Madison Medical Center

All Charges

Charge

Type

Setting

Price

BOVIE PENCIL CONMED #131307A

Facility

$141.00

Hospital Charge Code	1251120
Hospital Revenue Code	271
Min. Negotiated Rate	$50.76
Max. Negotiated Rate	$100.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$83.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$100.67
Rate for Payer: Cash Price	$126.90
Rate for Payer: UnitedHealthcare Commercial	$94.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$50.76

BP180

Facility

$281.00

Service Code	CPT 83516
Hospital Charge Code	2251490
Hospital Revenue Code	305
Rate for Payer: Cash Price	$252.90

BP180

Facility

$281.00

Service Code	CPT 83516
Hospital Charge Code	2251490
Hospital Revenue Code	305
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$200.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$166.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$200.63
Rate for Payer: Cash Price	$252.90
Rate for Payer: Cash Price	$252.90
Rate for Payer: Cash Price	$252.90
Rate for Payer: Cigna Commercial HMO & PPO	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$101.16

BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$7,440.34

Service Code	APR-DRG 1321
Min. Negotiated Rate	$7,440.34
Max. Negotiated Rate	$7,440.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,440.34
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,440.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,440.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,440.34

BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$25,851.03

Service Code	APR-DRG 1324
Min. Negotiated Rate	$25,851.03
Max. Negotiated Rate	$25,851.03
Rate for Payer: Aetna Better Health Medicaid/QHP	$25,851.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25,851.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25,851.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25,851.03

BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$12,523.16

Service Code	APR-DRG 1322
Min. Negotiated Rate	$12,523.16
Max. Negotiated Rate	$12,523.16
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,523.16
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,523.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,523.16
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,523.16

BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$21,165.85

Service Code	APR-DRG 1323
Min. Negotiated Rate	$21,165.85
Max. Negotiated Rate	$21,165.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$21,165.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21,165.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21,165.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21,165.85

B PERTUSSIS IGA

Facility

$107.00

Service Code	CPT 86615
Hospital Charge Code	2287265
Hospital Revenue Code	301
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$76.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.87
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cigna Commercial HMO & PPO	$13.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.70
Rate for Payer: Home State Health Plan Medicare Advantage	$13.19
Rate for Payer: Humana Commercial	$26.38
Rate for Payer: Humana Medicare Advantage	$13.19
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

B PERTUSSIS IGA

Facility

$107.00

Service Code	CPT 86615
Hospital Charge Code	2287265
Hospital Revenue Code	301
Rate for Payer: Cash Price	$96.30

B PERTUSSIS IGG

Facility

$118.00

Service Code	CPT 86615
Hospital Charge Code	22866151
Hospital Revenue Code	301
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$84.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.87
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$69.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$84.25
Rate for Payer: Cash Price	$106.20
Rate for Payer: Cash Price	$106.20
Rate for Payer: Cash Price	$106.20
Rate for Payer: Cigna Commercial HMO & PPO	$13.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.70
Rate for Payer: Home State Health Plan Medicare Advantage	$13.19
Rate for Payer: Humana Commercial	$26.38
Rate for Payer: Humana Medicare Advantage	$13.19
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.48

B PERTUSSIS IGG

Facility

$118.00

Service Code	CPT 86615
Hospital Charge Code	22866151
Hospital Revenue Code	301
Rate for Payer: Cash Price	$106.20

B PERTUSSIS IGM

Facility

$107.00

Service Code	CPT 86615
Hospital Charge Code	2287266
Hospital Revenue Code	301
Rate for Payer: Cash Price	$96.30

B PERTUSSIS IGM

Facility

$107.00

Service Code	CPT 86615
Hospital Charge Code	2287266
Hospital Revenue Code	301
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$76.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.87
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cigna Commercial HMO & PPO	$13.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.70
Rate for Payer: Home State Health Plan Medicare Advantage	$13.19
Rate for Payer: Humana Commercial	$26.38
Rate for Payer: Humana Medicare Advantage	$13.19
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

B PERTUSSIS PCR (AEL)

Facility

$285.00

Hospital Charge Code	2287708
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$203.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$102.60

B PERTUSSIS PCR (AEL)

Facility

$285.00

Hospital Charge Code	2287708
Hospital Revenue Code	306
Rate for Payer: Cash Price	$256.50

B PERTUSSIS PCR (LABCORP)

Facility

$285.00

Hospital Charge Code	2287701
Hospital Revenue Code	306
Rate for Payer: Cash Price	$256.50

B PERTUSSIS PCR (LABCORP)

Facility

$285.00

Hospital Charge Code	2287701
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$203.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$102.60

B QUINTANA IGG

Facility

$59.00

Service Code	CPT 86611
Hospital Charge Code	2286611
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 QUINTANA IGG

Facility

$59.00

Service Code	CPT 86611
Hospital Charge Code	2286611
Hospital Revenue Code	302
Rate for Payer: Cash Price	$53.10

B QUINTANA, IGM

Facility

$54.00

Service Code	CPT 86611
Hospital Charge Code	2286612
Hospital Revenue Code	302
Rate for Payer: Cash Price	$48.60

B QUINTANA, IGM

Facility

$54.00

Service Code	CPT 86611
Hospital Charge Code	2286612
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

BRACE, ANKLE LARGE W/STRAP

Facility

$125.00

Hospital Charge Code	90000388
Hospital Revenue Code	271
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$89.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: UnitedHealthcare Commercial	$83.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

BRACE, ANKLE LARGE W/STRAP

Facility

$125.00

Hospital Charge Code	90000388
Hospital Revenue Code	271
Rate for Payer: Cash Price	$112.50

BRACE, ANKLE X-LARGE W/STRAP

Facility

$125.00

Hospital Charge Code	90000389
Hospital Revenue Code	271
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$89.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: UnitedHealthcare Commercial	$83.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

BRACE, ANKLE X-LARGE W/STRAP

Facility

$125.00

Hospital Charge Code	90000389
Hospital Revenue Code	271
Rate for Payer: Cash Price	$112.50

Know your out-of-pocket cost for care.

All Charges