Madison Medical Center

All Charges

Charge

Type

Setting

Price

CLOPIDOGREL 75MG TAB EMP

Facility

$40.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2621141
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

CLOPIDOGREL 75MG TAB EMP

Facility

$40.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2621141
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

CLOPIDOGREL (PLAVIX) 75MG TAB UD

Facility

$40.00

Service Code	NDC 904629461
Hospital Charge Code	2654477
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

CLOPIDOGREL (PLAVIX) 75MG TAB UD

Facility

$40.00

Service Code	NDC 904629461
Hospital Charge Code	2654477
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

CLORA PREP 3ML 260400

Facility

$13.00

Hospital Charge Code	1217063
Hospital Revenue Code	272
Rate for Payer: Cash Price	$11.70

CLORA PREP 3ML 260400

Facility

$13.00

Hospital Charge Code	1217063
Hospital Revenue Code	272
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

CLOSED ELBOW DISLOCATION REDUCTION

Professional

Both

$2,450.00

Service Code	CPT 24600
Hospital Charge Code	1824600
Hospital Revenue Code	981
Min. Negotiated Rate	$286.18
Max. Negotiated Rate	$857.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$370.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$286.18
Rate for Payer: Cash Price	$2,205.00
Rate for Payer: Cash Price	$2,205.00
Rate for Payer: Cigna Commercial HMO & PPO	$370.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$286.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$314.80
Rate for Payer: Home State Health Plan Medicare Advantage	$370.10
Rate for Payer: Optum Medicare Advantage	$857.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$286.18

CLOSED FX TREATMENT CARPAL SCAPHOID W/O

Facility

$557.00

Service Code	CPT 25622
Hospital Charge Code	4425622
Hospital Revenue Code	521
Rate for Payer: Cash Price	$501.30

CLOSED FX TREATMENT CARPAL SCAPHOID W/O

Facility

$557.00

Service Code	CPT 25622
Hospital Charge Code	4425622
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$504.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$329.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$397.70
Rate for Payer: Cash Price	$501.30
Rate for Payer: Cash Price	$501.30
Rate for Payer: Cash Price	$501.30
Rate for Payer: Cash Price	$501.30
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$371.52
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED FX TREATMENT DISTAL RADIAL FX COL

Facility

$557.00

Service Code	CPT 25600
Hospital Charge Code	4425600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$501.30

CLOSED FX TREATMENT DISTAL RADIAL FX COL

Facility

$557.00

Service Code	CPT 25600
Hospital Charge Code	4425600
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$504.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$329.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$397.70
Rate for Payer: Cash Price	$501.30
Rate for Payer: Cash Price	$501.30
Rate for Payer: Cash Price	$501.30
Rate for Payer: Cash Price	$501.30
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$371.52
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED FX TX RADIAL HEAD W/O MANIPULATIO

Facility

$368.00

Service Code	CPT 24650
Hospital Charge Code	4424650
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$504.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$217.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$262.75
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$245.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED FX TX RADIAL HEAD W/O MANIPULATIO

Facility

$368.00

Service Code	CPT 24650
Hospital Charge Code	4424650
Hospital Revenue Code	521
Rate for Payer: Cash Price	$331.20

CLOSED REDUCTIONOF ELBOW DISLOCATION

Professional

Both

$263.00

Service Code	CPT 24640
Hospital Charge Code	1824640
Hospital Revenue Code	981
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$92.05
Rate for Payer: Aetna Commercial/Medicare Advantage	$67.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$79.36
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cigna Commercial HMO & PPO	$67.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$79.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$87.30
Rate for Payer: Home State Health Plan Medicare Advantage	$67.50
Rate for Payer: Optum Medicare Advantage	$92.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$79.36

CLOSED TREATMENT OF KNEE DISLOCATION

Facility

$2,230.00

Service Code	CPT 27550
Hospital Charge Code	1827550
Hospital Revenue Code	761
Rate for Payer: Cash Price	$2,007.00

CLOSED TREATMENT OF KNEE DISLOCATION

Facility

$2,230.00

Service Code	CPT 27550
Hospital Charge Code	1827550
Hospital Revenue Code	761
Min. Negotiated Rate	$222.36
Max. Negotiated Rate	$1,592.22
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,320.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,592.22
Rate for Payer: Cash Price	$2,007.00
Rate for Payer: Cash Price	$2,007.00
Rate for Payer: Cash Price	$2,007.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$222.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$1,487.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$802.80

CLOSED TREATMENT-SHOULDER DISLOCATION

Facility

$485.00

Service Code	CPT 23650
Hospital Charge Code	4423650
Hospital Revenue Code	250
Min. Negotiated Rate	$174.60
Max. Negotiated Rate	$504.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$287.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$346.29
Rate for Payer: Cash Price	$436.50
Rate for Payer: Cash Price	$436.50
Rate for Payer: Cash Price	$436.50
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$222.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$323.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$174.60

CLOSED TREATMENT-SHOULDER DISLOCATION

Facility

$485.00

Service Code	CPT 23650
Hospital Charge Code	4423650
Hospital Revenue Code	250
Rate for Payer: Cash Price	$436.50

CLOSED TREAT OF ANKLE FX W/MANI

Professional

Both

$603.00

Service Code	CPT 27825
Hospital Charge Code	1827825
Hospital Revenue Code	981
Min. Negotiated Rate	$211.05
Max. Negotiated Rate	$454.37
Rate for Payer: Aetna Commercial/Medicare Advantage	$447.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$413.06
Rate for Payer: Cash Price	$542.70
Rate for Payer: Cash Price	$542.70
Rate for Payer: Cigna Commercial HMO & PPO	$447.97
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$413.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$454.37
Rate for Payer: Home State Health Plan Medicare Advantage	$447.97
Rate for Payer: Optum Medicare Advantage	$211.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$413.06

CLOSED TX CARPOMETACARPAL DISL THUMB W M

Facility

$950.00

Service Code	CPT 26641
Hospital Charge Code	9826641
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$678.30
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$562.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$678.30
Rate for Payer: Cash Price	$855.00
Rate for Payer: Cash Price	$855.00
Rate for Payer: Cash Price	$855.00
Rate for Payer: Cash Price	$855.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$633.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX CARPOMETACARPAL DISL THUMB W M

Facility

$950.00

Service Code	CPT 26641
Hospital Charge Code	9826641
Hospital Revenue Code	521
Rate for Payer: Cash Price	$855.00

CLOSED TX CLAVICULAR FRACTURE W/O MANIPU

Facility

$780.00

Service Code	CPT 23500
Hospital Charge Code	9323500
Hospital Revenue Code	521
Rate for Payer: Cash Price	$702.00

CLOSED TX CLAVICULAR FRACTURE W/O MANIPU

Facility

$780.00

Service Code	CPT 23500
Hospital Charge Code	9323500
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$556.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$461.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$556.92
Rate for Payer: Cash Price	$702.00
Rate for Payer: Cash Price	$702.00
Rate for Payer: Cash Price	$702.00
Rate for Payer: Cash Price	$702.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$520.26
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX DISTAL PHALANGEAL FX WO MANIPU

Facility

$650.00

Service Code	CPT 26750
Hospital Charge Code	9326750
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$504.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$384.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$464.10
Rate for Payer: Cash Price	$585.00
Rate for Payer: Cash Price	$585.00
Rate for Payer: Cash Price	$585.00
Rate for Payer: Cash Price	$585.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$433.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX DISTAL PHALANGEAL FX WO MANIPU

Facility

$650.00

Service Code	CPT 26750
Hospital Charge Code	9326750
Hospital Revenue Code	521
Rate for Payer: Cash Price	$585.00

Know your out-of-pocket cost for care.

All Charges