Madison Medical Center

All Charges

Charge

Type

Setting

Price

BRACE, CLAVICLE

Facility

$119.00

Hospital Charge Code	282253
Hospital Revenue Code	271
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$84.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$70.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$84.97
Rate for Payer: Cash Price	$107.10
Rate for Payer: UnitedHealthcare Commercial	$79.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84

BRACE, CLAVICLE

Facility

$119.00

Hospital Charge Code	282253
Hospital Revenue Code	271
Rate for Payer: Cash Price	$107.10

BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$24,900.07

Service Code	APR-DRG 0564
Min. Negotiated Rate	$24,900.07
Max. Negotiated Rate	$24,900.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$24,900.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24,900.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24,900.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24,900.07

BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$6,516.93

Service Code	APR-DRG 0561
Min. Negotiated Rate	$6,516.93
Max. Negotiated Rate	$6,516.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,516.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,516.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,516.93
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,516.93

BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$11,963.28

Service Code	APR-DRG 0563
Min. Negotiated Rate	$11,963.28
Max. Negotiated Rate	$11,963.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,963.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,963.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,963.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,963.28

BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$11,963.28

Service Code	APR-DRG 0562
Min. Negotiated Rate	$11,963.28
Max. Negotiated Rate	$11,963.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,963.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,963.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,963.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,963.28

BREAST BIOPSY

Professional

Both

$224.00

Service Code	CPT 19100
Hospital Charge Code	4119100
Hospital Revenue Code	975
Min. Negotiated Rate	$60.10
Max. Negotiated Rate	$129.68
Rate for Payer: Aetna Commercial/Medicare Advantage	$60.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$117.89
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cigna Commercial HMO & PPO	$60.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$117.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$129.68
Rate for Payer: Home State Health Plan Medicare Advantage	$60.10
Rate for Payer: Optum Medicare Advantage	$78.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$117.89

BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC

Facility

$37,215.98

Service Code	MSDRG 584
Min. Negotiated Rate	$18,607.99
Max. Negotiated Rate	$37,215.98
Rate for Payer: Aetna Medicare Advantage	$18,607.99
Rate for Payer: Cigna Commercial HMO & PPO	$18,607.99
Rate for Payer: Home State Health Plan Medicare Advantage	$18,607.99
Rate for Payer: Humana Commercial	$37,215.98
Rate for Payer: Humana Medicare Advantage	$18,607.99

BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC

Facility

$33,882.46

Service Code	MSDRG 585
Min. Negotiated Rate	$16,941.23
Max. Negotiated Rate	$33,882.46
Rate for Payer: Aetna Medicare Advantage	$16,941.23
Rate for Payer: Cigna Commercial HMO & PPO	$16,941.23
Rate for Payer: Home State Health Plan Medicare Advantage	$16,941.23
Rate for Payer: Humana Commercial	$33,882.46
Rate for Payer: Humana Medicare Advantage	$16,941.23

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$13,616.32

Service Code	APR-DRG 3631
Min. Negotiated Rate	$13,616.32
Max. Negotiated Rate	$13,616.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,616.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,616.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,616.32
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,616.32

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$26,298.87

Service Code	APR-DRG 3632
Min. Negotiated Rate	$26,298.87
Max. Negotiated Rate	$26,298.87
Rate for Payer: Aetna Better Health Medicaid/QHP	$26,298.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26,298.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26,298.87
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26,298.87

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$34,294.11

Service Code	APR-DRG 3633
Min. Negotiated Rate	$34,294.11
Max. Negotiated Rate	$34,294.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$34,294.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$34,294.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$34,294.11
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$34,294.11

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$37,571.53

Service Code	APR-DRG 3634
Min. Negotiated Rate	$37,571.53
Max. Negotiated Rate	$37,571.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$37,571.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$37,571.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37,571.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$37,571.53

BREAST UNI W OR WO CONT

Facility

$2,844.00

Service Code	CPT 76093
Hospital Charge Code	3376093
Hospital Revenue Code	610
Min. Negotiated Rate	$1,023.84
Max. Negotiated Rate	$2,030.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,555.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,030.62
Rate for Payer: Cash Price	$2,559.60
Rate for Payer: Cash Price	$2,559.60
Rate for Payer: UnitedHealthcare Commercial	$1,896.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,023.84

BREAST UNI W OR WO CONT

Facility

$2,844.00

Service Code	CPT 76093
Hospital Charge Code	3376093
Hospital Revenue Code	610
Rate for Payer: Cash Price	$2,559.60

BREO ELLIPTA 100/25MCG INH 30 DOSE EMP

Facility

$367.00

Service Code	NDC 173085910
Hospital Charge Code	2623322
Hospital Revenue Code	250
Min. Negotiated Rate	$132.12
Max. Negotiated Rate	$262.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$217.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$262.04
Rate for Payer: Cash Price	$330.30
Rate for Payer: UnitedHealthcare Commercial	$244.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$132.12

BREO ELLIPTA 100/25MCG INH 30 DOSE EMP

Facility

$367.00

Service Code	NDC 173085910
Hospital Charge Code	2623322
Hospital Revenue Code	250
Rate for Payer: Cash Price	$330.30

BREVI-KATH MINI-KIT

Facility

$325.00

Hospital Charge Code	124410
Hospital Revenue Code	271
Rate for Payer: Cash Price	$292.50

BREVI-KATH MINI-KIT

Facility

$325.00

Hospital Charge Code	124410
Hospital Revenue Code	271
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$232.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$192.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$232.05
Rate for Payer: Cash Price	$292.50
Rate for Payer: UnitedHealthcare Commercial	$216.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$117.00

BREVI-XL CATHETER

Facility

$319.00

Hospital Charge Code	2824411
Hospital Revenue Code	270
Min. Negotiated Rate	$114.84
Max. Negotiated Rate	$227.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$188.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$227.77
Rate for Payer: Cash Price	$287.10
Rate for Payer: UnitedHealthcare Commercial	$212.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$114.84

BREVI-XL CATHETER

Facility

$319.00

Hospital Charge Code	2824411
Hospital Revenue Code	270
Rate for Payer: Cash Price	$287.10

BRIMONID(ALPHAGAN P)0.1% 10ML OP SOL

Facility

$810.00

Service Code	NDC 23866510
Hospital Charge Code	2654329
Hospital Revenue Code	250
Rate for Payer: Cash Price	$729.00

BRIMONID(ALPHAGAN P)0.1% 10ML OP SOL

Facility

$810.00

Service Code	NDC 23866510
Hospital Charge Code	2654329
Hospital Revenue Code	250
Min. Negotiated Rate	$291.60
Max. Negotiated Rate	$578.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$479.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$578.34
Rate for Payer: Cash Price	$729.00
Rate for Payer: UnitedHealthcare Commercial	$540.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$291.60

BRIMONID/TIMOL(COMBIGAN)5ML OP SOL

Facility

$305.00

Service Code	NDC 23921105
Hospital Charge Code	2626480
Hospital Revenue Code	250
Min. Negotiated Rate	$109.80
Max. Negotiated Rate	$217.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$180.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$217.77
Rate for Payer: Cash Price	$274.50
Rate for Payer: UnitedHealthcare Commercial	$203.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$109.80

BRIMONID/TIMOL(COMBIGAN)5ML OP SOL

Facility

$305.00

Service Code	NDC 23921105
Hospital Charge Code	2626480
Hospital Revenue Code	250
Rate for Payer: Cash Price	$274.50

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All Charges