Madison Medical Center

All Charges

Charge

Type

Setting

Price

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$56,217.23

Service Code	APR-DRG 1633
Min. Negotiated Rate	$56,217.23
Max. Negotiated Rate	$56,217.23
Rate for Payer: Aetna Better Health Medicaid/QHP	$56,217.23
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$56,217.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56,217.23
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$56,217.23

CARDIOLIPIN IgA

Facility

$113.00

Service Code	CPT 86147
Hospital Charge Code	2286147
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$80.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$22.91
Rate for Payer: Aetna Medicare Advantage	$25.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial HMO & PPO	$25.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24.51
Rate for Payer: Home State Health Plan Medicare Advantage	$25.45
Rate for Payer: Humana Commercial	$50.90
Rate for Payer: Humana Medicare Advantage	$25.45
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

CARDIOLIPIN IgA

Facility

$113.00

Service Code	CPT 86147
Hospital Charge Code	2286147
Hospital Revenue Code	302
Rate for Payer: Cash Price	$101.70

CARDIOLIPIN IgG

Facility

$113.00

Service Code	CPT 86147
Hospital Charge Code	2286146
Hospital Revenue Code	302
Rate for Payer: Cash Price	$101.70

CARDIOLIPIN IgG

Facility

$113.00

Service Code	CPT 86147
Hospital Charge Code	2286146
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$80.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$22.91
Rate for Payer: Aetna Medicare Advantage	$25.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial HMO & PPO	$25.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24.51
Rate for Payer: Home State Health Plan Medicare Advantage	$25.45
Rate for Payer: Humana Commercial	$50.90
Rate for Payer: Humana Medicare Advantage	$25.45
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

CARDIOLIPIN IgM

Facility

$113.00

Service Code	CPT 86147
Hospital Charge Code	2286148
Hospital Revenue Code	302
Rate for Payer: Cash Price	$101.70

CARDIOLIPIN IgM

Facility

$113.00

Service Code	CPT 86147
Hospital Charge Code	2286148
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$80.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$22.91
Rate for Payer: Aetna Medicare Advantage	$25.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial HMO & PPO	$25.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24.51
Rate for Payer: Home State Health Plan Medicare Advantage	$25.45
Rate for Payer: Humana Commercial	$50.90
Rate for Payer: Humana Medicare Advantage	$25.45
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

CARDIOMYOPATHY

Facility

$5,765.30

Service Code	APR-DRG 2051
Min. Negotiated Rate	$5,765.30
Max. Negotiated Rate	$5,765.30
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,765.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,765.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,765.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,765.30

CARDIOMYOPATHY

Facility

$20,883.96

Service Code	APR-DRG 2054
Min. Negotiated Rate	$20,883.96
Max. Negotiated Rate	$20,883.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,883.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,883.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,883.96
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,883.96

CARDIOMYOPATHY

Facility

$7,026.34

Service Code	APR-DRG 2052
Min. Negotiated Rate	$7,026.34
Max. Negotiated Rate	$7,026.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,026.34
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,026.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,026.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,026.34

CARDIOMYOPATHY

Facility

$13,129.09

Service Code	APR-DRG 2053
Min. Negotiated Rate	$13,129.09
Max. Negotiated Rate	$13,129.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,129.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,129.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,129.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,129.09

CARDIOVASCULAR STRESS TESTING

Facility

$359.00

Service Code	CPT 93015
Hospital Charge Code	4493015
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$256.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$212.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$256.33
Rate for Payer: Cash Price	$323.10
Rate for Payer: Cash Price	$323.10
Rate for Payer: UnitedHealthcare Commercial	$239.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CARDIOVASCULAR STRESS TESTING

Facility

$359.00

Service Code	CPT 93015
Hospital Charge Code	4493015
Hospital Revenue Code	525
Rate for Payer: Cash Price	$323.10

CARDIOVERSION

Facility

$436.00

Service Code	CPT 92960
Hospital Charge Code	4492960
Hospital Revenue Code	250
Min. Negotiated Rate	$156.96
Max. Negotiated Rate	$1,350.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$595.80
Rate for Payer: Aetna Medicare Advantage	$675.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$258.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$311.30
Rate for Payer: Cash Price	$392.40
Rate for Payer: Cash Price	$392.40
Rate for Payer: Cash Price	$392.40
Rate for Payer: Cigna Commercial HMO & PPO	$675.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$595.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$637.51
Rate for Payer: Home State Health Plan Medicare Advantage	$675.26
Rate for Payer: Humana Commercial	$1,350.52
Rate for Payer: Humana Medicare Advantage	$675.26
Rate for Payer: UnitedHealthcare Commercial	$290.81
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$595.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$156.96

CARDIOVERSION

Facility

$436.00

Service Code	CPT 92960
Hospital Charge Code	4492960
Hospital Revenue Code	250
Rate for Payer: Cash Price	$392.40

CARDIOVERSION, ELECTIVE ARRHY

Professional

Both

$1,287.00

Service Code	CPT 92960
Hospital Charge Code	1892960
Hospital Revenue Code	981
Min. Negotiated Rate	$91.32
Max. Negotiated Rate	$450.45
Rate for Payer: Aetna Commercial/Medicare Advantage	$91.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$175.25
Rate for Payer: Cash Price	$1,158.30
Rate for Payer: Cash Price	$1,158.30
Rate for Payer: Cigna Commercial HMO & PPO	$91.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$175.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$192.78
Rate for Payer: Home State Health Plan Medicare Advantage	$91.32
Rate for Payer: Optum Medicare Advantage	$450.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$175.25

CARE PLAN OVERSIGHT INITIAL CERTIFICATIO

Facility

$132.00

Service Code	CPT G0180
Hospital Charge Code	4400180
Hospital Revenue Code	521
Min. Negotiated Rate	$78.14
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$78.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$94.25
Rate for Payer: Cash Price	$118.80
Rate for Payer: Cash Price	$118.80
Rate for Payer: UnitedHealthcare Commercial	$88.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CARE PLAN OVERSIGHT INITIAL CERTIFICATIO

Facility

$132.00

Service Code	CPT G0180
Hospital Charge Code	4400180
Hospital Revenue Code	521
Rate for Payer: Cash Price	$118.80

CARE PLAN OVERSIGHT RECERTIFICATION

Facility

$110.00

Service Code	CPT G0179
Hospital Charge Code	4400179
Hospital Revenue Code	521
Rate for Payer: Cash Price	$99.00

CARE PLAN OVERSIGHT RECERTIFICATION

Facility

$110.00

Service Code	CPT G0179
Hospital Charge Code	4400179
Hospital Revenue Code	521
Min. Negotiated Rate	$65.12
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: UnitedHealthcare Commercial	$73.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CARH. BARD18 (TIEMAN)

Facility

$44.00

Hospital Charge Code	4000618
Hospital Revenue Code	271
Rate for Payer: Cash Price	$39.60

CARH. BARD18 (TIEMAN)

Facility

$44.00

Hospital Charge Code	4000618
Hospital Revenue Code	271
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

C-ARM DRAPE

Facility

$43.00

Hospital Charge Code	1211347
Hospital Revenue Code	271
Rate for Payer: Cash Price	$38.70

C-ARM DRAPE

Facility

$43.00

Hospital Charge Code	1211347
Hospital Revenue Code	271
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

C ARM FLUORO LESS THAN 1 HR

Facility

$431.00

Service Code	CPT 77002
Hospital Charge Code	3277002
Hospital Revenue Code	360
Rate for Payer: Cash Price	$387.90

Know your out-of-pocket cost for care.

All Charges