Madison Medical Center

All Charges

Charge

Type

Setting

Price

GI COCKTAIL

Facility

$6.00

Service Code	CPT Y7506
Hospital Charge Code	3956217
Hospital Revenue Code	636
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$4.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$3.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$4.28
Rate for Payer: Cash Price	$5.40
Rate for Payer: UnitedHealthcare Commercial	$4.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.16

GI COCKTAIL

Facility

$6.00

Service Code	CPT Y7506
Hospital Charge Code	3956217
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Cash Price	$5.40
Rate for Payer: UnitedHealthcare Commercial	$4.00

GI COCKTAIL

Facility

$6.00

Service Code	CPT Y7506
Hospital Charge Code	9656217
Hospital Revenue Code	636
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$4.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$3.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$4.28
Rate for Payer: Cash Price	$5.40
Rate for Payer: UnitedHealthcare Commercial	$4.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.16

GI PANEL STOOL

Facility

$839.00

Service Code	CPT 87507
Hospital Charge Code	2287507
Hospital Revenue Code	306
Rate for Payer: Cash Price	$755.10

GI PANEL STOOL

Facility

$839.00

Service Code	CPT 87507
Hospital Charge Code	2287507
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$833.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$375.10
Rate for Payer: Aetna Medicare Advantage	$416.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$496.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$599.05
Rate for Payer: Cash Price	$755.10
Rate for Payer: Cash Price	$755.10
Rate for Payer: Cash Price	$755.10
Rate for Payer: Cigna Commercial HMO & PPO	$416.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$375.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$401.36
Rate for Payer: Home State Health Plan Medicare Advantage	$416.78
Rate for Payer: Humana Commercial	$833.56
Rate for Payer: Humana Medicare Advantage	$416.78
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$375.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$302.04

GLIADIN IGA

Facility

$113.00

Service Code	CPT 83516
Hospital Charge Code	2283515
Hospital Revenue Code	301
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$80.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
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: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial HMO & PPO	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

GLIADIN IGA

Facility

$113.00

Service Code	CPT 83516
Hospital Charge Code	2283515
Hospital Revenue Code	301
Rate for Payer: Cash Price	$101.70

GLIADIN IgG

Facility

$113.00

Service Code	CPT 83516
Hospital Charge Code	2283510
Hospital Revenue Code	301
Rate for Payer: Cash Price	$101.70

GLIADIN IgG

Facility

$113.00

Service Code	CPT 83516
Hospital Charge Code	2283510
Hospital Revenue Code	301
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$80.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
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: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial HMO & PPO	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

GLIDESCOPE B FLEX BRONCOSCOPE

Facility

$642.00

Hospital Charge Code	2810044
Hospital Revenue Code	271
Rate for Payer: Cash Price	$577.80

GLIDESCOPE B FLEX BRONCOSCOPE

Facility

$642.00

Hospital Charge Code	2810044
Hospital Revenue Code	271
Min. Negotiated Rate	$231.12
Max. Negotiated Rate	$458.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$380.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$458.39
Rate for Payer: Cash Price	$577.80
Rate for Payer: UnitedHealthcare Commercial	$428.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$231.12

GLIDESCOPE HYPERANGLE 53 BLADE

Facility

$129.00

Hospital Charge Code	2810049
Hospital Revenue Code	271
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

GLIDESCOPE HYPERANGLE 53 BLADE

Facility

$129.00

Hospital Charge Code	2810049
Hospital Revenue Code	271
Rate for Payer: Cash Price	$116.10

GLIDESCOPE HYPERANGLE BLADE

Facility

$129.00

Hospital Charge Code	2810048
Hospital Revenue Code	271
Rate for Payer: Cash Price	$116.10

GLIDESCOPE HYPERANGLE BLADE

Facility

$129.00

Hospital Charge Code	2810048
Hospital Revenue Code	271
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

GLIDESCOPE LARGE STYLETTE

Facility

$43.00

Hospital Charge Code	2810051
Hospital Revenue Code	271
Rate for Payer: Cash Price	$38.70

GLIDESCOPE LARGE STYLETTE

Facility

$43.00

Hospital Charge Code	2810051
Hospital Revenue Code	271
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

GLIDESCOPE MAC 3 BLADE

Facility

$129.00

Hospital Charge Code	2810047
Hospital Revenue Code	271
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

GLIDESCOPE MAC 3 BLADE

Facility

$129.00

Hospital Charge Code	2810047
Hospital Revenue Code	271
Rate for Payer: Cash Price	$116.10

GLIDESCOPE MAC 4 BLADE

Facility

$129.00

Hospital Charge Code	2810046
Hospital Revenue Code	271
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

GLIDESCOPE MAC 4 BLADE

Facility

$129.00

Hospital Charge Code	2810046
Hospital Revenue Code	271
Rate for Payer: Cash Price	$116.10

GLIDESCOPE MED STYLET

Facility

$43.00

Hospital Charge Code	2810050
Hospital Revenue Code	271
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

GLIDESCOPE MED STYLET

Facility

$43.00

Hospital Charge Code	2810050
Hospital Revenue Code	271
Rate for Payer: Cash Price	$38.70

GLIDESCOPE MILLER 0 BLADE

Facility

$148.00

Hospital Charge Code	2810045
Hospital Revenue Code	271
Min. Negotiated Rate	$53.28
Max. Negotiated Rate	$105.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$87.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$105.67
Rate for Payer: Cash Price	$133.20
Rate for Payer: UnitedHealthcare Commercial	$98.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.28

GLIDESCOPE MILLER 0 BLADE

Facility

$148.00

Hospital Charge Code	2810045
Hospital Revenue Code	271
Rate for Payer: Cash Price	$133.20

Know your out-of-pocket cost for care.

All Charges