Madison Medical Center

All Charges

Charge

Type

Setting

Price

BIOGEL GLOVES SIZE 7-1/2

Facility

$22.00

Hospital Charge Code	287273
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

BIOPHYSICAL PROFILE

Facility

$234.00

Service Code	CPT 76818
Hospital Charge Code	4276818
Hospital Revenue Code	521
Rate for Payer: Cash Price	$210.60

BIOPHYSICAL PROFILE

Facility

$234.00

Service Code	CPT 76818
Hospital Charge Code	4276818
Hospital Revenue Code	521
Min. Negotiated Rate	$84.82
Max. Negotiated Rate	$213.62
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	$138.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.08
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$84.82
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	$156.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$42,234.66

Service Code	MSDRG 478
Min. Negotiated Rate	$21,117.33
Max. Negotiated Rate	$42,234.66
Rate for Payer: Aetna Medicare Advantage	$21,117.33
Rate for Payer: Cigna Commercial HMO & PPO	$21,117.33
Rate for Payer: Home State Health Plan Medicare Advantage	$21,117.33
Rate for Payer: Humana Commercial	$42,234.66
Rate for Payer: Humana Medicare Advantage	$21,117.33

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$57,985.16

Service Code	MSDRG 477
Min. Negotiated Rate	$28,992.58
Max. Negotiated Rate	$57,985.16
Rate for Payer: Aetna Medicare Advantage	$28,992.58
Rate for Payer: Cigna Commercial HMO & PPO	$28,992.58
Rate for Payer: Home State Health Plan Medicare Advantage	$28,992.58
Rate for Payer: Humana Commercial	$57,985.16
Rate for Payer: Humana Medicare Advantage	$28,992.58

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$32,776.58

Service Code	MSDRG 479
Min. Negotiated Rate	$16,388.29
Max. Negotiated Rate	$32,776.58
Rate for Payer: Aetna Medicare Advantage	$16,388.29
Rate for Payer: Cigna Commercial HMO & PPO	$16,388.29
Rate for Payer: Home State Health Plan Medicare Advantage	$16,388.29
Rate for Payer: Humana Commercial	$32,776.58
Rate for Payer: Humana Medicare Advantage	$16,388.29

BIOPSY- ADDITIONAL

Facility

$65.00

Service Code	CPT 56606
Hospital Charge Code	4256606
Hospital Revenue Code	521
Rate for Payer: Cash Price	$58.50

BIOPSY- ADDITIONAL

Facility

$65.00

Service Code	CPT 56606
Hospital Charge Code	4256606
Hospital Revenue Code	521
Min. Negotiated Rate	$38.48
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY, BREAST

Professional

Both

$605.00

Service Code	CPT 19101
Hospital Charge Code	4119101
Hospital Revenue Code	975
Min. Negotiated Rate	$204.04
Max. Negotiated Rate	$278.95
Rate for Payer: Aetna Commercial/Medicare Advantage	$204.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$253.59
Rate for Payer: Cash Price	$544.50
Rate for Payer: Cash Price	$544.50
Rate for Payer: Cigna Commercial HMO & PPO	$204.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$253.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$278.95
Rate for Payer: Home State Health Plan Medicare Advantage	$204.04
Rate for Payer: Optum Medicare Advantage	$211.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$253.59

BIOPSY- CERVIX/POLYP

Facility

$260.00

Service Code	CPT 57500
Hospital Charge Code	4257500
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.00

BIOPSY- CERVIX/POLYP

Facility

$260.00

Service Code	CPT 57500
Hospital Charge Code	4257500
Hospital Revenue Code	521
Min. Negotiated Rate	$153.92
Max. Negotiated Rate	$1,882.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$830.28
Rate for Payer: Aetna Medicare Advantage	$941.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cigna Commercial HMO & PPO	$941.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$747.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$888.40
Rate for Payer: Home State Health Plan Medicare Advantage	$941.00
Rate for Payer: Humana Commercial	$1,882.00
Rate for Payer: Humana Medicare Advantage	$941.00
Rate for Payer: UnitedHealthcare Commercial	$173.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$830.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY-CERVIX/POLYP

Facility

$255.00

Service Code	CPT 57500
Hospital Charge Code	5257500
Hospital Revenue Code	521
Min. Negotiated Rate	$150.96
Max. Negotiated Rate	$1,882.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$830.28
Rate for Payer: Aetna Medicare Advantage	$941.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.07
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cigna Commercial HMO & PPO	$941.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$747.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$888.40
Rate for Payer: Home State Health Plan Medicare Advantage	$941.00
Rate for Payer: Humana Commercial	$1,882.00
Rate for Payer: Humana Medicare Advantage	$941.00
Rate for Payer: UnitedHealthcare Commercial	$170.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$830.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY-CERVIX/POLYP

Facility

$255.00

Service Code	CPT 57500
Hospital Charge Code	5257500
Hospital Revenue Code	521
Rate for Payer: Cash Price	$229.50

BIOPSY EACH ADDITIONAL LES

Facility

$105.00

Service Code	CPT 11103
Hospital Charge Code	4111101
Hospital Revenue Code	521
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: UnitedHealthcare Commercial	$70.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY EACH ADDITIONAL LES

Facility

$105.00

Service Code	CPT 11103
Hospital Charge Code	4111101
Hospital Revenue Code	521
Rate for Payer: Cash Price	$94.50

BIOPSY EXTERNAL EAR

Facility

$230.00

Service Code	CPT 69100
Hospital Charge Code	9869100
Hospital Revenue Code	521
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$483.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$213.51
Rate for Payer: Aetna Medicare Advantage	$241.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$136.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$164.22
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cigna Commercial HMO & PPO	$241.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$192.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$228.46
Rate for Payer: Home State Health Plan Medicare Advantage	$241.98
Rate for Payer: Humana Commercial	$483.96
Rate for Payer: Humana Medicare Advantage	$241.98
Rate for Payer: UnitedHealthcare Commercial	$153.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$213.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY EXTERNAL EAR

Facility

$230.00

Service Code	CPT 69100
Hospital Charge Code	9869100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$207.00

BIOPSY EXTERNAL EAR

Facility

$200.00

Service Code	CPT 69100
Hospital Charge Code	4269100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$180.00

BIOPSY EXTERNAL EAR

Facility

$200.00

Service Code	CPT 69100
Hospital Charge Code	4269100
Hospital Revenue Code	521
Min. Negotiated Rate	$118.40
Max. Negotiated Rate	$483.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$213.51
Rate for Payer: Aetna Medicare Advantage	$241.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$118.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.80
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cigna Commercial HMO & PPO	$241.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$192.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$228.46
Rate for Payer: Home State Health Plan Medicare Advantage	$241.98
Rate for Payer: Humana Commercial	$483.96
Rate for Payer: Humana Medicare Advantage	$241.98
Rate for Payer: UnitedHealthcare Commercial	$133.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$213.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY FORCEP RADIAL JAW 4 JUMBO

Facility

$364.00

Hospital Charge Code	126687
Hospital Revenue Code	271
Rate for Payer: Cash Price	$327.60

BIOPSY FORCEP RADIAL JAW 4 JUMBO

Facility

$364.00

Hospital Charge Code	126687
Hospital Revenue Code	271
Min. Negotiated Rate	$131.04
Max. Negotiated Rate	$259.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$215.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$259.90
Rate for Payer: Cash Price	$327.60
Rate for Payer: UnitedHealthcare Commercial	$242.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$131.04

BIOPSY FORCEPS LARGE RADIAL JAW 4

Facility

$280.00

Hospital Charge Code	126684
Hospital Revenue Code	271
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$199.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$165.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$199.92
Rate for Payer: Cash Price	$252.00
Rate for Payer: UnitedHealthcare Commercial	$186.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$100.80

BIOPSY FORCEPS LARGE RADIAL JAW 4

Facility

$280.00

Hospital Charge Code	126684
Hospital Revenue Code	271
Rate for Payer: Cash Price	$252.00

BIOPSY LESION

Facility

$121.00

Service Code	CPT 11102
Hospital Charge Code	4111100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.90

BIOPSY LESION

Facility

$121.00

Service Code	CPT 11102
Hospital Charge Code	4111100
Hospital Revenue Code	521
Min. Negotiated Rate	$71.63
Max. Negotiated Rate	$830.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$366.45
Rate for Payer: Aetna Medicare Advantage	$415.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$71.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$86.39
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cigna Commercial HMO & PPO	$415.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$329.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$392.10
Rate for Payer: Home State Health Plan Medicare Advantage	$415.32
Rate for Payer: Humana Commercial	$830.64
Rate for Payer: Humana Medicare Advantage	$415.32
Rate for Payer: UnitedHealthcare Commercial	$80.71
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges