Madison Medical Center

All Charges

Charge

Type

Setting

Price

..17-HYDROXYPROGESTERONE

Facility

$165.00

Service Code	CPT 83498
Hospital Charge Code	228307
Hospital Revenue Code	301
Rate for Payer: Cash Price	$148.50

..17-HYDROXYPROGESTERONE

Facility

$165.00

Service Code	CPT 83498
Hospital Charge Code	228307
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$117.81
Rate for Payer: Aetna Better Health Medicaid/QHP	$24.45
Rate for Payer: Aetna Medicare Advantage	$27.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cigna Commercial HMO & PPO	$27.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26.16
Rate for Payer: Home State Health Plan Medicare Advantage	$27.17
Rate for Payer: Humana Commercial	$54.34
Rate for Payer: Humana Medicare Advantage	$27.17
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

17-KETOSTEROIDS

Facility

$118.00

Service Code	CPT 83593
Hospital Charge Code	2283586
Hospital Revenue Code	307
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$84.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$25.65
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$69.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$84.25
Rate for Payer: Cash Price	$106.20
Rate for Payer: Cash Price	$106.20
Rate for Payer: Cash Price	$106.20
Rate for Payer: Cigna Commercial HMO & PPO	$28.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27.45
Rate for Payer: Home State Health Plan Medicare Advantage	$28.50
Rate for Payer: Humana Commercial	$57.00
Rate for Payer: Humana Medicare Advantage	$28.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.48

17-KETOSTEROIDS

Facility

$118.00

Service Code	CPT 83593
Hospital Charge Code	2283586
Hospital Revenue Code	307
Rate for Payer: Cash Price	$106.20

17OH PROGESTERONE

Facility

$64.00

Service Code	CPT 83498
Hospital Charge Code	229865
Hospital Revenue Code	301
Rate for Payer: Cash Price	$57.60

17OH PROGESTERONE

Facility

$64.00

Service Code	CPT 83498
Hospital Charge Code	229865
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$54.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$24.45
Rate for Payer: Aetna Medicare Advantage	$27.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$45.70
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cigna Commercial HMO & PPO	$27.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26.16
Rate for Payer: Home State Health Plan Medicare Advantage	$27.17
Rate for Payer: Humana Commercial	$54.34
Rate for Payer: Humana Medicare Advantage	$27.17
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.04

18FR SALEM SUMP

Facility

$42.00

Hospital Charge Code	2819064
Hospital Revenue Code	270
Rate for Payer: Cash Price	$37.80

18FR SALEM SUMP

Facility

$42.00

Hospital Charge Code	2819064
Hospital Revenue Code	270
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

18G10CMX10MM CANNULA NEEDLE

Facility

$55.00

Hospital Charge Code	2824464
Hospital Revenue Code	270
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

18G10CMX10MM CANNULA NEEDLE

Facility

$55.00

Hospital Charge Code	2824464
Hospital Revenue Code	270
Rate for Payer: Cash Price	$49.50

18G 15CMX10MM CANNULA NEEDLE

Facility

$80.00

Hospital Charge Code	2824463
Hospital Revenue Code	270
Rate for Payer: Cash Price	$72.00

18G 15CMX10MM CANNULA NEEDLE

Facility

$80.00

Hospital Charge Code	2824463
Hospital Revenue Code	270
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$57.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: UnitedHealthcare Commercial	$53.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.80

18GX3.5 SPINAL NEEDLE

Facility

$15.00

Hospital Charge Code	2824461
Hospital Revenue Code	270
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
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: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

18GX3.5 SPINAL NEEDLE

Facility

$15.00

Hospital Charge Code	2824461
Hospital Revenue Code	270
Rate for Payer: Cash Price	$13.50

18GX3.5 TUOHY NEEDLE #

Facility

$55.00

Hospital Charge Code	2824557
Hospital Revenue Code	270
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

18GX3.5 TUOHY NEEDLE #

Facility

$55.00

Hospital Charge Code	2824557
Hospital Revenue Code	270
Rate for Payer: Cash Price	$49.50

18GX5 WEISS NEEDLE #405190

Facility

$55.00

Hospital Charge Code	2824457
Hospital Revenue Code	270
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

18GX5 WEISS NEEDLE #405190

Facility

$55.00

Hospital Charge Code	2824457
Hospital Revenue Code	270
Rate for Payer: Cash Price	$49.50

18GX6.0 TUOHY EPI NEEDLE

Facility

$48.00

Hospital Charge Code	2824474
Hospital Revenue Code	270
Rate for Payer: Cash Price	$43.20

18GX6.0 TUOHY EPI NEEDLE

Facility

$48.00

Hospital Charge Code	2824474
Hospital Revenue Code	270
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

19/20 ADJ PEEP VALVE

Facility

$13.00

Hospital Charge Code	4500221
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

19/20 ADJ PEEP VALVE

Facility

$13.00

Hospital Charge Code	4500221
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

1CC SYRINGE W/25GA 5/8 NEEDLE

Facility

$20.00

Hospital Charge Code	80000337
Hospital Revenue Code	272
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

1CC SYRINGE W/25GA 5/8 NEEDLE

Facility

$20.00

Hospital Charge Code	80000337
Hospital Revenue Code	272
Rate for Payer: Cash Price	$18.00

1-CLIC CAP RV 10-13DR 100

Facility

$13.00

Service Code	NDC 1E+11
Hospital Charge Code	2620412
Hospital Revenue Code	250
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

Know your out-of-pocket cost for care.

All Charges