882
Hospital Revenue Code	402
Rate for Payer: Cash Price	$669.60

US MASS SOFT TISSUE

Facility

$744.00

Service Code	CPT 76882
Hospital Charge Code	3576882
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$531.22
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$440.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$531.22
Rate for Payer: Cash Price	$669.60
Rate for Payer: Cash Price	$669.60
Rate for Payer: Cash Price	$669.60
Rate for Payer: Cash Price	$669.60
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$267.84

US M-MODE ECHOCARDIOGRAM

Facility

$1,157.00

Service Code	CPT 93307
Hospital Charge Code	3500235
Hospital Revenue Code	402
Rate for Payer: Cash Price	$1,041.30

US M-MODE ECHOCARDIOGRAM

Facility

$1,329.00

Service Code	CPT 93307
Hospital Charge Code	3593307
Hospital Revenue Code	480
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$948.91
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$786.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$948.91
Rate for Payer: Cash Price	$1,196.10
Rate for Payer: Cash Price	$1,196.10
Rate for Payer: Cash Price	$1,196.10
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$886.44
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$478.44

US M-MODE ECHOCARDIOGRAM

Facility

$1,329.00

Service Code	CPT 93307
Hospital Charge Code	3593307
Hospital Revenue Code	480
Rate for Payer: Cash Price	$1,196.10

US M-MODE ECHOCARDIOGRAM

Facility

$1,157.00

Service Code	CPT 93307
Hospital Charge Code	3500235
Hospital Revenue Code	402
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$826.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$684.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$826.10
Rate for Payer: Cash Price	$1,041.30
Rate for Payer: Cash Price	$1,041.30
Rate for Payer: Cash Price	$1,041.30
Rate for Payer: Cash Price	$1,041.30
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$416.52

US NEEDLE GUIDANCE

Facility

$288.00

Service Code	CPT 76942
Hospital Charge Code	3576942
Hospital Revenue Code	402
Min. Negotiated Rate	$103.68
Max. Negotiated Rate	$269.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$170.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$205.63
Rate for Payer: Cash Price	$259.20
Rate for Payer: Cash Price	$259.20
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.68

US NEEDLE GUIDANCE

Facility

$288.00

Service Code	CPT 76942
Hospital Charge Code	3576942
Hospital Revenue Code	402
Rate for Payer: Cash Price	$259.20

US OB < 14 WEEKS

Facility

$1,020.00

Service Code	CPT 76801
Hospital Charge Code	3576801
Hospital Revenue Code	402
Rate for Payer: Cash Price	$918.00

US OB < 14 WEEKS

Facility

$1,020.00

Service Code	CPT 76801
Hospital Charge Code	3576801
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$728.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$603.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$728.28
Rate for Payer: Cash Price	$918.00
Rate for Payer: Cash Price	$918.00
Rate for Payer: Cash Price	$918.00
Rate for Payer: Cash Price	$918.00
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$367.20

US OB > 14 WEEKS

Facility

$1,020.00

Service Code	CPT 76805
Hospital Charge Code	3576805
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$728.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$603.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$728.28
Rate for Payer: Cash Price	$918.00
Rate for Payer: Cash Price	$918.00
Rate for Payer: Cash Price	$918.00
Rate for Payer: Cash Price	$918.00
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$367.20

US OB > 14 WEEKS

Facility

$1,020.00

Service Code	CPT 76805
Hospital Charge Code	3576805
Hospital Revenue Code	402
Rate for Payer: Cash Price	$918.00

US PELVIC (NON-0B)

Facility

$972.00

Service Code	CPT 76856
Hospital Charge Code	3576856
Hospital Revenue Code	402
Rate for Payer: Cash Price	$874.80

US PELVIC (NON-0B)

Facility

$972.00

Service Code	CPT 76856
Hospital Charge Code	3576856
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$694.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$575.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$694.01
Rate for Payer: Cash Price	$874.80
Rate for Payer: Cash Price	$874.80
Rate for Payer: Cash Price	$874.80
Rate for Payer: Cash Price	$874.80
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$349.92

US PELVIC TRANS VAGINAL

Facility

$684.00

Service Code	CPT 76830
Hospital Charge Code	3576830
Hospital Revenue Code	402
Rate for Payer: Cash Price	$615.60

US PELVIC TRANS VAGINAL

Facility

$684.00

Service Code	CPT 76830
Hospital Charge Code	3576830
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$488.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$404.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$488.38
Rate for Payer: Cash Price	$615.60
Rate for Payer: Cash Price	$615.60
Rate for Payer: Cash Price	$615.60
Rate for Payer: Cash Price	$615.60
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$246.24

US PROSTATE TRANSRECTAL

Facility

$799.00

Service Code	CPT 76872
Hospital Charge Code	3576872
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$570.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$473.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$570.49
Rate for Payer: Cash Price	$719.10
Rate for Payer: Cash Price	$719.10
Rate for Payer: Cash Price	$719.10
Rate for Payer: Cash Price	$719.10
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$287.64

US PROSTATE TRANSRECTAL

Facility

$799.00

Service Code	CPT 76872
Hospital Charge Code	3576872
Hospital Revenue Code	402
Rate for Payer: Cash Price	$719.10

US RENAL

Facility

$831.00

Service Code	CPT 76770
Hospital Charge Code	3576770
Hospital Revenue Code	402
Rate for Payer: Cash Price	$747.90

US RENAL

Facility

$831.00

Service Code	CPT 76770
Hospital Charge Code	3576770
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$593.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$491.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$593.33
Rate for Payer: Cash Price	$747.90
Rate for Payer: Cash Price	$747.90
Rate for Payer: Cash Price	$747.90
Rate for Payer: Cash Price	$747.90
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$299.16

US RENAL UNILATERAL

Facility

$784.00

Service Code	CPT 76775
Hospital Charge Code	3576775
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$559.78
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$464.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$559.78
Rate for Payer: Cash Price	$705.60
Rate for Payer: Cash Price	$705.60
Rate for Payer: Cash Price	$705.60
Rate for Payer: Cash Price	$705.60
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$282.24

US RENAL UNILATERAL

Facility

$784.00

Service Code	CPT 76775
Hospital Charge Code	3576775
Hospital Revenue Code	402
Rate for Payer: Cash Price	$705.60

US STERILE CENTESIS KIT

Facility

$244.00

Hospital Charge Code	3500300
Hospital Revenue Code	402
Min. Negotiated Rate	$87.84
Max. Negotiated Rate	$269.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$144.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.22
Rate for Payer: Cash Price	$219.60
Rate for Payer: Cash Price	$219.60
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$87.84

US STERILE CENTESIS KIT

Facility

$244.00

Hospital Charge Code	3500300
Hospital Revenue Code	402
Rate for Payer: Cash Price	$219.60

Know your out-of-pocket cost for care.

All Charges