Madison Medical Center

All Charges

Charge

Type

Setting

Price

14FR STOMACH TUBE/LEVIN TYPE

Facility

$28.00

Hospital Charge Code	2819471
Hospital Revenue Code	271
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

14FT LENGTH OXYGEN SUPPLY TUBING

Facility

$21.00

Hospital Charge Code	4500451
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

14FT LENGTH OXYGEN SUPPLY TUBING

Facility

$21.00

Hospital Charge Code	4500451
Hospital Revenue Code	271
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

1/4 SHEET

Facility

$22.00

Hospital Charge Code	2820737
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

1/4 SHEET

Facility

$22.00

Hospital Charge Code	2820737
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

15MM-15GA, I/O NEEDLE SET

Facility

$480.00

Hospital Charge Code	281425
Hospital Revenue Code	271
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$342.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$284.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$342.72
Rate for Payer: Cash Price	$432.00
Rate for Payer: UnitedHealthcare Commercial	$320.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$172.80

15MM-15GA, I/O NEEDLE SET

Facility

$480.00

Hospital Charge Code	281425
Hospital Revenue Code	271
Rate for Payer: Cash Price	$432.00

1.5 MM ACCESSORY KIT

Facility

$992.00

Hospital Charge Code	123337
Hospital Revenue Code	271
Rate for Payer: Cash Price	$892.80

1.5 MM ACCESSORY KIT

Facility

$992.00

Hospital Charge Code	123337
Hospital Revenue Code	271
Min. Negotiated Rate	$357.12
Max. Negotiated Rate	$708.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$587.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$708.29
Rate for Payer: Cash Price	$892.80
Rate for Payer: UnitedHealthcare Commercial	$661.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$357.12

15MM SMART TOE ANGLED IMPLANT

Facility

$2,558.00

Hospital Charge Code	123426
Hospital Revenue Code	271
Rate for Payer: Cash Price	$2,302.20

15MM SMART TOE ANGLED IMPLANT

Facility

$2,558.00

Hospital Charge Code	123426
Hospital Revenue Code	271
Min. Negotiated Rate	$920.88
Max. Negotiated Rate	$1,826.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,514.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,826.41
Rate for Payer: Cash Price	$2,302.20
Rate for Payer: UnitedHealthcare Commercial	$1,706.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$920.88

15X10MM SHAPE MEMORY FIX

Facility

$3,221.00

Hospital Charge Code	123335
Hospital Revenue Code	271
Min. Negotiated Rate	$1,159.56
Max. Negotiated Rate	$2,299.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,906.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,299.79
Rate for Payer: Cash Price	$2,898.90
Rate for Payer: UnitedHealthcare Commercial	$2,148.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,159.56

15X10MM SHAPE MEMORY FIX

Facility

$3,221.00

Hospital Charge Code	123335
Hospital Revenue Code	271
Rate for Payer: Cash Price	$2,898.90

16FR SALEM SUMP

Facility

$42.00

Hospital Charge Code	2819062
Hospital Revenue Code	270
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

16FR SALEM SUMP

Facility

$42.00

Hospital Charge Code	2819062
Hospital Revenue Code	270
Rate for Payer: Cash Price	$37.80

16FR STOMACH TUBE/LEVIN TYPE

Facility

$28.00

Hospital Charge Code	2819472
Hospital Revenue Code	271
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

16FR STOMACH TUBE/LEVIN TYPE

Facility

$28.00

Hospital Charge Code	2819472
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

16MM SMART TOE ANGLED IMPLANT

Facility

$2,558.00

Hospital Charge Code	123427
Hospital Revenue Code	271
Rate for Payer: Cash Price	$2,302.20

16MM SMART TOE ANGLED IMPLANT

Facility

$2,558.00

Hospital Charge Code	123427
Hospital Revenue Code	271
Min. Negotiated Rate	$920.88
Max. Negotiated Rate	$1,826.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,514.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,826.41
Rate for Payer: Cash Price	$2,302.20
Rate for Payer: UnitedHealthcare Commercial	$1,706.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$920.88

17GX5 EPIDURAL NEEDLE

Facility

$63.00

Hospital Charge Code	2824475
Hospital Revenue Code	270
Rate for Payer: Cash Price	$56.70

17GX5 EPIDURAL NEEDLE

Facility

$63.00

Hospital Charge Code	2824475
Hospital Revenue Code	270
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

17-HYDROXYCORTICO/STEROIDS

Facility

$142.00

Service Code	CPT 83491
Hospital Charge Code	2283491
Hospital Revenue Code	301
Rate for Payer: Cash Price	$127.80

17-HYDROXYCORTICO/STEROIDS

Facility

$142.00

Service Code	CPT 83491
Hospital Charge Code	2283491
Hospital Revenue Code	301
Min. Negotiated Rate	$16.11
Max. Negotiated Rate	$101.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.11
Rate for Payer: Aetna Medicare Advantage	$17.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$84.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$101.39
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cigna Commercial HMO & PPO	$17.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.24
Rate for Payer: Home State Health Plan Medicare Advantage	$17.90
Rate for Payer: Humana Commercial	$35.80
Rate for Payer: Humana Medicare Advantage	$17.90
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.12

17-HYDROXYPREGNENOLONE

Facility

$149.00

Service Code	CPT 84143
Hospital Charge Code	2284143
Hospital Revenue Code	301
Rate for Payer: Cash Price	$134.10

17-HYDROXYPREGNENOLONE

Facility

$149.00

Service Code	CPT 84143
Hospital Charge Code	2284143
Hospital Revenue Code	301
Min. Negotiated Rate	$20.53
Max. Negotiated Rate	$106.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$20.53
Rate for Payer: Aetna Medicare Advantage	$22.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$106.39
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cigna Commercial HMO & PPO	$22.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21.97
Rate for Payer: Home State Health Plan Medicare Advantage	$22.81
Rate for Payer: Humana Commercial	$45.62
Rate for Payer: Humana Medicare Advantage	$22.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.64

Know your out-of-pocket cost for care.

All Charges