Madison Medical Center

All Charges

Charge

Type

Setting

Price

USTEKIMUMAB & USTEKINUMAB AB

Facility

$343.00

Service Code	CPT 80299
Hospital Charge Code	22504594
Hospital Revenue Code	301
Rate for Payer: Cash Price	$308.70

USTEKIMUMAB & USTEKINUMAB AB

Facility

$343.00

Service Code	CPT 80299
Hospital Charge Code	22504594
Hospital Revenue Code	301
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$244.90
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.78
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$203.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$244.90
Rate for Payer: Cash Price	$308.70
Rate for Payer: Cash Price	$308.70
Rate for Payer: Cash Price	$308.70
Rate for Payer: Cigna Commercial HMO & PPO	$18.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.95
Rate for Payer: Home State Health Plan Medicare Advantage	$18.64
Rate for Payer: Humana Commercial	$37.28
Rate for Payer: Humana Medicare Advantage	$18.64
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$123.48

.USTEKINUMAB AB

Facility

$253.00

Service Code	CPT 82397
Hospital Charge Code	2282398
Hospital Revenue Code	302
Rate for Payer: Cash Price	$227.70

.USTEKINUMAB AB

Facility

$253.00

Service Code	CPT 82397
Hospital Charge Code	2282398
Hospital Revenue Code	302
Min. Negotiated Rate	$12.71
Max. Negotiated Rate	$180.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.71
Rate for Payer: Aetna Medicare Advantage	$14.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$149.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$180.64
Rate for Payer: Cash Price	$227.70
Rate for Payer: Cash Price	$227.70
Rate for Payer: Cash Price	$227.70
Rate for Payer: Cigna Commercial HMO & PPO	$14.12
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.60
Rate for Payer: Home State Health Plan Medicare Advantage	$14.12
Rate for Payer: Humana Commercial	$28.24
Rate for Payer: Humana Medicare Advantage	$14.12
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$91.08

US TESTICULAR

Facility

$625.00

Service Code	CPT 76870
Hospital Charge Code	3576870
Hospital Revenue Code	402
Rate for Payer: Cash Price	$562.50

US TESTICULAR

Facility

$625.00

Service Code	CPT 76870
Hospital Charge Code	3576870
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$446.25
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	$370.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$446.25
Rate for Payer: Cash Price	$562.50
Rate for Payer: Cash Price	$562.50
Rate for Payer: Cash Price	$562.50
Rate for Payer: Cash Price	$562.50
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	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$225.00

US THYROID

Facility

$809.00

Service Code	CPT 76536
Hospital Charge Code	3576536
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$577.63
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	$478.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$577.63
Rate for Payer: Cash Price	$728.10
Rate for Payer: Cash Price	$728.10
Rate for Payer: Cash Price	$728.10
Rate for Payer: Cash Price	$728.10
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	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$291.24

US THYROID

Facility

$809.00

Service Code	CPT 76536
Hospital Charge Code	3576536
Hospital Revenue Code	402
Rate for Payer: Cash Price	$728.10

US VENOUS BILATERAL LOWER EXT

Facility

$2,030.00

Service Code	CPT 93970
Hospital Charge Code	3593970
Hospital Revenue Code	921
Rate for Payer: Cash Price	$1,827.00

US VENOUS BILATERAL LOWER EXT

Facility

$2,030.00

Service Code	CPT 93970
Hospital Charge Code	3593970
Hospital Revenue Code	921
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$1,449.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,201.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,449.42
Rate for Payer: Cash Price	$1,827.00
Rate for Payer: Cash Price	$1,827.00
Rate for Payer: Cash Price	$1,827.00
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$1,354.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$730.80

US VENOUS UNILATERAL LT

Facility

$733.00

Service Code	CPT 93971
Hospital Charge Code	3593972
Hospital Revenue Code	921
Rate for Payer: Cash Price	$659.70

US VENOUS UNILATERAL LT

Facility

$733.00

Service Code	CPT 93971
Hospital Charge Code	3593972
Hospital Revenue Code	921
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$523.36
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	$433.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$523.36
Rate for Payer: Cash Price	$659.70
Rate for Payer: Cash Price	$659.70
Rate for Payer: Cash Price	$659.70
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	$488.91
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$263.88

US VENOUS UNILATERAL RIGHT

Facility

$733.00

Service Code	CPT 93971
Hospital Charge Code	3593971
Hospital Revenue Code	921
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$523.36
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	$433.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$523.36
Rate for Payer: Cash Price	$659.70
Rate for Payer: Cash Price	$659.70
Rate for Payer: Cash Price	$659.70
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	$488.91
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$263.88

US VENOUS UNILATERAL RIGHT

Facility

$733.00

Service Code	CPT 93971
Hospital Charge Code	3593971
Hospital Revenue Code	921
Rate for Payer: Cash Price	$659.70

US VENOUS UPPER EXTREMITY DOPPLER

Facility

$1,118.00

Service Code	CPT 93971
Hospital Charge Code	3593965
Hospital Revenue Code	921
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$798.25
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	$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	$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	$745.71
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$402.48

US VENOUS UPPER EXTREMITY DOPPLER

Facility

$1,118.00

Service Code	CPT 93971
Hospital Charge Code	3593965
Hospital Revenue Code	921
Rate for Payer: Cash Price	$1,006.20

UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$25,096.07

Service Code	APR-DRG 5193
Min. Negotiated Rate	$25,096.07
Max. Negotiated Rate	$25,096.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$25,096.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25,096.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25,096.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25,096.07

UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$43,347.00

Service Code	APR-DRG 5194
Min. Negotiated Rate	$43,347.00
Max. Negotiated Rate	$43,347.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$43,347.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$43,347.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$43,347.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$43,347.00

UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$11,396.55

Service Code	APR-DRG 5191
Min. Negotiated Rate	$11,396.55
Max. Negotiated Rate	$11,396.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,396.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,396.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,396.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,396.55

UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$11,962.35

Service Code	APR-DRG 5192
Min. Negotiated Rate	$11,962.35
Max. Negotiated Rate	$11,962.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,962.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,962.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,962.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,962.35

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$6,075.94

Service Code	APR-DRG 5131
Min. Negotiated Rate	$6,075.94
Max. Negotiated Rate	$6,075.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,075.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,075.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,075.94
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,075.94

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$33,810.58

Service Code	APR-DRG 5134
Min. Negotiated Rate	$33,810.58
Max. Negotiated Rate	$33,810.58
Rate for Payer: Aetna Better Health Medicaid/QHP	$33,810.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33,810.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33,810.58
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33,810.58

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$23,216.52

Service Code	APR-DRG 5133
Min. Negotiated Rate	$23,216.52
Max. Negotiated Rate	$23,216.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,216.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,216.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,216.52
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,216.52

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$7,827.90

Service Code	APR-DRG 5132
Min. Negotiated Rate	$7,827.90
Max. Negotiated Rate	$7,827.90
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,827.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,827.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,827.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,827.90

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$32,396.90

Service Code	MSDRG 742
Min. Negotiated Rate	$16,198.45
Max. Negotiated Rate	$32,396.90
Rate for Payer: Aetna Medicare Advantage	$16,198.45
Rate for Payer: Cigna Commercial HMO & PPO	$16,198.45
Rate for Payer: Home State Health Plan Medicare Advantage	$16,198.45
Rate for Payer: Humana Commercial	$32,396.90
Rate for Payer: Humana Medicare Advantage	$16,198.45

Know your out-of-pocket cost for care.

All Charges