Madison Medical Center

All Charges

Charge

Type

Setting

Price

ENDOCUFF LARGE GREEN

Facility

$158.00

Hospital Charge Code	125347
Hospital Revenue Code	271
Min. Negotiated Rate	$56.88
Max. Negotiated Rate	$112.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$93.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$112.81
Rate for Payer: Cash Price	$142.20
Rate for Payer: UnitedHealthcare Commercial	$105.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.88

ENDOGATOR (STERILE WATER BOTTLE SYSTEM)

Facility

$102.00

Hospital Charge Code	124912
Hospital Revenue Code	360
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$68.03
Rate for Payer: Cash Price	$91.80
Rate for Payer: UnitedHealthcare Commercial	$68.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.72

ENDOGATOR (STERILE WATER BOTTLE SYSTEM)

Facility

$102.00

Hospital Charge Code	124912
Hospital Revenue Code	360
Rate for Payer: Cash Price	$91.80

ENDOLOOP, PDS 2 LIGATURE EZ10G

Facility

$202.00

Hospital Charge Code	125358
Hospital Revenue Code	271
Min. Negotiated Rate	$72.72
Max. Negotiated Rate	$144.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$119.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$144.23
Rate for Payer: Cash Price	$181.80
Rate for Payer: UnitedHealthcare Commercial	$134.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$72.72

ENDOLOOP, PDS 2 LIGATURE EZ10G

Facility

$202.00

Hospital Charge Code	125358
Hospital Revenue Code	271
Rate for Payer: Cash Price	$181.80

ENDOMETRIAL BIOPSY

Facility

$210.00

Service Code	CPT 58100
Hospital Charge Code	4458100
Hospital Revenue Code	521
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$413.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$182.25
Rate for Payer: Aetna Medicare Advantage	$206.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$124.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.94
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cigna Commercial HMO & PPO	$206.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$164.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$195.01
Rate for Payer: Home State Health Plan Medicare Advantage	$206.55
Rate for Payer: Humana Commercial	$413.10
Rate for Payer: Humana Medicare Advantage	$206.55
Rate for Payer: UnitedHealthcare Commercial	$140.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$182.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ENDOMETRIAL BIOPSY

Facility

$210.00

Service Code	CPT 58100
Hospital Charge Code	4458100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$189.00

ENDOMETRIAL CURETTAGE

Facility

$136.00

Service Code	CPT 57505
Hospital Charge Code	4257505
Hospital Revenue Code	521
Min. Negotiated Rate	$80.51
Max. Negotiated Rate	$1,882.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$830.28
Rate for Payer: Aetna Medicare Advantage	$941.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$80.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$97.10
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cigna Commercial HMO & PPO	$941.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$747.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$888.40
Rate for Payer: Home State Health Plan Medicare Advantage	$941.00
Rate for Payer: Humana Commercial	$1,882.00
Rate for Payer: Humana Medicare Advantage	$941.00
Rate for Payer: UnitedHealthcare Commercial	$90.71
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$830.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ENDOMETRIAL CURETTAGE

Facility

$136.00

Service Code	CPT 57505
Hospital Charge Code	4257505
Hospital Revenue Code	521
Rate for Payer: Cash Price	$122.40

ENDOMETRIAL SAMPLING

Facility

$171.00

Service Code	CPT 58100
Hospital Charge Code	5258100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$153.90

ENDOMETRIAL SAMPLING

Facility

$171.00

Service Code	CPT 58100
Hospital Charge Code	4258100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$153.90

ENDOMETRIAL SAMPLING

Facility

$171.00

Service Code	CPT 58100
Hospital Charge Code	4258100
Hospital Revenue Code	521
Min. Negotiated Rate	$101.23
Max. Negotiated Rate	$413.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$182.25
Rate for Payer: Aetna Medicare Advantage	$206.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$101.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$122.09
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cigna Commercial HMO & PPO	$206.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$164.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$195.01
Rate for Payer: Home State Health Plan Medicare Advantage	$206.55
Rate for Payer: Humana Commercial	$413.10
Rate for Payer: Humana Medicare Advantage	$206.55
Rate for Payer: UnitedHealthcare Commercial	$114.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$182.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ENDOMETRIAL SAMPLING

Facility

$171.00

Service Code	CPT 58100
Hospital Charge Code	5258100
Hospital Revenue Code	521
Min. Negotiated Rate	$101.23
Max. Negotiated Rate	$413.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$182.25
Rate for Payer: Aetna Medicare Advantage	$206.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$101.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$122.09
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cigna Commercial HMO & PPO	$206.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$164.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$195.01
Rate for Payer: Home State Health Plan Medicare Advantage	$206.55
Rate for Payer: Humana Commercial	$413.10
Rate for Payer: Humana Medicare Advantage	$206.55
Rate for Payer: UnitedHealthcare Commercial	$114.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$182.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ENDOMYSIAL ANTIBODY IGA

Facility

$334.00

Service Code	CPT 86255
Hospital Charge Code	2206255
Hospital Revenue Code	301
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$238.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.85
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$197.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$238.48
Rate for Payer: Cash Price	$300.60
Rate for Payer: Cash Price	$300.60
Rate for Payer: Cash Price	$300.60
Rate for Payer: Cigna Commercial HMO & PPO	$12.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.61
Rate for Payer: Home State Health Plan Medicare Advantage	$12.05
Rate for Payer: Humana Commercial	$24.10
Rate for Payer: Humana Medicare Advantage	$12.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.24

ENDOMYSIAL ANTIBODY IGA

Facility

$334.00

Service Code	CPT 86255
Hospital Charge Code	2206255
Hospital Revenue Code	301
Rate for Payer: Cash Price	$300.60

ENDOPATH VASCULAR RELOAD

Facility

$599.00

Hospital Charge Code	283985
Hospital Revenue Code	271
Min. Negotiated Rate	$215.64
Max. Negotiated Rate	$427.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$354.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$427.69
Rate for Payer: Cash Price	$539.10
Rate for Payer: UnitedHealthcare Commercial	$399.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$215.64

ENDOPATH VASCULAR RELOAD

Facility

$599.00

Hospital Charge Code	283985
Hospital Revenue Code	271
Rate for Payer: Cash Price	$539.10

ENDO POUCH 173050G

Facility

$487.00

Hospital Charge Code	125342
Hospital Revenue Code	271
Rate for Payer: Cash Price	$438.30

ENDO POUCH 173050G

Facility

$487.00

Hospital Charge Code	125342
Hospital Revenue Code	271
Min. Negotiated Rate	$175.32
Max. Negotiated Rate	$347.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$288.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$347.72
Rate for Payer: Cash Price	$438.30
Rate for Payer: UnitedHealthcare Commercial	$324.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$175.32

ENDO RETRACT II

Facility

$534.00

Hospital Charge Code	1256990
Hospital Revenue Code	271
Min. Negotiated Rate	$192.24
Max. Negotiated Rate	$381.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$316.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$381.28
Rate for Payer: Cash Price	$480.60
Rate for Payer: UnitedHealthcare Commercial	$356.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$192.24

ENDO RETRACT II

Facility

$534.00

Hospital Charge Code	1256990
Hospital Revenue Code	271
Rate for Payer: Cash Price	$480.60

ENDOSCOPIC ARTICULATING LINEAR CUTTER

Facility

$1,339.00

Hospital Charge Code	283983
Hospital Revenue Code	271
Min. Negotiated Rate	$482.04
Max. Negotiated Rate	$956.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$792.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$956.05
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: UnitedHealthcare Commercial	$893.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.04

ENDOSCOPIC ARTICULATING LINEAR CUTTER

Facility

$1,339.00

Hospital Charge Code	283983
Hospital Revenue Code	271
Rate for Payer: Cash Price	$1,205.10

ENDOSCOPIC INJ URETHRA/BLADDER

Professional

Both

$1,500.00

Service Code	CPT 51715
Hospital Charge Code	9351715
Hospital Revenue Code	975
Min. Negotiated Rate	$170.78
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$170.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$285.42
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Cigna Commercial HMO & PPO	$170.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$285.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$313.96
Rate for Payer: Home State Health Plan Medicare Advantage	$170.78
Rate for Payer: Optum Medicare Advantage	$525.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$285.42

ENDOSCOPIC INST SET

Facility

$2,451.00

Hospital Charge Code	285344
Hospital Revenue Code	271
Rate for Payer: Cash Price	$2,205.90

Know your out-of-pocket cost for care.

All Charges