Madison Medical Center

All Charges

Charge

Type

Setting

Price

CL- FLUAD 65+

Facility

$90.00

Service Code	HCPCS 90694
Hospital Charge Code	9890694
Hospital Revenue Code	636
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL- FLUAD 65+

Facility

$90.00

Service Code	HCPCS 90694
Hospital Charge Code	4490694
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

CL- FLUAD 65+

Facility

$90.00

Service Code	HCPCS 90694
Hospital Charge Code	4290694
Hospital Revenue Code	636
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL- FLUAD 65+

Facility

$90.00

Service Code	HCPCS 90694
Hospital Charge Code	4290694
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

CL- FLUAD 65+

Facility

$90.00

Service Code	HCPCS 90694
Hospital Charge Code	4490694
Hospital Revenue Code	636
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL- FLUAD 65+

Facility

$90.00

Service Code	HCPCS 90694
Hospital Charge Code	9790694
Hospital Revenue Code	521
Min. Negotiated Rate	$53.28
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CL- FLUAD 65+

Facility

$90.00

Service Code	HCPCS 90694
Hospital Charge Code	9490694
Hospital Revenue Code	636
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL- FLUAD 65+

Facility

$90.00

Service Code	HCPCS 90694
Hospital Charge Code	9890694
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

CL- FLUAD 65+

Facility

$90.00

Service Code	HCPCS 90694
Hospital Charge Code	5290694
Hospital Revenue Code	521
Rate for Payer: Cash Price	$81.00

CL-FLUAD 65 +

Facility

$90.00

Service Code	HCPCS 90682
Hospital Charge Code	3990694
Hospital Revenue Code	771
Rate for Payer: Cash Price	$81.00

CL-FLUAD 65 +

Facility

$90.00

Service Code	HCPCS 90682
Hospital Charge Code	3990694
Hospital Revenue Code	771
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL - FLUAD HI DOSE

Facility

$100.00

Service Code	HCPCS 90653
Hospital Charge Code	9690653
Hospital Revenue Code	636
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$71.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.00

CL - FLUAD HI DOSE

Facility

$100.00

Service Code	HCPCS 90653
Hospital Charge Code	9290653
Hospital Revenue Code	636
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$71.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.00

CL - FLUAD HI DOSE

Facility

$100.00

Service Code	HCPCS 90653
Hospital Charge Code	9690653
Hospital Revenue Code	636
Min. Negotiated Rate	$66.70
Max. Negotiated Rate	$66.70
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70

CL - FLUAD HI DOSE

Facility

$100.00

Service Code	HCPCS 90653
Hospital Charge Code	9290653
Hospital Revenue Code	636
Min. Negotiated Rate	$66.70
Max. Negotiated Rate	$66.70
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70

CL- FLUAD HI DOSE

Facility

$100.00

Service Code	HCPCS 90653
Hospital Charge Code	9890653
Hospital Revenue Code	636
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$71.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.00

CL- FLUAD HI DOSE

Facility

$100.00

Service Code	HCPCS 90653
Hospital Charge Code	4490653
Hospital Revenue Code	636
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$71.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.00

CL- FLUAD HI DOSE

Facility

$100.00

Service Code	HCPCS 90653
Hospital Charge Code	5290653
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.00

CL- FLUAD HI DOSE

Facility

$100.00

Service Code	HCPCS 90653
Hospital Charge Code	9490653
Hospital Revenue Code	636
Min. Negotiated Rate	$66.70
Max. Negotiated Rate	$66.70
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70

CL- FLUAD HI DOSE

Facility

$100.00

Service Code	HCPCS 90653
Hospital Charge Code	9890653
Hospital Revenue Code	636
Min. Negotiated Rate	$66.70
Max. Negotiated Rate	$66.70
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70

CL- FLUAD HI DOSE

Facility

$100.00

Service Code	HCPCS 90653
Hospital Charge Code	5290653
Hospital Revenue Code	521
Min. Negotiated Rate	$59.20
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CL- FLUAD HI DOSE

Facility

$100.00

Service Code	HCPCS 90653
Hospital Charge Code	9490653
Hospital Revenue Code	636
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$71.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.00

CL- FLUAD HI DOSE

Facility

$100.00

Service Code	HCPCS 90653
Hospital Charge Code	4490653
Hospital Revenue Code	636
Min. Negotiated Rate	$66.70
Max. Negotiated Rate	$66.70
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70

CL-FLUAD HI DOSE

Facility

$100.00

Service Code	HCPCS 90653
Hospital Charge Code	3990653
Hospital Revenue Code	771
Rate for Payer: Cash Price	$90.00

CL-FLUAD HI DOSE

Facility

$100.00

Service Code	HCPCS 90653
Hospital Charge Code	3990653
Hospital Revenue Code	771
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$71.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.00

Know your out-of-pocket cost for care.

All Charges