Madison Medical Center

All Charges

Charge

Type

Setting

Price

MARSUPIALIZATION OF BARTHOLIN'S GLAND

Facility

$900.00

Service Code	CPT 56440
Hospital Charge Code	4456440
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$6,614.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,918.10
Rate for Payer: Aetna Medicare Advantage	$3,307.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$532.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$642.60
Rate for Payer: Cash Price	$810.00
Rate for Payer: Cash Price	$810.00
Rate for Payer: Cash Price	$810.00
Rate for Payer: Cash Price	$810.00
Rate for Payer: Cigna Commercial HMO & PPO	$3,307.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,626.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,122.37
Rate for Payer: Home State Health Plan Medicare Advantage	$3,307.24
Rate for Payer: Humana Commercial	$6,614.48
Rate for Payer: Humana Medicare Advantage	$3,307.24
Rate for Payer: UnitedHealthcare Commercial	$600.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,918.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MASK

Facility

$106.00

Hospital Charge Code	2813683
Hospital Revenue Code	271
Rate for Payer: Cash Price	$95.40

MASK

Facility

$106.00

Hospital Charge Code	2813683
Hospital Revenue Code	271
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$75.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: UnitedHealthcare Commercial	$70.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

MASK (AEROSOL) HUDSON#1083

Facility

$21.00

Hospital Charge Code	4500442
Hospital Revenue Code	271
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

MASK (AEROSOL) HUDSON#1083

Facility

$21.00

Hospital Charge Code	4500442
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

MASK, ANESTHESIA

Facility

$60.00

Hospital Charge Code	2813680
Hospital Revenue Code	271
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

MASK, ANESTHESIA

Facility

$60.00

Hospital Charge Code	2813680
Hospital Revenue Code	271
Rate for Payer: Cash Price	$54.00

MASK, ANESTHESIA-CHILD

Facility

$11.00

Hospital Charge Code	4500455
Hospital Revenue Code	271
Rate for Payer: Cash Price	$9.90

MASK, ANESTHESIA-CHILD

Facility

$11.00

Hospital Charge Code	4500455
Hospital Revenue Code	271
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$7.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$6.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.85
Rate for Payer: Cash Price	$9.90
Rate for Payer: UnitedHealthcare Commercial	$7.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.96

MASK, ANESTHESIA-INFANT

Facility

$11.00

Hospital Charge Code	4500454
Hospital Revenue Code	271
Rate for Payer: Cash Price	$9.90

MASK, ANESTHESIA-INFANT

Facility

$11.00

Hospital Charge Code	4500454
Hospital Revenue Code	271
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$7.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$6.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.85
Rate for Payer: Cash Price	$9.90
Rate for Payer: UnitedHealthcare Commercial	$7.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.96

MASK, ANESTHESIA-NEONATAL

Facility

$11.00

Hospital Charge Code	4500453
Hospital Revenue Code	271
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$7.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$6.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.85
Rate for Payer: Cash Price	$9.90
Rate for Payer: UnitedHealthcare Commercial	$7.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.96

MASK, ANESTHESIA-NEONATAL

Facility

$11.00

Hospital Charge Code	4500453
Hospital Revenue Code	271
Rate for Payer: Cash Price	$9.90

MASK (ISOLATION)

Facility

$52.00

Hospital Charge Code	2813685
Hospital Revenue Code	271
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$37.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.13
Rate for Payer: Cash Price	$46.80
Rate for Payer: UnitedHealthcare Commercial	$34.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.72

MASK (ISOLATION)

Facility

$52.00

Hospital Charge Code	2813685
Hospital Revenue Code	271
Rate for Payer: Cash Price	$46.80

MASK, LMA #4

Facility

$152.00

Hospital Charge Code	1211305
Hospital Revenue Code	271
Rate for Payer: Cash Price	$136.80

MASK, LMA #4

Facility

$152.00

Hospital Charge Code	1211305
Hospital Revenue Code	271
Min. Negotiated Rate	$54.72
Max. Negotiated Rate	$108.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$108.53
Rate for Payer: Cash Price	$136.80
Rate for Payer: UnitedHealthcare Commercial	$101.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.72

MASK, LMA #5

Facility

$113.00

Hospital Charge Code	1211306
Hospital Revenue Code	272
Rate for Payer: Cash Price	$101.70

MASK, LMA #5

Facility

$113.00

Hospital Charge Code	1211306
Hospital Revenue Code	272
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$80.68
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: UnitedHealthcare Commercial	$75.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

MASK (OXYGEN) #1041

Facility

$21.00

Hospital Charge Code	4500440
Hospital Revenue Code	271
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

MASK (OXYGEN) #1041

Facility

$21.00

Hospital Charge Code	4500440
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

MASK, TRACHEOSTOMY

Facility

$3.00

Hospital Charge Code	4500452
Hospital Revenue Code	272
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$2.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2.14
Rate for Payer: Cash Price	$2.70
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.08

MASK, TRACHEOSTOMY

Facility

$3.00

Hospital Charge Code	4500452
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2.70

MASTECTOMY FOR MALIGNANCY WITH CC/MCC

Facility

$33,843.08

Service Code	MSDRG 582
Min. Negotiated Rate	$16,921.54
Max. Negotiated Rate	$33,843.08
Rate for Payer: Aetna Medicare Advantage	$16,921.54
Rate for Payer: Cigna Commercial HMO & PPO	$16,921.54
Rate for Payer: Home State Health Plan Medicare Advantage	$16,921.54
Rate for Payer: Humana Commercial	$33,843.08
Rate for Payer: Humana Medicare Advantage	$16,921.54

MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC

Facility

$30,657.68

Service Code	MSDRG 583
Min. Negotiated Rate	$15,328.84
Max. Negotiated Rate	$30,657.68
Rate for Payer: Aetna Medicare Advantage	$15,328.84
Rate for Payer: Cigna Commercial HMO & PPO	$15,328.84
Rate for Payer: Home State Health Plan Medicare Advantage	$15,328.84
Rate for Payer: Humana Commercial	$30,657.68
Rate for Payer: Humana Medicare Advantage	$15,328.84

Know your out-of-pocket cost for care.

All Charges