Madison Medical Center

All Charges

Charge

Type

Setting

Price

KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	9687210
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

KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	4187210
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

KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	4287210
Hospital Revenue Code	521
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$173.53
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: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$5.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.72
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	$26.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

KOZY-EARS

Facility

$18.00

Hospital Charge Code	4500435
Hospital Revenue Code	271
Rate for Payer: Cash Price	$16.20

KOZY-EARS

Facility

$18.00

Hospital Charge Code	4500435
Hospital Revenue Code	271
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

K-PAD

Facility

$55.00

Hospital Charge Code	1216838
Hospital Revenue Code	271
Rate for Payer: Cash Price	$49.50

K-PAD

Facility

$55.00

Hospital Charge Code	1216838
Hospital Revenue Code	271
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

.KRATOM REFLEX CONFIRMATION

Facility

$197.00

Service Code	CPT 80323
Hospital Charge Code	22280323
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$140.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$116.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$140.66
Rate for Payer: Cash Price	$177.30
Rate for Payer: Cash Price	$177.30
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.92

.KRATOM REFLEX CONFIRMATION

Facility

$197.00

Service Code	CPT 80323
Hospital Charge Code	22280323
Hospital Revenue Code	301
Rate for Payer: Cash Price	$177.30

KRATOM SCREEN AND CONFIRMATION

Facility

$262.00

Service Code	CPT 80307
Hospital Charge Code	2228307
Hospital Revenue Code	301
Rate for Payer: Cash Price	$235.80

KRATOM SCREEN AND CONFIRMATION

Facility

$262.00

Service Code	CPT 80307
Hospital Charge Code	2228307
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$187.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$55.93
Rate for Payer: Aetna Medicare Advantage	$62.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$155.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$187.07
Rate for Payer: Cash Price	$235.80
Rate for Payer: Cash Price	$235.80
Rate for Payer: Cash Price	$235.80
Rate for Payer: Cigna Commercial HMO & PPO	$62.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$59.85
Rate for Payer: Home State Health Plan Medicare Advantage	$62.14
Rate for Payer: Humana Commercial	$124.28
Rate for Payer: Humana Medicare Advantage	$62.14
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$94.32

KUB

Facility

$441.00

Service Code	CPT 74018
Hospital Charge Code	321144
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$314.87
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	$261.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$314.87
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cash Price	$396.90
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	$158.76

KUB

Facility

$441.00

Service Code	CPT 74018
Hospital Charge Code	321144
Hospital Revenue Code	320
Rate for Payer: Cash Price	$396.90

KUB FLAT AND UPRIGHT

Facility

$501.00

Service Code	CPT 74019
Hospital Charge Code	321145
Hospital Revenue Code	320
Rate for Payer: Cash Price	$450.90

KUB FLAT AND UPRIGHT

Facility

$501.00

Service Code	CPT 74019
Hospital Charge Code	321145
Hospital Revenue Code	320
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$357.71
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$296.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$357.71
Rate for Payer: Cash Price	$450.90
Rate for Payer: Cash Price	$450.90
Rate for Payer: Cash Price	$450.90
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$180.36

K-WIRE 1.25

Facility

$496.00

Hospital Charge Code	127787
Hospital Revenue Code	271
Min. Negotiated Rate	$178.56
Max. Negotiated Rate	$354.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$293.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$354.14
Rate for Payer: Cash Price	$446.40
Rate for Payer: UnitedHealthcare Commercial	$330.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$178.56

K-WIRE 1.25

Facility

$496.00

Hospital Charge Code	127787
Hospital Revenue Code	271
Rate for Payer: Cash Price	$446.40

K-WIRE 1.4MMX100MM SMOOTH

Facility

$173.00

Hospital Charge Code	123511
Hospital Revenue Code	271
Rate for Payer: Cash Price	$155.70

K-WIRE 1.4MMX100MM SMOOTH

Facility

$173.00

Hospital Charge Code	123511
Hospital Revenue Code	271
Min. Negotiated Rate	$62.28
Max. Negotiated Rate	$123.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$102.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$123.52
Rate for Payer: Cash Price	$155.70
Rate for Payer: UnitedHealthcare Commercial	$115.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.28

K-WIRE 4 (STRYKER)

Facility

$65.00

Hospital Charge Code	127785
Hospital Revenue Code	271
Rate for Payer: Cash Price	$58.50

K-WIRE 4 (STRYKER)

Facility

$65.00

Hospital Charge Code	127785
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

K-WIRE 6

Facility

$60.00

Hospital Charge Code	127798
Hospital Revenue Code	271
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
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 Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

K-WIRE 6

Facility

$60.00

Hospital Charge Code	127798
Hospital Revenue Code	271
Rate for Payer: Cash Price	$54.00

K-WIRE 6 (STRYKER)

Facility

$168.00

Hospital Charge Code	127786
Hospital Revenue Code	271
Min. Negotiated Rate	$60.48
Max. Negotiated Rate	$119.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$99.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$119.95
Rate for Payer: Cash Price	$151.20
Rate for Payer: UnitedHealthcare Commercial	$112.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.48

K-WIRE 6 (STRYKER)

Facility

$168.00

Hospital Charge Code	127786
Hospital Revenue Code	271
Rate for Payer: Cash Price	$151.20

Know your out-of-pocket cost for care.

All Charges