Madison Medical Center

All Charges

Charge

Type

Setting

Price

GAUGE, SNAP DEVICE (DACOMED)

Facility

$113.00

Hospital Charge Code	407392
Hospital Revenue Code	271
Rate for Payer: Cash Price	$101.70

GAUGE, SNAP DEVICE (DACOMED)

Facility

$113.00

Hospital Charge Code	407392
Hospital Revenue Code	271
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$80.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: UnitedHealthcare Commercial	$75.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

GAUZE, 1/2 PLAIN PACKING

Facility

$13.00

Hospital Charge Code	287630
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

GAUZE, 1/2 PLAIN PACKING

Facility

$13.00

Hospital Charge Code	287630
Hospital Revenue Code	271
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

GAUZE, 1/4 PLAIN PACKING

Facility

$13.00

Hospital Charge Code	287631
Hospital Revenue Code	271
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

GAUZE, 1/4 PLAIN PACKING

Facility

$13.00

Hospital Charge Code	287631
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

GAUZE, 1 PLAIN PACKING

Facility

$13.00

Hospital Charge Code	287629
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

GAUZE, 1 PLAIN PACKING

Facility

$13.00

Hospital Charge Code	287629
Hospital Revenue Code	271
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

GAUZE, 2 IODOFORM PACKING #7834

Facility

$65.00

Hospital Charge Code	287266
Hospital Revenue Code	271
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

GAUZE, 2 IODOFORM PACKING #7834

Facility

$65.00

Hospital Charge Code	287266
Hospital Revenue Code	271
Rate for Payer: Cash Price	$58.50

GAUZE, CARRA

Facility

$21.00

Hospital Charge Code	287261
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

GAUZE, CARRA

Facility

$21.00

Hospital Charge Code	287261
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

GAUZE,IODOFORM 1/2

Facility

$60.00

Hospital Charge Code	287264
Hospital Revenue Code	271
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: UnitedHealthcare Commercial	$40.02
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 Medicare Advantage	$21.60

GAUZE,IODOFORM 1/2

Facility

$60.00

Hospital Charge Code	287264
Hospital Revenue Code	271
Rate for Payer: Cash Price	$54.00

GAUZE IODOFORM 1/4 7831

Facility

$58.00

Hospital Charge Code	287263
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

GAUZE IODOFORM 1/4 7831

Facility

$58.00

Hospital Charge Code	287263
Hospital Revenue Code	271
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

GAUZE,IODOFORM 1IN

Facility

$62.00

Hospital Charge Code	287265
Hospital Revenue Code	271
Rate for Payer: Cash Price	$55.80

GAUZE,IODOFORM 1IN

Facility

$62.00

Hospital Charge Code	287265
Hospital Revenue Code	271
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$44.27
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: UnitedHealthcare Commercial	$41.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

GAUZE,VASELINE

Facility

$39.00

Hospital Charge Code	287182
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

GAUZE,VASELINE

Facility

$39.00

Hospital Charge Code	287182
Hospital Revenue Code	271
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

GAYMAR AQUA K PAD PUMP

Facility

$105.00

Service Code	CPT E0217
Hospital Charge Code	57970
Hospital Revenue Code	940
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$74.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: UnitedHealthcare Commercial	$70.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.80

GAYMAR AQUA K PAD PUMP

Facility

$105.00

Service Code	CPT E0217
Hospital Charge Code	57970
Hospital Revenue Code	940
Rate for Payer: Cash Price	$94.50

GB LIPOMUL ADMIN

Facility

$63.00

Hospital Charge Code	3200120
Hospital Revenue Code	271
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

GB LIPOMUL ADMIN

Facility

$63.00

Hospital Charge Code	3200120
Hospital Revenue Code	271
Rate for Payer: Cash Price	$56.70

GC CHLAMYDIA DNA PROBE

Facility

$105.00

Service Code	CPT 87491
Hospital Charge Code	308000
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$74.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.58
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cigna Commercial HMO & PPO	$35.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33.79
Rate for Payer: Home State Health Plan Medicare Advantage	$35.09
Rate for Payer: Humana Commercial	$70.18
Rate for Payer: Humana Medicare Advantage	$35.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.80

Know your out-of-pocket cost for care.

All Charges