Madison Medical Center

All Charges

Charge

Type

Setting

Price

ADULT ET TUBE HOLDER

Facility

$112.00

Hospital Charge Code	2800347
Hospital Revenue Code	271
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$79.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: UnitedHealthcare Commercial	$74.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

ADULT FLEX CONNECTOR

Facility

$3.00

Hospital Charge Code	4524489
Hospital Revenue Code	271
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$2.14
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2.14
Rate for Payer: Cash Price	$2.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.08

ADULT FLEX CONNECTOR

Facility

$3.00

Hospital Charge Code	4524489
Hospital Revenue Code	271
Rate for Payer: Cash Price	$2.70

ADULT RES ELECTRODE

Facility

$370.00

Hospital Charge Code	28021401
Hospital Revenue Code	271
Rate for Payer: Cash Price	$333.00

ADULT RES ELECTRODE

Facility

$370.00

Hospital Charge Code	28021401
Hospital Revenue Code	271
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$264.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$219.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$264.18
Rate for Payer: Cash Price	$333.00
Rate for Payer: UnitedHealthcare Commercial	$246.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$133.20

ADVAIR 150/50 INH 60-DOSE EMP

Facility

$414.00

Service Code	NDC 173069500
Hospital Charge Code	2623505
Hospital Revenue Code	250
Min. Negotiated Rate	$149.04
Max. Negotiated Rate	$295.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$245.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$295.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: UnitedHealthcare Commercial	$276.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$149.04

ADVAIR 150/50 INH 60-DOSE EMP

Facility

$414.00

Service Code	NDC 173069500
Hospital Charge Code	2623505
Hospital Revenue Code	250
Rate for Payer: Cash Price	$372.60

ADVAIR 250/50 INH 60-DOSE EMP

Facility

$414.00

Service Code	NDC 173069600
Hospital Charge Code	2622336
Hospital Revenue Code	250
Rate for Payer: Cash Price	$372.60

ADVAIR 250/50 INH 60-DOSE EMP

Facility

$414.00

Service Code	NDC 173069600
Hospital Charge Code	2622336
Hospital Revenue Code	250
Min. Negotiated Rate	$149.04
Max. Negotiated Rate	$295.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$245.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$295.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: UnitedHealthcare Commercial	$276.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$149.04

ADVAIR HFA 115/21 12GM INH

Facility

$941.00

Service Code	NDC 173071620
Hospital Charge Code	2697602
Hospital Revenue Code	250
Rate for Payer: Cash Price	$846.90

ADVAIR HFA 115/21 12GM INH

Facility

$941.00

Service Code	NDC 173071620
Hospital Charge Code	2697602
Hospital Revenue Code	250
Min. Negotiated Rate	$338.76
Max. Negotiated Rate	$671.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$557.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$671.87
Rate for Payer: Cash Price	$846.90
Rate for Payer: UnitedHealthcare Commercial	$627.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$338.76

ADVAIR HFA 230/21 12GM 120-DOSE INH EMP

Facility

$941.00

Service Code	NDC 173071720
Hospital Charge Code	2625782
Hospital Revenue Code	250
Rate for Payer: Cash Price	$846.90

ADVAIR HFA 230/21 12GM 120-DOSE INH EMP

Facility

$941.00

Service Code	NDC 173071720
Hospital Charge Code	2625782
Hospital Revenue Code	250
Min. Negotiated Rate	$338.76
Max. Negotiated Rate	$671.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$557.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$671.87
Rate for Payer: Cash Price	$846.90
Rate for Payer: UnitedHealthcare Commercial	$627.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$338.76

ADVAIR HFA 45/21 12GM 120-DOSE INH EMP

Facility

$941.00

Service Code	NDC 173071520
Hospital Charge Code	2624682
Hospital Revenue Code	250
Rate for Payer: Cash Price	$846.90

ADVAIR HFA 45/21 12GM 120-DOSE INH EMP

Facility

$941.00

Service Code	NDC 173071520
Hospital Charge Code	2624682
Hospital Revenue Code	250
Min. Negotiated Rate	$338.76
Max. Negotiated Rate	$671.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$557.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$671.87
Rate for Payer: Cash Price	$846.90
Rate for Payer: UnitedHealthcare Commercial	$627.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$338.76

AERO DRAINAGE

Facility

$10.00

Hospital Charge Code	28251799
Hospital Revenue Code	271
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$7.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.14
Rate for Payer: Cash Price	$9.00
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.60

AERO DRAINAGE

Facility

$10.00

Hospital Charge Code	28251799
Hospital Revenue Code	271
Rate for Payer: Cash Price	$9.00

.AFB ACID-FAST BACILLI (AFB)

Facility

$95.00

Service Code	CPT 87116
Hospital Charge Code	3000002
Hospital Revenue Code	306
Rate for Payer: Cash Price	$85.50

.AFB ACID-FAST BACILLI (AFB)

Facility

$95.00

Service Code	CPT 87116
Hospital Charge Code	3000002
Hospital Revenue Code	306
Min. Negotiated Rate	$9.72
Max. Negotiated Rate	$67.83
Rate for Payer: Humana Medicare Advantage	$10.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.72
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$67.83
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cigna Commercial HMO & PPO	$10.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10.40
Rate for Payer: Home State Health Plan Medicare Advantage	$10.80
Rate for Payer: Humana Commercial	$21.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.20

.AFB ACID-FAST BACILLI (AFB)SMEAR

Facility

$76.00

Service Code	CPT 87206
Hospital Charge Code	3000004
Hospital Revenue Code	306
Rate for Payer: Cash Price	$68.40

.AFB ACID-FAST BACILLI (AFB)SMEAR

Facility

$76.00

Service Code	CPT 87206
Hospital Charge Code	3000004
Hospital Revenue Code	306
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$54.26
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.85
Rate for Payer: Aetna Medicare Advantage	$5.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$54.26
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cigna Commercial HMO & PPO	$5.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.19
Rate for Payer: Home State Health Plan Medicare Advantage	$5.39
Rate for Payer: Humana Commercial	$10.78
Rate for Payer: Humana Medicare Advantage	$5.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.36

AFP/AFP-L3

Facility

$260.00

Service Code	CPT 82107
Hospital Charge Code	2282107
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$185.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$57.97
Rate for Payer: Aetna Medicare Advantage	$64.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cigna Commercial HMO & PPO	$64.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$57.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$62.03
Rate for Payer: Home State Health Plan Medicare Advantage	$64.41
Rate for Payer: Humana Commercial	$128.82
Rate for Payer: Humana Medicare Advantage	$64.41
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$57.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$93.60

AFP/AFP-L3

Facility

$260.00

Service Code	CPT 82107
Hospital Charge Code	2282107
Hospital Revenue Code	301
Rate for Payer: Cash Price	$234.00

AFP MATERNAL

Facility

$52.00

Service Code	CPT 82105
Hospital Charge Code	221239
Hospital Revenue Code	301
Min. Negotiated Rate	$15.09
Max. Negotiated Rate	$37.13
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.09
Rate for Payer: Aetna Medicare Advantage	$16.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.13
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cigna Commercial HMO & PPO	$16.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.15
Rate for Payer: Home State Health Plan Medicare Advantage	$16.77
Rate for Payer: Humana Commercial	$33.54
Rate for Payer: Humana Medicare Advantage	$16.77
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.72

AFP MATERNAL

Facility

$52.00

Service Code	CPT 82105
Hospital Charge Code	221239
Hospital Revenue Code	301
Rate for Payer: Cash Price	$46.80

Know your out-of-pocket cost for care.

All Charges