Madison Medical Center

All Charges

Charge

Type

Setting

Price

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	9469210
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	3969210
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	9669210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	9469210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	4269210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	5269210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	3969210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	5269210
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	9669210
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	9569210
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	4169210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	4269210
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	9869210
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	9869210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	4169210
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	9769210
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	9269210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	9269210
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	5469210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

EARWAX REMOVAL IRRIGATION

Facility

$75.00

Service Code	CPT 69209
Hospital Charge Code	9869209
Hospital Revenue Code	521
Rate for Payer: Cash Price	$67.50

EARWAX REMOVAL IRRIGATION

Facility

$75.00

Service Code	CPT 69209
Hospital Charge Code	9869209
Hospital Revenue Code	521
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EAR WICK

Facility

$20.00

Hospital Charge Code	28605200
Hospital Revenue Code	271
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

EAR WICK

Facility

$20.00

Hospital Charge Code	28605200
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

EAR WICKS (DISPOSABLE)

Facility

$20.00

Hospital Charge Code	4070006
Hospital Revenue Code	510
Rate for Payer: Cash Price	$18.00

EAR WICKS (DISPOSABLE)

Facility

$20.00

Hospital Charge Code	4070006
Hospital Revenue Code	510
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

Know your out-of-pocket cost for care.

All Charges