Madison Medical Center

All Charges

Charge

Type

Setting

Price

EKG WITH INTERPRETATION & REPORT

Facility

$223.00

Service Code	CPT 93000
Hospital Charge Code	4193000
Hospital Revenue Code	521
Min. Negotiated Rate	$132.02
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$132.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$159.22
Rate for Payer: Cash Price	$200.70
Rate for Payer: Cash Price	$200.70
Rate for Payer: UnitedHealthcare Commercial	$148.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EKG WITH REPORT AND INTERPRETATION

Facility

$223.00

Service Code	CPT 93000
Hospital Charge Code	3993000
Hospital Revenue Code	521
Min. Negotiated Rate	$132.02
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$132.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$159.22
Rate for Payer: Cash Price	$200.70
Rate for Payer: Cash Price	$200.70
Rate for Payer: UnitedHealthcare Commercial	$148.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EKG WITH REPORT AND INTERPRETATION

Facility

$223.00

Service Code	CPT 93000
Hospital Charge Code	3993000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$200.70

EKG W/REPORT AND INTERPRETATION

Facility

$223.00

Service Code	CPT 93000
Hospital Charge Code	9693000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$200.70

EKG W/REPORT AND INTERPRETATION

Facility

$223.00

Service Code	CPT 93000
Hospital Charge Code	9693000
Hospital Revenue Code	521
Min. Negotiated Rate	$132.02
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$132.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$159.22
Rate for Payer: Cash Price	$200.70
Rate for Payer: Cash Price	$200.70
Rate for Payer: UnitedHealthcare Commercial	$148.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ELASTOGEL

Facility

$24.00

Hospital Charge Code	285009
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

ELASTOGEL

Facility

$24.00

Hospital Charge Code	285009
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

ELASTOPLAST 1 INCH

Facility

$21.00

Hospital Charge Code	285203
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

ELASTOPLAST 1 INCH

Facility

$21.00

Hospital Charge Code	285203
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

ELASTOPLAST 2 INCH

Facility

$45.00

Hospital Charge Code	285204
Hospital Revenue Code	271
Rate for Payer: Cash Price	$40.50

ELASTOPLAST 2 INCH

Facility

$45.00

Hospital Charge Code	285204
Hospital Revenue Code	271
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

ELASTOPLAST 3 INCCH

Facility

$60.00

Hospital Charge Code	285205
Hospital Revenue Code	271
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

ELASTOPLAST 3 INCCH

Facility

$60.00

Hospital Charge Code	285205
Hospital Revenue Code	271
Rate for Payer: Cash Price	$54.00

ELASTOPLAST 4 INCH

Facility

$91.00

Hospital Charge Code	285206
Hospital Revenue Code	271
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$64.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: UnitedHealthcare Commercial	$60.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

ELASTOPLAST 4 INCH

Facility

$91.00

Hospital Charge Code	285206
Hospital Revenue Code	271
Rate for Payer: Cash Price	$81.90

ELBOW OR WRIST STRAPPING

Professional

Both

$250.00

Service Code	CPT 29260
Hospital Charge Code	1829260
Hospital Revenue Code	981
Min. Negotiated Rate	$15.36
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$15.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$29.67
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial HMO & PPO	$15.36
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32.64
Rate for Payer: Home State Health Plan Medicare Advantage	$15.36
Rate for Payer: Optum Medicare Advantage	$87.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29.67

ELBOW XRAY LT

Facility

$465.00

Service Code	CPT 73080
Hospital Charge Code	325128
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$332.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$275.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$332.01
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$167.40

ELBOW XRAY LT

Facility

$465.00

Service Code	CPT 73080
Hospital Charge Code	325128
Hospital Revenue Code	320
Rate for Payer: Cash Price	$418.50

ELBOW XRAY RT

Facility

$465.00

Service Code	CPT 73080
Hospital Charge Code	325127
Hospital Revenue Code	320
Rate for Payer: Cash Price	$418.50

ELBOW XRAY RT

Facility

$465.00

Service Code	CPT 73080
Hospital Charge Code	325127
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$332.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$275.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$332.01
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$167.40

ELEC CAUTERY

Facility

$208.00

Hospital Charge Code	123023
Hospital Revenue Code	360
Rate for Payer: Cash Price	$187.20

ELEC CAUTERY

Facility

$208.00

Hospital Charge Code	123023
Hospital Revenue Code	360
Min. Negotiated Rate	$74.88
Max. Negotiated Rate	$138.74
Rate for Payer: Cash Price	$187.20
Rate for Payer: UnitedHealthcare Commercial	$138.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$74.88

ELECTIVE HIP JOINT REPLACEMENT

Facility

$40,556.80

Service Code	APR-DRG 3244
Min. Negotiated Rate	$40,556.80
Max. Negotiated Rate	$40,556.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$40,556.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$40,556.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$40,556.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$40,556.80

ELECTIVE HIP JOINT REPLACEMENT

Facility

$26,325.68

Service Code	APR-DRG 3243
Min. Negotiated Rate	$26,325.68
Max. Negotiated Rate	$26,325.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$26,325.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26,325.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26,325.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26,325.68

ELECTIVE HIP JOINT REPLACEMENT

Facility

$16,654.29

Service Code	APR-DRG 3242
Min. Negotiated Rate	$16,654.29
Max. Negotiated Rate	$16,654.29
Rate for Payer: Aetna Better Health Medicaid/QHP	$16,654.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16,654.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16,654.29
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16,654.29

Know your out-of-pocket cost for care.

All Charges