Madison Medical Center

All Charges

Charge

Type

Setting

Price

CAUTERIAZTION OF CERVIX CRYCAUTERY

Facility

$255.00

Service Code	CPT 57511
Hospital Charge Code	5257511
Hospital Revenue Code	521
Rate for Payer: Cash Price	$229.50

CAUTERIAZTION OF CERVIX CRYCAUTERY

Facility

$255.00

Service Code	CPT 57511
Hospital Charge Code	5257511
Hospital Revenue Code	521
Min. Negotiated Rate	$150.96
Max. Negotiated Rate	$622.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$274.70
Rate for Payer: Aetna Medicare Advantage	$311.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.07
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cigna Commercial HMO & PPO	$311.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$247.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$293.93
Rate for Payer: Home State Health Plan Medicare Advantage	$311.33
Rate for Payer: Humana Commercial	$622.66
Rate for Payer: Humana Medicare Advantage	$311.33
Rate for Payer: UnitedHealthcare Commercial	$170.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$274.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CAUTERIZATION CHEM GRANULATION TISSUE

Facility

$100.00

Service Code	CPT 17250
Hospital Charge Code	4117250
Hospital Revenue Code	521
Min. Negotiated Rate	$59.20
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CAUTERIZATION CHEM GRANULATION TISSUE

Facility

$100.00

Service Code	CPT 17250
Hospital Charge Code	4117250
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.00

CAUTERY/ABLATION MUCOSA

Facility

$158.00

Service Code	CPT 30801
Hospital Charge Code	4430801
Hospital Revenue Code	521
Rate for Payer: Cash Price	$142.20

CAUTERY/ABLATION MUCOSA

Facility

$158.00

Service Code	CPT 30801
Hospital Charge Code	4430801
Hospital Revenue Code	521
Min. Negotiated Rate	$93.54
Max. Negotiated Rate	$3,170.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,398.67
Rate for Payer: Aetna Medicare Advantage	$1,585.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$93.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$112.81
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cigna Commercial HMO & PPO	$1,585.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,258.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,496.58
Rate for Payer: Home State Health Plan Medicare Advantage	$1,585.19
Rate for Payer: Humana Commercial	$3,170.38
Rate for Payer: Humana Medicare Advantage	$1,585.19
Rate for Payer: UnitedHealthcare Commercial	$105.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,398.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CAUTERY, DISP. HI-TEMP

Facility

$273.00

Hospital Charge Code	283023
Hospital Revenue Code	271
Rate for Payer: Cash Price	$245.70

CAUTERY, DISP. HI-TEMP

Facility

$273.00

Hospital Charge Code	283023
Hospital Revenue Code	271
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$194.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$161.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$194.92
Rate for Payer: Cash Price	$245.70
Rate for Payer: UnitedHealthcare Commercial	$182.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$98.28

.CBC AUTO DIFF CHG ONLY

Facility

$166.00

Service Code	CPT 85025
Hospital Charge Code	223106
Hospital Revenue Code	305
Rate for Payer: Cash Price	$149.40

.CBC AUTO DIFF CHG ONLY

Facility

$166.00

Service Code	CPT 85025
Hospital Charge Code	223106
Hospital Revenue Code	305
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$118.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.99
Rate for Payer: Aetna Medicare Advantage	$7.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$98.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$118.52
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cigna Commercial HMO & PPO	$7.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.48
Rate for Payer: Home State Health Plan Medicare Advantage	$7.77
Rate for Payer: Humana Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$7.77
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

.CBC CHG ONLY (NO AUTO DIFF)

Facility

$116.00

Service Code	CPT 85027
Hospital Charge Code	223100
Hospital Revenue Code	305
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$82.82
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.82
Rate for Payer: Aetna Medicare Advantage	$6.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$68.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$82.82
Rate for Payer: Cash Price	$104.40
Rate for Payer: Cash Price	$104.40
Rate for Payer: Cash Price	$104.40
Rate for Payer: Cigna Commercial HMO & PPO	$6.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.23
Rate for Payer: Home State Health Plan Medicare Advantage	$6.47
Rate for Payer: Humana Commercial	$12.94
Rate for Payer: Humana Medicare Advantage	$6.47
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$41.76

.CBC CHG ONLY (NO AUTO DIFF)

Facility

$116.00

Service Code	CPT 85027
Hospital Charge Code	223100
Hospital Revenue Code	305
Rate for Payer: Cash Price	$104.40

CBC PLT NO DIFFERENTIAL

Facility

$155.00

Service Code	CPT 85027
Hospital Charge Code	228100
Hospital Revenue Code	305
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$110.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.82
Rate for Payer: Aetna Medicare Advantage	$6.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$91.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$110.67
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cigna Commercial HMO & PPO	$6.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.23
Rate for Payer: Home State Health Plan Medicare Advantage	$6.47
Rate for Payer: Humana Commercial	$12.94
Rate for Payer: Humana Medicare Advantage	$6.47
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.80

CBC PLT NO DIFFERENTIAL

Facility

$155.00

Service Code	CPT 85027
Hospital Charge Code	228100
Hospital Revenue Code	305
Rate for Payer: Cash Price	$139.50

CBC W/ RFX PATH SLIDE REVIEW (LABCORP)

Facility

$10.00

Service Code	CPT 85025
Hospital Charge Code	225009
Hospital Revenue Code	305
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.99
Rate for Payer: Aetna Medicare Advantage	$7.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.14
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cigna Commercial HMO & PPO	$7.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.48
Rate for Payer: Home State Health Plan Medicare Advantage	$7.77
Rate for Payer: Humana Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$7.77
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.60

CBC W/ RFX PATH SLIDE REVIEW (LABCORP)

Facility

$10.00

Service Code	CPT 85025
Hospital Charge Code	225009
Hospital Revenue Code	305
Rate for Payer: Cash Price	$9.00

CCK

Facility

$644.00

Hospital Charge Code	3214015
Hospital Revenue Code	320
Rate for Payer: Cash Price	$579.60

CCK

Facility

$644.00

Hospital Charge Code	3214015
Hospital Revenue Code	320
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$459.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$381.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$459.82
Rate for Payer: Cash Price	$579.60
Rate for Payer: Cash Price	$579.60
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$231.84

C-COLLAR RIGID&FLEX

Facility

$199.00

Hospital Charge Code	283242
Hospital Revenue Code	271
Min. Negotiated Rate	$71.64
Max. Negotiated Rate	$142.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$117.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.09
Rate for Payer: Cash Price	$179.10
Rate for Payer: UnitedHealthcare Commercial	$132.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.64

C-COLLAR RIGID&FLEX

Facility

$199.00

Hospital Charge Code	283242
Hospital Revenue Code	271
Rate for Payer: Cash Price	$179.10

CCP ANTI

Facility

$112.00

Service Code	CPT 86200
Hospital Charge Code	2283500
Hospital Revenue Code	302
Rate for Payer: Cash Price	$100.80

CCP ANTI

Facility

$112.00

Service Code	CPT 86200
Hospital Charge Code	2283500
Hospital Revenue Code	302
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.66
Rate for Payer: Aetna Medicare Advantage	$12.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$12.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.48
Rate for Payer: Home State Health Plan Medicare Advantage	$12.95
Rate for Payer: Humana Commercial	$25.90
Rate for Payer: Humana Medicare Advantage	$12.95
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

CD4/CD8 RATIO PROFILE

Facility

$178.00

Service Code	CPT 86360
Hospital Charge Code	2286360
Hospital Revenue Code	305
Rate for Payer: Cash Price	$160.20

CD4/CD8 RATIO PROFILE

Facility

$178.00

Service Code	CPT 86360
Hospital Charge Code	2286360
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$127.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$42.28
Rate for Payer: Aetna Medicare Advantage	$46.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cigna Commercial HMO & PPO	$46.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$42.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$45.24
Rate for Payer: Home State Health Plan Medicare Advantage	$46.98
Rate for Payer: Humana Commercial	$93.96
Rate for Payer: Humana Medicare Advantage	$46.98
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$42.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

CD4 COUNT

Facility

$211.00

Service Code	CPT 86361
Hospital Charge Code	2286362
Hospital Revenue Code	301
Rate for Payer: Cash Price	$189.90

Know your out-of-pocket cost for care.

All Charges