Madison Medical Center

All Charges

Charge

Type

Setting

Price

BIOPSY OF VULVA ONE LESION

Facility

$232.00

Service Code	CPT 56605
Hospital Charge Code	5256605
Hospital Revenue Code	521
Min. Negotiated Rate	$137.34
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	$137.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$165.65
Rate for Payer: Cash Price	$208.80
Rate for Payer: Cash Price	$208.80
Rate for Payer: Cash Price	$208.80
Rate for Payer: Cash Price	$208.80
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	$154.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$830.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY OR EXC OF LYMPH NODE;OPEN SUPERFI

Professional

Both

$866.00

Service Code	CPT 38500
Hospital Charge Code	5438500
Hospital Revenue Code	975
Min. Negotiated Rate	$232.04
Max. Negotiated Rate	$303.10
Rate for Payer: Aetna Commercial/Medicare Advantage	$232.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$256.97
Rate for Payer: Cash Price	$779.40
Rate for Payer: Cash Price	$779.40
Rate for Payer: Cigna Commercial HMO & PPO	$232.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$256.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$282.67
Rate for Payer: Home State Health Plan Medicare Advantage	$232.04
Rate for Payer: Optum Medicare Advantage	$303.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$256.97

BIOPSY- PERCPEUM/VULVA

Facility

$129.00

Service Code	CPT 56605
Hospital Charge Code	4256605
Hospital Revenue Code	521
Rate for Payer: Cash Price	$116.10

BIOPSY- PERCPEUM/VULVA

Facility

$129.00

Service Code	CPT 56605
Hospital Charge Code	4256605
Hospital Revenue Code	521
Min. Negotiated Rate	$76.37
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	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
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	$86.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$830.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY, PROSTATE

Professional

Both

$820.00

Service Code	CPT 55700
Hospital Charge Code	9355700
Hospital Revenue Code	975
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$287.00
Rate for Payer: Cash Price	$738.00
Rate for Payer: Optum Medicare Advantage	$287.00

BIOPSY SKIN SIMPLE

Facility

$53.00

Service Code	CPT 11102
Hospital Charge Code	5211100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$47.70

BIOPSY SKIN SIMPLE

Facility

$53.00

Service Code	CPT 11102
Hospital Charge Code	5211100
Hospital Revenue Code	521
Min. Negotiated Rate	$31.38
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	$31.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.84
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cash Price	$47.70
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	$35.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY, SOFT TISSUE OF BACK SUPERFICIAL

Professional

Both

$378.00

Service Code	CPT 21920
Hospital Charge Code	5421920
Hospital Revenue Code	975
Min. Negotiated Rate	$132.30
Max. Negotiated Rate	$216.96
Rate for Payer: Aetna Commercial/Medicare Advantage	$133.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$197.24
Rate for Payer: Cash Price	$340.20
Rate for Payer: Cash Price	$340.20
Rate for Payer: Cigna Commercial HMO & PPO	$133.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$216.96
Rate for Payer: Home State Health Plan Medicare Advantage	$133.27
Rate for Payer: Optum Medicare Advantage	$132.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.24

BIOPSY-VAGINA

Facility

$104.00

Service Code	CPT 57100
Hospital Charge Code	5257100
Hospital Revenue Code	521
Min. Negotiated Rate	$61.57
Max. Negotiated Rate	$1,882.00
Rate for Payer: Cash Price	$93.60
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	$61.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.26
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
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	$69.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$830.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY-VAGINA

Facility

$104.00

Service Code	CPT 57100
Hospital Charge Code	5257100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$93.60

BIOPSY- VAGINAL

Facility

$104.00

Service Code	CPT 57100
Hospital Charge Code	4257100
Hospital Revenue Code	521
Min. Negotiated Rate	$61.57
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	$61.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.26
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
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	$69.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$830.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY- VAGINAL

Facility

$104.00

Service Code	CPT 57100
Hospital Charge Code	4257100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$93.60

BIOTIN-KERATIN ORAL TAB/CAP

Facility

$16.00

Service Code	NDC 1E+11
Hospital Charge Code	2620614
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

BIOTIN-KERATIN ORAL TAB/CAP

Facility

$16.00

Service Code	NDC 1E+11
Hospital Charge Code	2620614
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

BI-PAP C-PAP MACHINE (daily)

Facility

$474.00

Service Code	CPT 94003
Hospital Charge Code	281050
Hospital Revenue Code	271
Min. Negotiated Rate	$170.64
Max. Negotiated Rate	$1,262.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$556.91
Rate for Payer: Aetna Medicare Advantage	$631.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$280.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$338.44
Rate for Payer: Cash Price	$426.60
Rate for Payer: Cash Price	$426.60
Rate for Payer: Cash Price	$426.60
Rate for Payer: Cigna Commercial HMO & PPO	$631.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$556.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$595.89
Rate for Payer: Home State Health Plan Medicare Advantage	$631.17
Rate for Payer: Humana Commercial	$1,262.34
Rate for Payer: Humana Medicare Advantage	$631.17
Rate for Payer: UnitedHealthcare Commercial	$316.16
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$556.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$170.64

BI-PAP C-PAP MACHINE (daily)

Facility

$474.00

Service Code	CPT 94003
Hospital Charge Code	281050
Hospital Revenue Code	271
Rate for Payer: Cash Price	$426.60

BI-PAP MACHINE (INITIAL SETUP)

Facility

$729.00

Service Code	CPT 94002
Hospital Charge Code	281040
Hospital Revenue Code	271
Min. Negotiated Rate	$262.44
Max. Negotiated Rate	$1,262.34
Rate for Payer: Cash Price	$656.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$556.91
Rate for Payer: Aetna Medicare Advantage	$631.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$431.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$520.51
Rate for Payer: Cash Price	$656.10
Rate for Payer: Cash Price	$656.10
Rate for Payer: Cigna Commercial HMO & PPO	$631.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$556.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$595.89
Rate for Payer: Home State Health Plan Medicare Advantage	$631.17
Rate for Payer: Humana Commercial	$1,262.34
Rate for Payer: Humana Medicare Advantage	$631.17
Rate for Payer: UnitedHealthcare Commercial	$486.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$556.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$262.44

BI-PAP MACHINE (INITIAL SETUP)

Facility

$729.00

Service Code	CPT 94002
Hospital Charge Code	281040
Hospital Revenue Code	271
Rate for Payer: Cash Price	$656.10

BIPOLAR CORD

Facility

$125.00

Hospital Charge Code	126903
Hospital Revenue Code	360
Rate for Payer: Cash Price	$112.50

BIPOLAR CORD

Facility

$125.00

Hospital Charge Code	126903
Hospital Revenue Code	360
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$83.38
Rate for Payer: Cash Price	$112.50
Rate for Payer: UnitedHealthcare Commercial	$83.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

BIPOLAR DISORDERS

Facility

$15,276.31

Service Code	APR-DRG 7532
Min. Negotiated Rate	$15,276.31
Max. Negotiated Rate	$15,276.31
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,276.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,276.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,276.31
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,276.31

BIPOLAR DISORDERS

Facility

$11,312.56

Service Code	APR-DRG 7531
Min. Negotiated Rate	$11,312.56
Max. Negotiated Rate	$11,312.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,312.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,312.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,312.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,312.56

BIPOLAR DISORDERS

Facility

$36,669.53

Service Code	APR-DRG 7534
Min. Negotiated Rate	$36,669.53
Max. Negotiated Rate	$36,669.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$36,669.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$36,669.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$36,669.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$36,669.53

BIPOLAR DISORDERS

Facility

$16,799.32

Service Code	APR-DRG 7533
Min. Negotiated Rate	$16,799.32
Max. Negotiated Rate	$16,799.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$16,799.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16,799.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16,799.32
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16,799.32

BIPOLAR PENCIL (EYE)

Facility

$58.00

Hospital Charge Code	126905
Hospital Revenue Code	360
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$38.69
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

Know your out-of-pocket cost for care.

All Charges