Madison Medical Center

All Charges

Charge

Type

Setting

Price

LOWER EXTREMITY INFANT LT

Facility

$276.00

Service Code	CPT 73592
Hospital Charge Code	3273593
Hospital Revenue Code	320
Rate for Payer: Cash Price	$248.40

LOWER EXTREMITY INFANT LT

Facility

$276.00

Service Code	CPT 73592
Hospital Charge Code	3273593
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$197.06
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	$163.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$197.06
Rate for Payer: Cash Price	$248.40
Rate for Payer: Cash Price	$248.40
Rate for Payer: Cash Price	$248.40
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	$99.36

LOWER EXTREMITY INFANT RT

Facility

$276.00

Service Code	CPT 73592
Hospital Charge Code	3273592
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$197.06
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	$163.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$197.06
Rate for Payer: Cash Price	$248.40
Rate for Payer: Cash Price	$248.40
Rate for Payer: Cash Price	$248.40
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	$99.36

LOWER EXTREMITY INFANT RT

Facility

$276.00

Service Code	CPT 73592
Hospital Charge Code	3273592
Hospital Revenue Code	320
Rate for Payer: Cash Price	$248.40

LOWER EXTREMITY VASCULAR PROCEDURES

Facility

$22,732.07

Service Code	APR-DRG 1812
Min. Negotiated Rate	$22,732.07
Max. Negotiated Rate	$22,732.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,732.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,732.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,732.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,732.07

LOWER EXTREMITY VASCULAR PROCEDURES

Facility

$33,211.50

Service Code	APR-DRG 1813
Min. Negotiated Rate	$33,211.50
Max. Negotiated Rate	$33,211.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$33,211.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33,211.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33,211.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33,211.50

LOWER EXTREMITY VASCULAR PROCEDURES

Facility

$54,260.94

Service Code	APR-DRG 1814
Min. Negotiated Rate	$54,260.94
Max. Negotiated Rate	$54,260.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$54,260.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$54,260.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$54,260.94
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$54,260.94

LOWER EXTREMITY VASCULAR PROCEDURES

Facility

$13,890.90

Service Code	APR-DRG 1811
Min. Negotiated Rate	$13,890.90
Max. Negotiated Rate	$13,890.90
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,890.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,890.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,890.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,890.90

LOWER LEG X-RAY LEFT

Facility

$463.00

Service Code	CPT 73590
Hospital Charge Code	3212136
Hospital Revenue Code	320
Rate for Payer: Cash Price	$416.70

LOWER LEG X-RAY LEFT

Facility

$463.00

Service Code	CPT 73590
Hospital Charge Code	3212136
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$330.58
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	$274.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$330.58
Rate for Payer: Cash Price	$416.70
Rate for Payer: Cash Price	$416.70
Rate for Payer: Cash Price	$416.70
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	$166.68

LOWER LEG X-RAY RIGHT

Facility

$463.00

Service Code	CPT 73590
Hospital Charge Code	3212135
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$330.58
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
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	$274.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$330.58
Rate for Payer: Cash Price	$416.70
Rate for Payer: Cash Price	$416.70
Rate for Payer: Cash Price	$416.70
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	$166.68

LOWER LEG X-RAY RIGHT

Facility

$463.00

Service Code	CPT 73590
Hospital Charge Code	3212135
Hospital Revenue Code	320
Rate for Payer: Cash Price	$416.70

LOW SEVERITY ADM AND DISCHARGE SAME DAY

Facility

$150.00

Service Code	CPT 99234
Hospital Charge Code	9699234
Hospital Revenue Code	521
Rate for Payer: Cash Price	$135.00

LOW SEVERITY ADM AND DISCHARGE SAME DAY

Facility

$150.00

Service Code	CPT 99234
Hospital Charge Code	9699234
Hospital Revenue Code	521
Min. Negotiated Rate	$88.80
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

LR 1000ML IV FLUID

Facility

$129.00

Service Code	NDC 338011704
Hospital Charge Code	2659109
Hospital Revenue Code	258
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

LR 1000ML IV FLUID

Facility

$129.00

Service Code	NDC 338011704
Hospital Charge Code	2659109
Hospital Revenue Code	258
Min. Negotiated Rate	$86.04
Max. Negotiated Rate	$86.04
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04

LR 500ML

Facility

$129.00

Service Code	NDC 338011703
Hospital Charge Code	2697372
Hospital Revenue Code	258
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

LR 500ML

Facility

$129.00

Service Code	NDC 338011703
Hospital Charge Code	2697372
Hospital Revenue Code	258
Min. Negotiated Rate	$86.04
Max. Negotiated Rate	$86.04
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04

LR 500ML AVIVA BAG

Facility

$121.00

Hospital Charge Code	2697373
Hospital Revenue Code	258
Min. Negotiated Rate	$80.71
Max. Negotiated Rate	$80.71
Rate for Payer: Cash Price	$108.90
Rate for Payer: UnitedHealthcare Commercial	$80.71

LR 500ML AVIVA BAG

Facility

$121.00

Hospital Charge Code	2697373
Hospital Revenue Code	258
Min. Negotiated Rate	$43.56
Max. Negotiated Rate	$86.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$71.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$86.39
Rate for Payer: Cash Price	$108.90
Rate for Payer: UnitedHealthcare Commercial	$80.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$43.56

L SPINE OBLS XRAY

Facility

$625.00

Service Code	CPT 72110
Hospital Charge Code	3212123
Hospital Revenue Code	320
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$446.25
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	$370.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$446.25
Rate for Payer: Cash Price	$562.50
Rate for Payer: Cash Price	$562.50
Rate for Payer: Cash Price	$562.50
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	$225.00

L SPINE OBLS XRAY

Facility

$625.00

Service Code	CPT 72110
Hospital Charge Code	3212123
Hospital Revenue Code	320
Rate for Payer: Cash Price	$562.50

L SPINE X-RAY

Facility

$633.00

Service Code	CPT 72100
Hospital Charge Code	3212122
Hospital Revenue Code	320
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$451.96
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	$374.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$451.96
Rate for Payer: Cash Price	$569.70
Rate for Payer: Cash Price	$569.70
Rate for Payer: Cash Price	$569.70
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	$227.88

L SPINE X-RAY

Facility

$633.00

Service Code	CPT 72100
Hospital Charge Code	3212122
Hospital Revenue Code	320
Rate for Payer: Cash Price	$569.70

LUBRICANT EYE DROPS 15ML

Facility

$58.00

Service Code	NDC 23079815
Hospital Charge Code	2654235
Hospital Revenue Code	250
Rate for Payer: Cash Price	$52.20

Know your out-of-pocket cost for care.

All Charges