Madison Medical Center

All Charges

Charge

Type

Setting

Price

VACCINE ADMINISTRATION

Facility

$35.00

Service Code	CPT 90471
Hospital Charge Code	9490471
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	$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

$35.00

Service Code	CPT 90471
Hospital Charge Code	5490471
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
Rate for Payer: Cash Price	$31.50

VACCINE ADMINISTRATION

Facility

$35.00

Service Code	CPT 90471
Hospital Charge Code	9790471
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	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

$40.00

Service Code	CPT 90460
Hospital Charge Code	9690471
Hospital Revenue Code	636
Min. Negotiated Rate	$26.68
Max. Negotiated Rate	$26.68
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68

VACCINE ADMINISTRATION ONE

Facility

$35.00

Service Code	CPT 90471
Hospital Charge Code	3990471
Hospital Revenue Code	771
Rate for Payer: Cash Price	$31.50

VACCINE ADMINISTRATION ONE

Facility

$35.00

Service Code	CPT 90471
Hospital Charge Code	3990471
Hospital Revenue Code	771
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	$23.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

VACCUUM BOTTLE / BBRAUN#S9901-10

Facility

$52.00

Hospital Charge Code	2821877
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

VACCUUM BOTTLE / BBRAUN#S9901-10

Facility

$52.00

Hospital Charge Code	2821877
Hospital Revenue Code	271
Rate for Payer: Cash Price	$46.80

VAG/DEL PP CARE

Facility

$1,389.00

Service Code	CPT 59410
Hospital Charge Code	5259410
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,250.10

VAG/DEL PP CARE

Facility

$1,389.00

Service Code	CPT 59410
Hospital Charge Code	5259410
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$991.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$822.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$991.75
Rate for Payer: Cash Price	$1,250.10
Rate for Payer: Cash Price	$1,250.10
Rate for Payer: UnitedHealthcare Commercial	$926.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

VAG. DEL. W/POST PARTUMCARE

Facility

$1,275.00

Service Code	CPT 59410
Hospital Charge Code	4259410
Rate for Payer: Cash Price	$1,147.50

VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC

Facility

$30,857.76

Service Code	MSDRG 746
Min. Negotiated Rate	$15,428.88
Max. Negotiated Rate	$30,857.76
Rate for Payer: Aetna Medicare Advantage	$15,428.88
Rate for Payer: Cigna Commercial HMO & PPO	$15,428.88
Rate for Payer: Home State Health Plan Medicare Advantage	$15,428.88
Rate for Payer: Humana Commercial	$30,857.76
Rate for Payer: Humana Medicare Advantage	$15,428.88

VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC

Facility

$17,098.28

Service Code	MSDRG 747
Min. Negotiated Rate	$8,549.14
Max. Negotiated Rate	$17,098.28
Rate for Payer: Aetna Medicare Advantage	$8,549.14
Rate for Payer: Cigna Commercial HMO & PPO	$8,549.14
Rate for Payer: Home State Health Plan Medicare Advantage	$8,549.14
Rate for Payer: Humana Commercial	$17,098.28
Rate for Payer: Humana Medicare Advantage	$8,549.14

VAGINAL DELIVERY

Facility

$5,930.58

Service Code	APR-DRG 5602
Min. Negotiated Rate	$5,930.58
Max. Negotiated Rate	$5,930.58
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,930.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,930.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,930.58
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,930.58

VAGINAL DELIVERY

Facility

$8,415.06

Service Code	APR-DRG 5603
Min. Negotiated Rate	$8,415.06
Max. Negotiated Rate	$8,415.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,415.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,415.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,415.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,415.06

VAGINAL DELIVERY

Facility

$5,357.60

Service Code	APR-DRG 5601
Min. Negotiated Rate	$5,357.60
Max. Negotiated Rate	$5,357.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,357.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,357.60
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,357.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,357.60

VAGINAL DELIVERY

Facility

$19,480.14

Service Code	APR-DRG 5604
Min. Negotiated Rate	$19,480.14
Max. Negotiated Rate	$19,480.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,480.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,480.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,480.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,480.14

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$7,255.01

Service Code	APR-DRG 5422
Min. Negotiated Rate	$7,255.01
Max. Negotiated Rate	$7,255.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,255.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,255.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,255.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,255.01

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$6,195.93

Service Code	APR-DRG 5421
Min. Negotiated Rate	$6,195.93
Max. Negotiated Rate	$6,195.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,195.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,195.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,195.93
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,195.93

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$9,162.98

Service Code	APR-DRG 5423
Min. Negotiated Rate	$9,162.98
Max. Negotiated Rate	$9,162.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,162.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,162.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,162.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,162.98

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$33,169.43

Service Code	APR-DRG 5424
Min. Negotiated Rate	$33,169.43
Max. Negotiated Rate	$33,169.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$33,169.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33,169.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33,169.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33,169.43

Know your out-of-pocket cost for care.

All Charges