Madison Medical Center

All Charges

Charge

Type

Setting

Price

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$23,060.68

Service Code	MSDRG 743
Min. Negotiated Rate	$11,530.34
Max. Negotiated Rate	$23,060.68
Rate for Payer: Aetna Medicare Advantage	$11,530.34
Rate for Payer: Cigna Commercial HMO & PPO	$11,530.34
Rate for Payer: Home State Health Plan Medicare Advantage	$11,530.34
Rate for Payer: Humana Commercial	$23,060.68
Rate for Payer: Humana Medicare Advantage	$11,530.34

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$17,390.20

Service Code	APR-DRG 5121
Min. Negotiated Rate	$17,390.20
Max. Negotiated Rate	$17,390.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,390.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,390.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,390.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,390.20

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$27,575.63

Service Code	APR-DRG 5123
Min. Negotiated Rate	$27,575.63
Max. Negotiated Rate	$27,575.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,575.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,575.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,575.63
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,575.63

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$52,782.64

Service Code	APR-DRG 5124
Min. Negotiated Rate	$52,782.64
Max. Negotiated Rate	$52,782.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$52,782.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$52,782.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$52,782.64
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$52,782.64

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$19,386.24

Service Code	APR-DRG 5122
Min. Negotiated Rate	$19,386.24
Max. Negotiated Rate	$19,386.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,386.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,386.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,386.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,386.24

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility

$31,999.90

Service Code	MSDRG 740
Min. Negotiated Rate	$15,999.95
Max. Negotiated Rate	$31,999.90
Rate for Payer: Aetna Medicare Advantage	$15,999.95
Rate for Payer: Cigna Commercial HMO & PPO	$15,999.95
Rate for Payer: Home State Health Plan Medicare Advantage	$15,999.95
Rate for Payer: Humana Commercial	$31,999.90
Rate for Payer: Humana Medicare Advantage	$15,999.95

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility

$60,018.48

Service Code	MSDRG 739
Min. Negotiated Rate	$30,009.24
Max. Negotiated Rate	$60,018.48
Rate for Payer: Aetna Medicare Advantage	$30,009.24
Rate for Payer: Cigna Commercial HMO & PPO	$30,009.24
Rate for Payer: Home State Health Plan Medicare Advantage	$30,009.24
Rate for Payer: Humana Commercial	$60,018.48
Rate for Payer: Humana Medicare Advantage	$30,009.24

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$25,964.94

Service Code	MSDRG 741
Min. Negotiated Rate	$12,982.47
Max. Negotiated Rate	$25,964.94
Rate for Payer: Aetna Medicare Advantage	$12,982.47
Rate for Payer: Cigna Commercial HMO & PPO	$12,982.47
Rate for Payer: Home State Health Plan Medicare Advantage	$12,982.47
Rate for Payer: Humana Commercial	$25,964.94
Rate for Payer: Humana Medicare Advantage	$12,982.47

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility

$19,870.69

Service Code	APR-DRG 5112
Min. Negotiated Rate	$19,870.69
Max. Negotiated Rate	$19,870.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,870.69
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,870.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,870.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,870.69

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility

$53,042.43

Service Code	APR-DRG 5114
Min. Negotiated Rate	$53,042.43
Max. Negotiated Rate	$53,042.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$53,042.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$53,042.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$53,042.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53,042.43

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility

$32,786.22

Service Code	APR-DRG 5113
Min. Negotiated Rate	$32,786.22
Max. Negotiated Rate	$32,786.22
Rate for Payer: Aetna Better Health Medicaid/QHP	$32,786.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$32,786.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32,786.22
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$32,786.22

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility

$17,172.94

Service Code	APR-DRG 5111
Min. Negotiated Rate	$17,172.94
Max. Negotiated Rate	$17,172.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,172.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,172.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,172.94
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,172.94

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility

$35,954.10

Service Code	MSDRG 737
Min. Negotiated Rate	$17,977.05
Max. Negotiated Rate	$35,954.10
Rate for Payer: Aetna Medicare Advantage	$17,977.05
Rate for Payer: Cigna Commercial HMO & PPO	$17,977.05
Rate for Payer: Home State Health Plan Medicare Advantage	$17,977.05
Rate for Payer: Humana Commercial	$35,954.10
Rate for Payer: Humana Medicare Advantage	$17,977.05

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC

Facility

$59,886.84

Service Code	MSDRG 736
Min. Negotiated Rate	$29,943.42
Max. Negotiated Rate	$59,886.84
Rate for Payer: Aetna Medicare Advantage	$29,943.42
Rate for Payer: Cigna Commercial HMO & PPO	$29,943.42
Rate for Payer: Home State Health Plan Medicare Advantage	$29,943.42
Rate for Payer: Humana Commercial	$59,886.84
Rate for Payer: Humana Medicare Advantage	$29,943.42

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$26,630.08

Service Code	MSDRG 738
Min. Negotiated Rate	$13,315.04
Max. Negotiated Rate	$26,630.08
Rate for Payer: Aetna Medicare Advantage	$13,315.04
Rate for Payer: Cigna Commercial HMO & PPO	$13,315.04
Rate for Payer: Home State Health Plan Medicare Advantage	$13,315.04
Rate for Payer: Humana Commercial	$26,630.08
Rate for Payer: Humana Medicare Advantage	$13,315.04

VACCINE ADMINISTRATION

Facility

$35.00

Service Code	CPT 90471
Hospital Charge Code	5490471
Hospital Revenue Code	636
Min. Negotiated Rate	$23.34
Max. Negotiated Rate	$23.34
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34

VACCINE ADMINISTRATION

Facility

$35.00

Service Code	CPT 90471
Hospital Charge Code	5290471
Hospital Revenue Code	521
Rate for Payer: Cash Price	$31.50

VACCINE ADMINISTRATION

Facility

$70.00

Service Code	CPT 90471
Hospital Charge Code	9890471
Hospital Revenue Code	636
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$147.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$73.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

VACCINE ADMINISTRATION

Facility

$70.00

Service Code	CPT 90471
Hospital Charge Code	9890471
Hospital Revenue Code	636
Min. Negotiated Rate	$46.69
Max. Negotiated Rate	$46.69
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69

VACCINE ADMINISTRATION

Facility

$35.00

Service Code	CPT 90471
Hospital Charge Code	4290471
Hospital Revenue Code	636
Min. Negotiated Rate	$23.34
Max. Negotiated Rate	$23.34
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34

VACCINE ADMINISTRATION

Facility

$35.00

Service Code	CPT 90471
Hospital Charge Code	9290471
Hospital Revenue Code	636
Min. Negotiated Rate	$23.34
Max. Negotiated Rate	$23.34
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34

VACCINE ADMINISTRATION

Facility

$35.00

Service Code	CPT 90471
Hospital Charge Code	9790471
Hospital Revenue Code	636
Min. Negotiated Rate	$23.34
Max. Negotiated Rate	$23.34
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34

VACCINE ADMINISTRATION

Facility

$35.00

Service Code	CPT 90471
Hospital Charge Code	9490471
Hospital Revenue Code	636
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$147.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$73.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

VACCINE ADMINISTRATION

Facility

$35.00

Service Code	CPT 90471
Hospital Charge Code	5290471
Hospital Revenue Code	521
Min. Negotiated Rate	$20.72
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

VACCINE ADMINISTRATION

Facility

$40.00

Service Code	CPT 90460
Hospital Charge Code	9690471
Hospital Revenue Code	636
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

Know your out-of-pocket cost for care.

All Charges