Madison Medical Center

All Charges

Charge

Type

Setting

Price

DRAIN FLAT

Facility

$119.00

Hospital Charge Code	284718
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

DRAIN MALECOT

Facility

$205.00

Hospital Charge Code	284130
Hospital Revenue Code	271
Rate for Payer: Cash Price	$184.50

DRAIN MALECOT

Facility

$205.00

Hospital Charge Code	284130
Hospital Revenue Code	271
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$146.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$73.80

DRAIN, PENROSE

Facility

$21.00

Hospital Charge Code	284198
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

DRAIN, PENROSE

Facility

$22.00

Hospital Charge Code	124198
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

DRAIN, PENROSE

Facility

$21.00

Hospital Charge Code	284198
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

DRAIN, PENROSE

Facility

$22.00

Hospital Charge Code	124198
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

DRAIN,PEZZOR, 3-3 1-

Facility

$48.00

Hospital Charge Code	284132
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

DRAIN,PEZZOR, 3-3 1-

Facility

$48.00

Hospital Charge Code	284132
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

DRAIN SUMP

Facility

$89.00

Hospital Charge Code	284724
Hospital Revenue Code	271
Rate for Payer: Cash Price	$80.10

DRAIN SUMP

Facility

$89.00

Hospital Charge Code	284724
Hospital Revenue Code	271
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$63.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.55
Rate for Payer: Cash Price	$80.10
Rate for Payer: UnitedHealthcare Commercial	$59.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

DRAIN SYST URINARY

Facility

$48.00

Hospital Charge Code	284364
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

DRAIN SYST URINARY

Facility

$48.00

Hospital Charge Code	284364
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

DRAIN WOUND SHIRLEY

Facility

$81.00

Hospital Charge Code	284722
Hospital Revenue Code	271
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$57.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

DRAIN WOUND SHIRLEY

Facility

$81.00

Hospital Charge Code	284722
Hospital Revenue Code	271
Rate for Payer: Cash Price	$72.90

DRAPE, LARGE

Facility

$43.00

Hospital Charge Code	284777
Hospital Revenue Code	271
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

DRAPE, LARGE

Facility

$43.00

Hospital Charge Code	284777
Hospital Revenue Code	271
Rate for Payer: Cash Price	$38.70

DRAPE, LG. (HALF SHEET)

Facility

$43.00

Hospital Charge Code	124777
Hospital Revenue Code	271
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

DRAPE, LG. (HALF SHEET)

Facility

$43.00

Hospital Charge Code	124777
Hospital Revenue Code	271
Rate for Payer: Cash Price	$38.70

DRESS-DEBRID W/O ANESTH,LARGE

Professional

Both

$1,100.00

Service Code	CPT 16030
Hospital Charge Code	1816030
Hospital Revenue Code	981
Min. Negotiated Rate	$116.92
Max. Negotiated Rate	$385.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$116.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$149.12
Rate for Payer: Cash Price	$990.00
Rate for Payer: Cash Price	$990.00
Rate for Payer: Cigna Commercial HMO & PPO	$116.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$149.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$164.03
Rate for Payer: Home State Health Plan Medicare Advantage	$116.92
Rate for Payer: Optum Medicare Advantage	$385.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$149.12

DRESS-DEBRID W/O ANESTH,SMALL

Professional

Both

$388.00

Service Code	CPT 16020
Hospital Charge Code	1816020
Hospital Revenue Code	981
Min. Negotiated Rate	$50.56
Max. Negotiated Rate	$135.80
Rate for Payer: Aetna Commercial/Medicare Advantage	$50.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$63.78
Rate for Payer: Cash Price	$349.20
Rate for Payer: Cash Price	$349.20
Rate for Payer: Cigna Commercial HMO & PPO	$50.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$63.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$70.16
Rate for Payer: Home State Health Plan Medicare Advantage	$50.56
Rate for Payer: Optum Medicare Advantage	$135.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$63.78

DRESSING, ADHESIVE SURG.

Facility

$15.00

Hospital Charge Code	284842
Hospital Revenue Code	271
Rate for Payer: Cash Price	$13.50

DRESSING, ADHESIVE SURG.

Facility

$15.00

Hospital Charge Code	284842
Hospital Revenue Code	271
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

DRESSING/DEBRIDEMENT BURN

Facility

$200.00

Service Code	CPT 16020
Hospital Charge Code	9816020
Hospital Revenue Code	521
Rate for Payer: Cash Price	$180.00

DRESSING/DEBRIDEMENT BURN

Facility

$200.00

Service Code	CPT 16020
Hospital Charge Code	9816020
Hospital Revenue Code	521
Min. Negotiated Rate	$118.40
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$118.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.80
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$133.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges