Madison Medical Center

All Charges

Charge

Type

Setting

Price

FILTER STRAW

Facility

$21.00

Hospital Charge Code	286820
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

FILTER STRAW

Facility

$21.00

Hospital Charge Code	286820
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

FINASTERIDE (PROSCAR) 5MG TAB

Facility

$28.00

Service Code	NDC 904683006
Hospital Charge Code	2626265
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

FINASTERIDE (PROSCAR) 5MG TAB

Facility

$28.00

Service Code	NDC 904683006
Hospital Charge Code	2626265
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

FINASTERIDE (PROSCAR) 5MG TAB EMP

Facility

$28.00

Service Code	NDC 4.3598E+10
Hospital Charge Code	2697718
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

FINASTERIDE (PROSCAR) 5MG TAB EMP

Facility

$28.00

Service Code	NDC 4.3598E+10
Hospital Charge Code	2697718
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

FINGER DISLOCATION REDUCTION

Professional

Both

$1,454.00

Service Code	CPT 26770
Hospital Charge Code	1826770
Hospital Revenue Code	981
Min. Negotiated Rate	$218.44
Max. Negotiated Rate	$508.90
Rate for Payer: Aetna Commercial/Medicare Advantage	$281.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$218.44
Rate for Payer: Cash Price	$1,308.60
Rate for Payer: Cash Price	$1,308.60
Rate for Payer: Cigna Commercial HMO & PPO	$281.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$218.44
Rate for Payer: Home State Health Plan Medicaid Managed Care	$240.28
Rate for Payer: Home State Health Plan Medicare Advantage	$281.90
Rate for Payer: Optum Medicare Advantage	$508.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$218.44

FINGER SPLINT

Facility

$15.00

Service Code	CPT Q4049
Hospital Charge Code	9804049
Hospital Revenue Code	521
Rate for Payer: Cash Price	$13.50

FINGER SPLINT

Facility

$15.00

Service Code	CPT Q4049
Hospital Charge Code	9804049
Hospital Revenue Code	521
Min. Negotiated Rate	$8.88
Max. Negotiated Rate	$173.53
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: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FINGER STICK

Facility

$62.00

Service Code	HCPCS 82948
Hospital Charge Code	2697037
Hospital Revenue Code	301
Rate for Payer: Cash Price	$55.80

FINGER STICK

Facility

$62.00

Service Code	HCPCS 82948
Hospital Charge Code	2697037
Hospital Revenue Code	301
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$44.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.54
Rate for Payer: Aetna Medicare Advantage	$5.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.86
Rate for Payer: Home State Health Plan Medicare Advantage	$5.04
Rate for Payer: Humana Commercial	$10.08
Rate for Payer: Humana Medicare Advantage	$5.04
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

FINGERS XRAY LT

Facility

$449.00

Service Code	CPT 73140
Hospital Charge Code	326132
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$320.59
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	$265.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$320.59
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
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	$161.64

FINGERS XRAY LT

Facility

$449.00

Service Code	CPT 73140
Hospital Charge Code	326132
Hospital Revenue Code	320
Rate for Payer: Cash Price	$404.10

FINGERS XRAY RT

Facility

$449.00

Service Code	CPT 73140
Hospital Charge Code	326131
Hospital Revenue Code	320
Rate for Payer: Cash Price	$404.10

FINGERS XRAY RT

Facility

$449.00

Service Code	CPT 73140
Hospital Charge Code	326131
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$320.59
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	$265.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$320.59
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
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	$161.64

FISCHER GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	3982962
Hospital Revenue Code	636
Min. Negotiated Rate	$20.01
Max. Negotiated Rate	$20.01
Rate for Payer: Cash Price	$27.00
Rate for Payer: UnitedHealthcare Commercial	$20.01

FISCHER GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	3982962
Hospital Revenue Code	636
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$21.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.95
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$3.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.16
Rate for Payer: Home State Health Plan Medicare Advantage	$3.28
Rate for Payer: Humana Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.28
Rate for Payer: UnitedHealthcare Commercial	$3.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

FISCHER INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	3987804
Hospital Revenue Code	301
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$50.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.90
Rate for Payer: Aetna Medicare Advantage	$16.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial HMO & PPO	$16.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.94
Rate for Payer: Home State Health Plan Medicare Advantage	$16.55
Rate for Payer: Humana Commercial	$33.10
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.56

FISCHER INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	3987804
Hospital Revenue Code	301
Rate for Payer: Cash Price	$63.90

FISCHER INFLUENZA A&B TEST

Facility

$123.00

Service Code	CPT 87502
Hospital Charge Code	3987502
Hospital Revenue Code	301
Rate for Payer: Cash Price	$110.70

FISCHER INFLUENZA A&B TEST

Facility

$123.00

Service Code	CPT 87502
Hospital Charge Code	3987502
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$191.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$86.22
Rate for Payer: Aetna Medicare Advantage	$95.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$72.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$87.82
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna Commercial HMO & PPO	$95.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$86.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$92.26
Rate for Payer: Home State Health Plan Medicare Advantage	$95.80
Rate for Payer: Humana Commercial	$191.60
Rate for Payer: Humana Medicare Advantage	$95.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$86.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.28

FISCHER KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	3987210
Hospital Revenue Code	301
Rate for Payer: Cash Price	$36.00

FISCHER KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	3987210
Hospital Revenue Code	301
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.24
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$5.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.61
Rate for Payer: Home State Health Plan Medicare Advantage	$5.82
Rate for Payer: Humana Commercial	$11.64
Rate for Payer: Humana Medicare Advantage	$5.82
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

FISCHER OCCULT BLOOD

Facility

$25.00

Service Code	CPT 82270
Hospital Charge Code	3982270
Hospital Revenue Code	301
Rate for Payer: Cash Price	$22.50

FISCHER OCCULT BLOOD

Facility

$25.00

Service Code	CPT 82270
Hospital Charge Code	3982270
Hospital Revenue Code	301
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.94
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.85
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna Commercial HMO & PPO	$4.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.22
Rate for Payer: Home State Health Plan Medicare Advantage	$4.38
Rate for Payer: Humana Commercial	$8.76
Rate for Payer: Humana Medicare Advantage	$4.38
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.00

Know your out-of-pocket cost for care.

All Charges