Madison Medical Center

All Charges

Charge

Type

Setting

Price

MALIGNANT BREAST DISORDERS

Facility

$6,295.05

Service Code	APR-DRG 3821
Min. Negotiated Rate	$6,295.05
Max. Negotiated Rate	$6,295.05
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,295.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,295.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,295.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,295.05

MALIGNANT BREAST DISORDERS WITH CC

Facility

$21,348.64

Service Code	MSDRG 598
Min. Negotiated Rate	$10,674.32
Max. Negotiated Rate	$21,348.64
Rate for Payer: Aetna Medicare Advantage	$10,674.32
Rate for Payer: Cigna Commercial HMO & PPO	$10,674.32
Rate for Payer: Home State Health Plan Medicare Advantage	$10,674.32
Rate for Payer: Humana Commercial	$21,348.64
Rate for Payer: Humana Medicare Advantage	$10,674.32

MALIGNANT BREAST DISORDERS WITH MCC

Facility

$29,755.00

Service Code	MSDRG 597
Min. Negotiated Rate	$14,877.50
Max. Negotiated Rate	$29,755.00
Rate for Payer: Aetna Medicare Advantage	$14,877.50
Rate for Payer: Cigna Commercial HMO & PPO	$14,877.50
Rate for Payer: Home State Health Plan Medicare Advantage	$14,877.50
Rate for Payer: Humana Commercial	$29,755.00
Rate for Payer: Humana Medicare Advantage	$14,877.50

MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$15,685.16

Service Code	MSDRG 599
Min. Negotiated Rate	$7,842.58
Max. Negotiated Rate	$15,685.16
Rate for Payer: Aetna Medicare Advantage	$7,842.58
Rate for Payer: Cigna Commercial HMO & PPO	$7,842.58
Rate for Payer: Home State Health Plan Medicare Advantage	$7,842.58
Rate for Payer: Humana Commercial	$15,685.16
Rate for Payer: Humana Medicare Advantage	$7,842.58

MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS

Facility

$28,475.85

Service Code	APR-DRG 4214
Min. Negotiated Rate	$28,475.85
Max. Negotiated Rate	$28,475.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$28,475.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28,475.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28,475.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28,475.85

MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS

Facility

$24,129.14

Service Code	APR-DRG 4213
Min. Negotiated Rate	$24,129.14
Max. Negotiated Rate	$24,129.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$24,129.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24,129.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24,129.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24,129.14

MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS

Facility

$12,845.14

Service Code	APR-DRG 4212
Min. Negotiated Rate	$12,845.14
Max. Negotiated Rate	$12,845.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,845.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,845.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,845.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,845.14

MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS

Facility

$10,904.92

Service Code	APR-DRG 4211
Min. Negotiated Rate	$10,904.92
Max. Negotiated Rate	$10,904.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,904.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,904.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,904.92
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,904.92

MAMMOGRAM BILAT DIAG

Facility

$521.00

Service Code	CPT 77066
Hospital Charge Code	3777056
Hospital Revenue Code	401
Rate for Payer: Cash Price	$468.90

MAMMOGRAM BILAT DIAG

Facility

$521.00

Service Code	CPT 77066
Hospital Charge Code	3777056
Hospital Revenue Code	401
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$371.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$136.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$308.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$371.99
Rate for Payer: Cash Price	$468.90
Rate for Payer: Cash Price	$468.90
Rate for Payer: Cash Price	$468.90
Rate for Payer: Cash Price	$468.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$136.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$145.56
Rate for Payer: UnitedHealthcare Commercial	$111.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$136.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$187.56

MAMMOGRAM SCREENING

Facility

$326.00

Service Code	CPT 77067
Hospital Charge Code	374275
Hospital Revenue Code	403
Min. Negotiated Rate	$109.32
Max. Negotiated Rate	$232.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$109.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$192.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$232.76
Rate for Payer: Cash Price	$293.40
Rate for Payer: Cash Price	$293.40
Rate for Payer: Cash Price	$293.40
Rate for Payer: Cash Price	$293.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$109.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$116.97
Rate for Payer: UnitedHealthcare Commercial	$111.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$109.32

MAMMOGRAM SCREENING

Facility

$326.00

Service Code	CPT 77067
Hospital Charge Code	374275
Hospital Revenue Code	403
Rate for Payer: Cash Price	$293.40

MAMMOGRAM UNILATERAL LEFT

Facility

$326.00

Service Code	CPT 77065
Hospital Charge Code	3777054
Hospital Revenue Code	401
Rate for Payer: Cash Price	$293.40

MAMMOGRAM UNILATERAL LEFT

Facility

$326.00

Service Code	CPT 77065
Hospital Charge Code	3777054
Hospital Revenue Code	401
Min. Negotiated Rate	$107.41
Max. Negotiated Rate	$232.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$107.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$192.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$232.76
Rate for Payer: Cash Price	$293.40
Rate for Payer: Cash Price	$293.40
Rate for Payer: Cash Price	$293.40
Rate for Payer: Cash Price	$293.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$114.93
Rate for Payer: UnitedHealthcare Commercial	$111.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$107.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$117.36

MAMMOGRAM UNILATERAL RIGHT

Facility

$326.00

Service Code	CPT 77065
Hospital Charge Code	3777055
Hospital Revenue Code	401
Min. Negotiated Rate	$107.41
Max. Negotiated Rate	$232.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$107.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$192.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$232.76
Rate for Payer: Cash Price	$293.40
Rate for Payer: Cash Price	$293.40
Rate for Payer: Cash Price	$293.40
Rate for Payer: Cash Price	$293.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$114.93
Rate for Payer: UnitedHealthcare Commercial	$111.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$107.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$117.36

MAMMOGRAM UNILATERAL RIGHT

Facility

$326.00

Service Code	CPT 77065
Hospital Charge Code	3777055
Hospital Revenue Code	401
Rate for Payer: Cash Price	$293.40

MANDIBLE X-RAY

Facility

$583.00

Service Code	CPT 70110
Hospital Charge Code	3213106
Hospital Revenue Code	320
Rate for Payer: Cash Price	$524.70

MANDIBLE X-RAY

Facility

$583.00

Service Code	CPT 70110
Hospital Charge Code	3213106
Hospital Revenue Code	320
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$416.26
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	$345.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$416.26
Rate for Payer: Cash Price	$524.70
Rate for Payer: Cash Price	$524.70
Rate for Payer: Cash Price	$524.70
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	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$209.88

MANGANESE BLOOD

Facility

$307.00

Service Code	CPT 83785
Hospital Charge Code	2283785
Hospital Revenue Code	301
Rate for Payer: Cash Price	$276.30

MANGANESE BLOOD

Facility

$307.00

Service Code	CPT 83785
Hospital Charge Code	2283785
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$219.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$23.99
Rate for Payer: Aetna Medicare Advantage	$26.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$181.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$219.20
Rate for Payer: Cash Price	$276.30
Rate for Payer: Cash Price	$276.30
Rate for Payer: Cash Price	$276.30
Rate for Payer: Cigna Commercial HMO & PPO	$26.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25.67
Rate for Payer: Home State Health Plan Medicare Advantage	$26.65
Rate for Payer: Humana Commercial	$53.30
Rate for Payer: Humana Medicare Advantage	$26.65
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$110.52

MANIPULATION 1 -2

Facility

$95.00

Service Code	CPT 98925
Hospital Charge Code	4198925
Hospital Revenue Code	521
Rate for Payer: Cash Price	$85.50

MANIPULATION 1 -2

Facility

$95.00

Service Code	CPT 98925
Hospital Charge Code	4198925
Hospital Revenue Code	521
Min. Negotiated Rate	$17.51
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.46
Rate for Payer: Aetna Medicare Advantage	$22.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$67.83
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cigna Commercial HMO & PPO	$22.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.82
Rate for Payer: Home State Health Plan Medicare Advantage	$22.06
Rate for Payer: Humana Commercial	$44.12
Rate for Payer: Humana Medicare Advantage	$22.06
Rate for Payer: UnitedHealthcare Commercial	$63.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MANIPULATION 3 - 4

Facility

$130.00

Service Code	CPT 98926
Hospital Charge Code	4198926
Hospital Revenue Code	521
Min. Negotiated Rate	$17.51
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.46
Rate for Payer: Aetna Medicare Advantage	$22.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.82
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial HMO & PPO	$22.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.82
Rate for Payer: Home State Health Plan Medicare Advantage	$22.06
Rate for Payer: Humana Commercial	$44.12
Rate for Payer: Humana Medicare Advantage	$22.06
Rate for Payer: UnitedHealthcare Commercial	$86.71
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MANIPULATION 3 - 4

Facility

$130.00

Service Code	CPT 98926
Hospital Charge Code	4198926
Hospital Revenue Code	521
Rate for Payer: Cash Price	$117.00

MANIPULATION 5 -6

Facility

$170.00

Service Code	CPT 98927
Hospital Charge Code	4198927
Hospital Revenue Code	521
Min. Negotiated Rate	$17.51
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.46
Rate for Payer: Aetna Medicare Advantage	$22.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$121.38
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cigna Commercial HMO & PPO	$22.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.82
Rate for Payer: Home State Health Plan Medicare Advantage	$22.06
Rate for Payer: Humana Commercial	$44.12
Rate for Payer: Humana Medicare Advantage	$22.06
Rate for Payer: UnitedHealthcare Commercial	$113.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges