Madison Medical Center

All Charges

Charge

Type

Setting

Price

MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY

Facility

$25,182.97

Service Code	APR-DRG 3434
Min. Negotiated Rate	$25,182.97
Max. Negotiated Rate	$25,182.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$25,182.97
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25,182.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25,182.97
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25,182.97

MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY

Facility

$11,824.60

Service Code	APR-DRG 3432
Min. Negotiated Rate	$11,824.60
Max. Negotiated Rate	$11,824.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,824.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,824.60
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,824.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,824.60

MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY

Facility

$18,684.53

Service Code	APR-DRG 3433
Min. Negotiated Rate	$18,684.53
Max. Negotiated Rate	$18,684.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$18,684.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18,684.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18,684.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18,684.53

MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY

Facility

$10,268.63

Service Code	APR-DRG 3431
Min. Negotiated Rate	$10,268.63
Max. Negotiated Rate	$10,268.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,268.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,268.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,268.63
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,268.63

MUSK ANTIBODIES

Facility

$1,118.00

Service Code	CPT 86366
Hospital Charge Code	2286366
Hospital Revenue Code	301
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$798.25
Rate for Payer: Humana Commercial	$36.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.56
Rate for Payer: Aetna Medicare Advantage	$18.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$661.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$798.25
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Cigna Commercial HMO & PPO	$18.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.72
Rate for Payer: Home State Health Plan Medicare Advantage	$18.40
Rate for Payer: Humana Medicare Advantage	$18.40
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$402.48

MUSK ANTIBODIES

Facility

$1,118.00

Service Code	CPT 86366
Hospital Charge Code	2286366
Hospital Revenue Code	301
Rate for Payer: Cash Price	$1,006.20

MYCOPLASMA ANTIBODY IGG

Facility

$89.00

Service Code	CPT 86738
Hospital Charge Code	2286738
Hospital Revenue Code	301
Rate for Payer: Cash Price	$80.10

MYCOPLASMA ANTIBODY IGG

Facility

$89.00

Service Code	CPT 86738
Hospital Charge Code	2286738
Hospital Revenue Code	301
Min. Negotiated Rate	$11.92
Max. Negotiated Rate	$63.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.92
Rate for Payer: Aetna Medicare Advantage	$13.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.55
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cigna Commercial HMO & PPO	$13.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.75
Rate for Payer: Home State Health Plan Medicare Advantage	$13.24
Rate for Payer: Humana Commercial	$26.48
Rate for Payer: Humana Medicare Advantage	$13.24
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

MYCOPLASMA ANTIBODY IGM

Facility

$89.00

Service Code	CPT 86738
Hospital Charge Code	2286739
Hospital Revenue Code	301
Min. Negotiated Rate	$11.92
Max. Negotiated Rate	$63.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.92
Rate for Payer: Aetna Medicare Advantage	$13.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.55
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cigna Commercial HMO & PPO	$13.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.75
Rate for Payer: Home State Health Plan Medicare Advantage	$13.24
Rate for Payer: Humana Commercial	$26.48
Rate for Payer: Humana Medicare Advantage	$13.24
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

MYCOPLASMA ANTIBODY IGM

Facility

$89.00

Service Code	CPT 86738
Hospital Charge Code	2286739
Hospital Revenue Code	301
Rate for Payer: Cash Price	$80.10

MYELIN BASIC PROTEIN

Facility

$124.00

Service Code	CPT 83873
Hospital Charge Code	2283873
Hospital Revenue Code	305
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$88.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.48
Rate for Payer: Aetna Medicare Advantage	$17.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna Commercial HMO & PPO	$17.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.56
Rate for Payer: Home State Health Plan Medicare Advantage	$17.20
Rate for Payer: Humana Commercial	$34.40
Rate for Payer: Humana Medicare Advantage	$17.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

MYELIN BASIC PROTEIN

Facility

$124.00

Service Code	CPT 83873
Hospital Charge Code	2283873
Hospital Revenue Code	305
Rate for Payer: Cash Price	$111.60

MYELOGRAM

Facility

$944.00

Service Code	CPT 72270
Hospital Charge Code	3213912
Hospital Revenue Code	320
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$1,601.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$706.66
Rate for Payer: Aetna Medicare Advantage	$800.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$558.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$674.02
Rate for Payer: Cash Price	$849.60
Rate for Payer: Cash Price	$849.60
Rate for Payer: Cash Price	$849.60
Rate for Payer: Cigna Commercial HMO & PPO	$800.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$706.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$756.13
Rate for Payer: Home State Health Plan Medicare Advantage	$800.90
Rate for Payer: Humana Commercial	$1,601.80
Rate for Payer: Humana Medicare Advantage	$800.90
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$706.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$339.84

MYELOGRAM

Facility

$944.00

Service Code	CPT 72270
Hospital Charge Code	3213912
Hospital Revenue Code	320
Rate for Payer: Cash Price	$849.60

MYELOGRAM TRAY

Facility

$384.00

Hospital Charge Code	3213914
Hospital Revenue Code	320
Min. Negotiated Rate	$138.24
Max. Negotiated Rate	$274.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$227.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$274.18
Rate for Payer: Cash Price	$345.60
Rate for Payer: Cash Price	$345.60
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$138.24

MYELOGRAM TRAY

Facility

$384.00

Hospital Charge Code	3213914
Hospital Revenue Code	320
Rate for Payer: Cash Price	$345.60

MYELOPEROXIDASE AB

Facility

$14.00

Service Code	CPT 83516
Hospital Charge Code	2283517
Hospital Revenue Code	302
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$23.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.00
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cigna Commercial HMO & PPO	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04

MYELOPEROXIDASE AB

Facility

$14.00

Service Code	CPT 83516
Hospital Charge Code	2283517
Hospital Revenue Code	302
Rate for Payer: Cash Price	$12.60

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$39,902.00

Service Code	MSDRG 827
Min. Negotiated Rate	$19,951.00
Max. Negotiated Rate	$39,902.00
Rate for Payer: Aetna Medicare Advantage	$19,951.00
Rate for Payer: Cigna Commercial HMO & PPO	$19,951.00
Rate for Payer: Home State Health Plan Medicare Advantage	$19,951.00
Rate for Payer: Humana Commercial	$39,902.00
Rate for Payer: Humana Medicare Advantage	$19,951.00

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$77,392.92

Service Code	MSDRG 826
Min. Negotiated Rate	$38,696.46
Max. Negotiated Rate	$77,392.92
Rate for Payer: Aetna Medicare Advantage	$38,696.46
Rate for Payer: Cigna Commercial HMO & PPO	$38,696.46
Rate for Payer: Home State Health Plan Medicare Advantage	$38,696.46
Rate for Payer: Humana Commercial	$77,392.92
Rate for Payer: Humana Medicare Advantage	$38,696.46

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$30,333.14

Service Code	MSDRG 828
Min. Negotiated Rate	$15,166.57
Max. Negotiated Rate	$30,333.14
Rate for Payer: Aetna Medicare Advantage	$15,166.57
Rate for Payer: Cigna Commercial HMO & PPO	$15,166.57
Rate for Payer: Home State Health Plan Medicare Advantage	$15,166.57
Rate for Payer: Humana Commercial	$30,333.14
Rate for Payer: Humana Medicare Advantage	$15,166.57

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC

Facility

$53,318.52

Service Code	MSDRG 829
Min. Negotiated Rate	$26,659.26
Max. Negotiated Rate	$53,318.52
Rate for Payer: Aetna Medicare Advantage	$26,659.26
Rate for Payer: Cigna Commercial HMO & PPO	$26,659.26
Rate for Payer: Home State Health Plan Medicare Advantage	$26,659.26
Rate for Payer: Humana Commercial	$53,318.52
Rate for Payer: Humana Medicare Advantage	$26,659.26

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$27,202.64

Service Code	MSDRG 830
Min. Negotiated Rate	$13,601.32
Max. Negotiated Rate	$27,202.64
Rate for Payer: Aetna Medicare Advantage	$13,601.32
Rate for Payer: Cigna Commercial HMO & PPO	$13,601.32
Rate for Payer: Home State Health Plan Medicare Advantage	$13,601.32
Rate for Payer: Humana Commercial	$27,202.64
Rate for Payer: Humana Medicare Advantage	$13,601.32

MYOCARDIAL AB

Facility

$205.00

Service Code	CPT 86255
Hospital Charge Code	2286205
Hospital Revenue Code	301
Rate for Payer: Cash Price	$184.50

MYOCARDIAL AB

Facility

$205.00

Service Code	CPT 86255
Hospital Charge Code	2286205
Hospital Revenue Code	301
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$146.37
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.85
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$12.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.61
Rate for Payer: Home State Health Plan Medicare Advantage	$12.05
Rate for Payer: Humana Commercial	$24.10
Rate for Payer: Humana Medicare Advantage	$12.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$73.80

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