Madison Medical Center

All Charges

Charge

Type

Setting

Price

LOCKING PLATE LATERAL 8mm

Facility

$3,160.00

Hospital Charge Code	123408
Hospital Revenue Code	271
Min. Negotiated Rate	$1,137.60
Max. Negotiated Rate	$2,256.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,870.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,256.24
Rate for Payer: Cash Price	$2,844.00
Rate for Payer: UnitedHealthcare Commercial	$2,107.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,137.60

LOCKING PLATE MIDFOOT CROSS-PLT LNG (T10

Facility

$5,160.00

Hospital Charge Code	123506
Hospital Revenue Code	271
Rate for Payer: Cash Price	$4,644.00

LOCKING PLATE MIDFOOT CROSS-PLT LNG (T10

Facility

$5,160.00

Hospital Charge Code	123506
Hospital Revenue Code	271
Min. Negotiated Rate	$1,857.60
Max. Negotiated Rate	$3,684.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$3,054.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3,684.24
Rate for Payer: Cash Price	$4,644.00
Rate for Payer: UnitedHealthcare Commercial	$3,441.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,857.60

LOCKING SCREW 3.5MMX16MM FULL THREAD(STR

Facility

$701.00

Hospital Charge Code	123416
Hospital Revenue Code	271
Min. Negotiated Rate	$252.36
Max. Negotiated Rate	$500.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$414.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$500.51
Rate for Payer: Cash Price	$630.90
Rate for Payer: UnitedHealthcare Commercial	$467.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.36

LOCKING SCREW 3.5MMX16MM FULL THREAD(STR

Facility

$701.00

Hospital Charge Code	123416
Hospital Revenue Code	271
Rate for Payer: Cash Price	$630.90

LOCKING SCREW 3.5MMX18MM FULL THREAD(STR

Facility

$701.00

Hospital Charge Code	123401
Hospital Revenue Code	271
Rate for Payer: Cash Price	$630.90

LOCKING SCREW 3.5MMX18MM FULL THREAD(STR

Facility

$701.00

Hospital Charge Code	123401
Hospital Revenue Code	271
Min. Negotiated Rate	$252.36
Max. Negotiated Rate	$500.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$414.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$500.51
Rate for Payer: Cash Price	$630.90
Rate for Payer: UnitedHealthcare Commercial	$467.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.36

LOCKING SCREW 3.5MMX22MM FULL THREAD(STR

Facility

$678.00

Hospital Charge Code	123403
Hospital Revenue Code	271
Min. Negotiated Rate	$244.08
Max. Negotiated Rate	$484.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$401.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$484.09
Rate for Payer: Cash Price	$610.20
Rate for Payer: UnitedHealthcare Commercial	$452.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$244.08

LOCKING SCREW 3.5MMX22MM FULL THREAD(STR

Facility

$678.00

Hospital Charge Code	123403
Hospital Revenue Code	271
Rate for Payer: Cash Price	$610.20

LOCKING SCREW 3.5MMX24MM FULL THREAD(STR

Facility

$701.00

Hospital Charge Code	123414
Hospital Revenue Code	271
Rate for Payer: Cash Price	$630.90

LOCKING SCREW 3.5MMX24MM FULL THREAD(STR

Facility

$701.00

Hospital Charge Code	123414
Hospital Revenue Code	271
Min. Negotiated Rate	$252.36
Max. Negotiated Rate	$500.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$414.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$500.51
Rate for Payer: Cash Price	$630.90
Rate for Payer: UnitedHealthcare Commercial	$467.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.36

LOCKING SCREW 3.5MMX26MM FULL THREAD(STR

Facility

$678.00

Hospital Charge Code	123407
Hospital Revenue Code	271
Min. Negotiated Rate	$244.08
Max. Negotiated Rate	$484.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$401.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$484.09
Rate for Payer: Cash Price	$610.20
Rate for Payer: UnitedHealthcare Commercial	$452.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$244.08

LOCKING SCREW 3.5MMX26MM FULL THREAD(STR

Facility

$678.00

Hospital Charge Code	123407
Hospital Revenue Code	271
Rate for Payer: Cash Price	$610.20

LOCKING SCREW 3.5MMX28MM FULL THREAD(STR

Facility

$701.00

Hospital Charge Code	123415
Hospital Revenue Code	271
Rate for Payer: Cash Price	$630.90

LOCKING SCREW 3.5MMX28MM FULL THREAD(STR

Facility

$701.00

Hospital Charge Code	123415
Hospital Revenue Code	271
Min. Negotiated Rate	$252.36
Max. Negotiated Rate	$500.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$414.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$500.51
Rate for Payer: Cash Price	$630.90
Rate for Payer: UnitedHealthcare Commercial	$467.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.36

LOCKING SCREW 3.5MMX34MM FULL THREAD(STR

Facility

$678.00

Hospital Charge Code	123420
Hospital Revenue Code	271
Rate for Payer: Cash Price	$610.20

LOCKING SCREW 3.5MMX34MM FULL THREAD(STR

Facility

$678.00

Hospital Charge Code	123420
Hospital Revenue Code	271
Min. Negotiated Rate	$244.08
Max. Negotiated Rate	$484.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$401.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$484.09
Rate for Payer: Cash Price	$610.20
Rate for Payer: UnitedHealthcare Commercial	$452.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$244.08

LODGE INFLUENZA A&B TEST

Facility

$123.00

Service Code	CPT 87502
Hospital Charge Code	9687502
Hospital Revenue Code	301
Rate for Payer: Cash Price	$110.70

LODGE INFLUENZA A&B TEST

Facility

$123.00

Service Code	CPT 87502
Hospital Charge Code	9687502
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

LODGE RSV

Facility

$123.00

Service Code	CPT 87634
Hospital Charge Code	9687634
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$63.18
Rate for Payer: Aetna Medicare Advantage	$70.20
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	$70.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$63.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$67.60
Rate for Payer: Home State Health Plan Medicare Advantage	$70.20
Rate for Payer: Humana Commercial	$140.40
Rate for Payer: Humana Medicare Advantage	$70.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$63.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.28

LODGE RSV

Facility

$123.00

Service Code	CPT 87634
Hospital Charge Code	9687634
Hospital Revenue Code	301
Rate for Payer: Cash Price	$110.70

LODGE STREP

Facility

$75.00

Service Code	CPT 87651
Hospital Charge Code	9687651
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$70.18
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	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
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	$27.00

LODGE STREP

Facility

$75.00

Service Code	CPT 87651
Hospital Charge Code	9687651
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

LOOP OSTOMY SET

Facility

$89.00

Hospital Charge Code	2812045
Hospital Revenue Code	271
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$63.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.55
Rate for Payer: Cash Price	$80.10
Rate for Payer: UnitedHealthcare Commercial	$59.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

LOOP OSTOMY SET

Facility

$89.00

Hospital Charge Code	2812045
Hospital Revenue Code	271
Rate for Payer: Cash Price	$80.10

Know your out-of-pocket cost for care.

All Charges