Madison Medical Center

All Charges

Charge

Type

Setting

Price

5 OCL SPLINTING

Facility

$16.00

Hospital Charge Code	2816332
Hospital Revenue Code	271
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

6.0MM ENDOTRACHEAL TUBE--CUFFED

Facility

$178.00

Hospital Charge Code	285818
Hospital Revenue Code	270
Min. Negotiated Rate	$64.08
Max. Negotiated Rate	$127.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: UnitedHealthcare Commercial	$118.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

6.0MM ENDOTRACHEAL TUBE--CUFFED

Facility

$178.00

Hospital Charge Code	285818
Hospital Revenue Code	270
Rate for Payer: Cash Price	$160.20

6.5MM ENDOTRACHEAL TUBE--CUFFED

Facility

$178.00

Hospital Charge Code	285819
Hospital Revenue Code	270
Rate for Payer: Cash Price	$160.20

6.5MM ENDOTRACHEAL TUBE--CUFFED

Facility

$178.00

Hospital Charge Code	285819
Hospital Revenue Code	270
Min. Negotiated Rate	$64.08
Max. Negotiated Rate	$127.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: UnitedHealthcare Commercial	$118.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

.6-AM REFLEX CONFIRMATION

Facility

$110.00

Service Code	CPT 80356
Hospital Charge Code	221296
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

.6-AM REFLEX CONFIRMATION

Facility

$110.00

Service Code	CPT 80356
Hospital Charge Code	221296
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$78.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

7.0 BUGBEE ELECTRODE

Facility

$373.00

Hospital Charge Code	1216051
Hospital Revenue Code	271
Min. Negotiated Rate	$134.28
Max. Negotiated Rate	$266.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$220.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$266.32
Rate for Payer: Cash Price	$335.70
Rate for Payer: UnitedHealthcare Commercial	$248.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$134.28

7.0 BUGBEE ELECTRODE

Facility

$373.00

Hospital Charge Code	1216051
Hospital Revenue Code	271
Rate for Payer: Cash Price	$335.70

7.0MM ENDOTRACHEAL TUBE--CUFFED

Facility

$178.00

Hospital Charge Code	285820
Hospital Revenue Code	270
Min. Negotiated Rate	$64.08
Max. Negotiated Rate	$127.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: UnitedHealthcare Commercial	$118.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

7.0MM ENDOTRACHEAL TUBE--CUFFED

Facility

$178.00

Hospital Charge Code	285820
Hospital Revenue Code	270
Rate for Payer: Cash Price	$160.20

7.5MM ENDOTRACHEAL TUBE--CUFFED

Facility

$178.00

Hospital Charge Code	285821
Hospital Revenue Code	270
Rate for Payer: Cash Price	$160.20

7.5MM ENDOTRACHEAL TUBE--CUFFED

Facility

$178.00

Hospital Charge Code	285821
Hospital Revenue Code	270
Min. Negotiated Rate	$64.08
Max. Negotiated Rate	$127.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: UnitedHealthcare Commercial	$118.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

7.6CM-12.5CM REPAIR HAND, FOOT, NECK, EX

Professional

Both

$1,349.00

Service Code	CPT 12044
Hospital Charge Code	1812044
Hospital Revenue Code	981
Min. Negotiated Rate	$180.38
Max. Negotiated Rate	$472.15
Rate for Payer: Aetna Commercial/Medicare Advantage	$180.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$289.55
Rate for Payer: Cash Price	$1,214.10
Rate for Payer: Cash Price	$1,214.10
Rate for Payer: Cigna Commercial HMO & PPO	$180.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$289.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$318.50
Rate for Payer: Home State Health Plan Medicare Advantage	$180.38
Rate for Payer: Optum Medicare Advantage	$472.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$289.55

7.6CM-12.5CM REPAIR INTERMEDIA

Professional

Both

$1,208.00

Service Code	CPT 12034
Hospital Charge Code	1812034
Hospital Revenue Code	981
Min. Negotiated Rate	$170.01
Max. Negotiated Rate	$422.80
Rate for Payer: Aetna Commercial/Medicare Advantage	$170.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$254.27
Rate for Payer: Cash Price	$1,087.20
Rate for Payer: Cash Price	$1,087.20
Rate for Payer: Cigna Commercial HMO & PPO	$170.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$254.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$279.70
Rate for Payer: Home State Health Plan Medicare Advantage	$170.01
Rate for Payer: Optum Medicare Advantage	$422.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$254.27

8.0MM ENDOTRACHEAL TUBE--CUFFED

Facility

$178.00

Hospital Charge Code	285822
Hospital Revenue Code	270
Rate for Payer: Cash Price	$160.20

8.0MM ENDOTRACHEAL TUBE--CUFFED

Facility

$178.00

Hospital Charge Code	285822
Hospital Revenue Code	270
Min. Negotiated Rate	$64.08
Max. Negotiated Rate	$127.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: UnitedHealthcare Commercial	$118.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

8.5MM ENDOTRACHEAL TUBE--CUFFED

Facility

$178.00

Hospital Charge Code	285823
Hospital Revenue Code	270
Rate for Payer: Cash Price	$160.20

8.5MM ENDOTRACHEAL TUBE--CUFFED

Facility

$178.00

Hospital Charge Code	285823
Hospital Revenue Code	270
Min. Negotiated Rate	$64.08
Max. Negotiated Rate	$127.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: UnitedHealthcare Commercial	$118.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

9.0MM ENDOTRACHEAL TUBE--CUFFED

Facility

$178.00

Hospital Charge Code	285824
Hospital Revenue Code	270
Rate for Payer: Cash Price	$160.20

9.0MM ENDOTRACHEAL TUBE--CUFFED

Facility

$178.00

Hospital Charge Code	285824
Hospital Revenue Code	270
Min. Negotiated Rate	$64.08
Max. Negotiated Rate	$127.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: UnitedHealthcare Commercial	$118.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

ABBOTT ADPTR SCR CAP

Facility

$62.00

Hospital Charge Code	281019
Hospital Revenue Code	271
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$44.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: UnitedHealthcare Commercial	$41.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

ABBOTT ADPTR SCR CAP

Facility

$62.00

Hospital Charge Code	281019
Hospital Revenue Code	271
Rate for Payer: Cash Price	$55.80

ABBOTT IVEX FILTER

Facility

$62.00

Hospital Charge Code	281024
Hospital Revenue Code	271
Rate for Payer: Cash Price	$55.80

ABBOTT IVEX FILTER

Facility

$62.00

Hospital Charge Code	281024
Hospital Revenue Code	271
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$44.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: UnitedHealthcare Commercial	$41.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

Know your out-of-pocket cost for care.

All Charges