Madison Medical Center

All Charges

Charge

Type

Setting

Price

MASTECTOMY,PARTIAL W/LYMPHADENECTOMY

Professional

Both

$3,465.00

Service Code	CPT 19302
Hospital Charge Code	5419162
Hospital Revenue Code	975
Min. Negotiated Rate	$687.60
Max. Negotiated Rate	$1,212.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$823.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$687.60
Rate for Payer: Cash Price	$3,118.50
Rate for Payer: Cash Price	$3,118.50
Rate for Payer: Cigna Commercial HMO & PPO	$823.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$687.60
Rate for Payer: Home State Health Plan Medicaid Managed Care	$756.36
Rate for Payer: Home State Health Plan Medicare Advantage	$823.72
Rate for Payer: Optum Medicare Advantage	$1,212.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$687.60

MASTECTOMY PROCEDURES

Facility

$27,858.53

Service Code	APR-DRG 3623
Min. Negotiated Rate	$27,858.53
Max. Negotiated Rate	$27,858.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,858.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,858.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,858.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,858.53

MASTECTOMY PROCEDURES

Facility

$27,858.53

Service Code	APR-DRG 3621
Min. Negotiated Rate	$27,858.53
Max. Negotiated Rate	$27,858.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,858.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,858.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,858.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,858.53

MASTECTOMY PROCEDURES

Facility

$27,858.53

Service Code	APR-DRG 3624
Min. Negotiated Rate	$27,858.53
Max. Negotiated Rate	$27,858.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,858.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,858.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,858.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,858.53

MASTECTOMY PROCEDURES

Facility

$27,858.53

Service Code	APR-DRG 3622
Min. Negotiated Rate	$27,858.53
Max. Negotiated Rate	$27,858.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,858.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,858.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,858.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,858.53

MASTISOL ADH SURG LIQ DROP0.67MLSOL

Facility

$45.00

Service Code	NDC 496052348
Hospital Charge Code	2626447
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

MASTISOL ADH SURG LIQ DROP0.67MLSOL

Facility

$45.00

Service Code	NDC 496052348
Hospital Charge Code	2626447
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

MASTOIDS X-RAY

Facility

$508.00

Service Code	CPT 70130
Hospital Charge Code	3213103
Hospital Revenue Code	320
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$362.71
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	$300.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$362.71
Rate for Payer: Cash Price	$457.20
Rate for Payer: Cash Price	$457.20
Rate for Payer: Cash Price	$457.20
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	$182.88

MASTOIDS X-RAY

Facility

$508.00

Service Code	CPT 70130
Hospital Charge Code	3213103
Hospital Revenue Code	320
Rate for Payer: Cash Price	$457.20

MASTOTOMY W/DRAINAGE OF ABSCESS

Professional

Both

$500.00

Service Code	CPT 19020
Hospital Charge Code	4119020
Hospital Revenue Code	975
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$395.26
Rate for Payer: Aetna Commercial/Medicare Advantage	$293.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$359.33
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cigna Commercial HMO & PPO	$293.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$359.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$395.26
Rate for Payer: Home State Health Plan Medicare Advantage	$293.29
Rate for Payer: Optum Medicare Advantage	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$359.33

MASTOTOMY W/EXPL OR DRAIN OF ABSCES DEEP

Professional

Both

$866.00

Service Code	CPT 19020
Hospital Charge Code	5419020
Hospital Revenue Code	975
Min. Negotiated Rate	$293.29
Max. Negotiated Rate	$395.26
Rate for Payer: Aetna Commercial/Medicare Advantage	$293.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$359.33
Rate for Payer: Cash Price	$779.40
Rate for Payer: Cash Price	$779.40
Rate for Payer: Cigna Commercial HMO & PPO	$293.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$359.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$395.26
Rate for Payer: Home State Health Plan Medicare Advantage	$293.29
Rate for Payer: Optum Medicare Advantage	$303.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$359.33

MATTRESS, AIR FLUIDIZED

Facility

$107.00

Service Code	NDC 1E+11
Hospital Charge Code	2696424
Hospital Revenue Code	250
Rate for Payer: Cash Price	$96.30

MATTRESS, AIR FLUIDIZED

Facility

$107.00

Service Code	NDC 1E+11
Hospital Charge Code	2696424
Hospital Revenue Code	250
Min. Negotiated Rate	$38.52
Max. Negotiated Rate	$76.40
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: UnitedHealthcare Commercial	$71.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

MATTRESS EGG CREATE

Facility

$102.00

Hospital Charge Code	2813100
Hospital Revenue Code	271
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$72.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$60.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.83
Rate for Payer: Cash Price	$91.80
Rate for Payer: UnitedHealthcare Commercial	$68.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.72

MATTRESS EGG CREATE

Facility

$102.00

Hospital Charge Code	2813100
Hospital Revenue Code	271
Rate for Payer: Cash Price	$91.80

MATTRESS LOW AIR LOSS

Facility

$125.00

Hospital Charge Code	2833550
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

MATTRESS LOW AIR LOSS

Facility

$125.00

Hospital Charge Code	2833550
Hospital Revenue Code	271
Rate for Payer: Cash Price	$112.50

MAVIGRAPH

Facility

$28.00

Hospital Charge Code	1211817
Hospital Revenue Code	360
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$18.68
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

MAVIGRAPH

Facility

$28.00

Hospital Charge Code	1211817
Hospital Revenue Code	360
Rate for Payer: Cash Price	$25.20

MAXORB XTRA AG ROPE DRESSING

Facility

$52.00

Hospital Charge Code	2894120
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

MAXORB XTRA AG ROPE DRESSING

Facility

$52.00

Hospital Charge Code	2894120
Hospital Revenue Code	271
Rate for Payer: Cash Price	$46.80

MAYO STAND COVER

Facility

$12.00

Hospital Charge Code	124778
Hospital Revenue Code	271
Rate for Payer: Cash Price	$10.80

MAYO STAND COVER

Facility

$12.00

Hospital Charge Code	124778
Hospital Revenue Code	271
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$8.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$8.57
Rate for Payer: Cash Price	$10.80
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.32

MC CERVICAL/VAGINAL EXAMINATION

Facility

$66.00

Service Code	CPT G0101
Hospital Charge Code	3900101
Hospital Revenue Code	521
Rate for Payer: Cash Price	$59.40

MC CERVICAL/VAGINAL EXAMINATION

Facility

$66.00

Service Code	CPT G0101
Hospital Charge Code	3900101
Hospital Revenue Code	521
Min. Negotiated Rate	$39.07
Max. Negotiated Rate	$207.58
Rate for Payer: Aetna Medicare Advantage	$103.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.12
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cigna Commercial HMO & PPO	$103.79
Rate for Payer: Home State Health Plan Medicare Advantage	$103.79
Rate for Payer: Humana Commercial	$207.58
Rate for Payer: Humana Medicare Advantage	$103.79
Rate for Payer: UnitedHealthcare Commercial	$44.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges