Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

1-CLIC CLEAR-VU VIAL 40DR

Facility

$13.00

Service Code	NDC 1E+11
Hospital Charge Code	2620411
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

1-CLIC CLEAR-VU VIAL 40DR

Facility

$13.00

Service Code	NDC 1E+11
Hospital Charge Code	2620411
Hospital Revenue Code	250
Rate for Payer: Cash Price	$11.70

1' GLOCOSE CHALLANGE TEST

Facility

$19.00

Service Code	CPT 82950
Hospital Charge Code	4282950
Hospital Revenue Code	521
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.28
Rate for Payer: Aetna Medicare Advantage	$4.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$13.57
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cigna Commercial HMO & PPO	$4.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.58
Rate for Payer: Home State Health Plan Medicare Advantage	$4.75
Rate for Payer: Humana Commercial	$9.50
Rate for Payer: Humana Medicare Advantage	$4.75
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

1' GLOCOSE CHALLANGE TEST

Facility

$19.00

Service Code	CPT 82950
Hospital Charge Code	4282950
Hospital Revenue Code	521
Rate for Payer: Cash Price	$17.10

(1) MISSED ABORTION D&C

Facility

$700.00

Service Code	CPT 59820
Hospital Charge Code	4259820
Rate for Payer: Cash Price	$630.00

20CM RF ELECTRODE PROBE

Facility

$302.00

Hospital Charge Code	1216045
Hospital Revenue Code	360
Min. Negotiated Rate	$108.72
Max. Negotiated Rate	$201.43
Rate for Payer: Cash Price	$271.80
Rate for Payer: UnitedHealthcare Commercial	$201.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.72

20CM RF ELECTRODE PROBE

Facility

$302.00

Hospital Charge Code	1216045
Hospital Revenue Code	360
Rate for Payer: Cash Price	$271.80

2.0 DRILL BIT

Facility

$612.00

Hospital Charge Code	123319
Hospital Revenue Code	271
Min. Negotiated Rate	$220.32
Max. Negotiated Rate	$436.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$362.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$436.97
Rate for Payer: Cash Price	$550.80
Rate for Payer: UnitedHealthcare Commercial	$408.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$220.32

2.0 DRILL BIT

Facility

$612.00

Hospital Charge Code	123319
Hospital Revenue Code	271
Rate for Payer: Cash Price	$550.80

20G 10.3 CMX10MM CANNULA NEEDLE

Facility

$55.00

Hospital Charge Code	2824480
Hospital Revenue Code	270
Rate for Payer: Cash Price	$49.50

20G 10.3 CMX10MM CANNULA NEEDLE

Facility

$55.00

Hospital Charge Code	2824480
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

20G 10CMX5MM CANNULA NEEDLE

Facility

$55.00

Hospital Charge Code	2824482
Hospital Revenue Code	270
Rate for Payer: Cash Price	$49.50

20G 10CMX5MM CANNULA NEEDLE

Facility

$55.00

Hospital Charge Code	2824482
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

20G 15CMX10MM CANNULA NEEDLE

Facility

$55.00

Hospital Charge Code	2824466
Hospital Revenue Code	270
Rate for Payer: Cash Price	$49.50

20G 15CMX10MM CANNULA NEEDLE

Facility

$55.00

Hospital Charge Code	2824466
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

20GX3.5 SPINAL NEEDLE

Facility

$15.00

Hospital Charge Code	2824460
Hospital Revenue Code	270
Rate for Payer: Cash Price	$13.50

20GX3.5 SPINAL NEEDLE

Facility

$15.00

Hospital Charge Code	2824460
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

20MEQ K++ D51/2NS 1000ML IV

Facility

$126.00

Service Code	HCPCS J3480
Hospital Charge Code	2626428
Hospital Revenue Code	250
Rate for Payer: Cash Price	$113.40

20MEQ K++ D51/2NS 1000ML IV

Facility

$126.00

Service Code	HCPCS J3480
Hospital Charge Code	2626428
Hospital Revenue Code	250
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$89.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: UnitedHealthcare Commercial	$84.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

20MEQ K++ IN D5W 1000ML IV

Facility

$126.00

Service Code	HCPCS J3480
Hospital Charge Code	2626414
Hospital Revenue Code	250
Rate for Payer: Cash Price	$113.40

20MEQ K++ IN D5W 1000ML IV

Facility

$126.00

Service Code	HCPCS J3480
Hospital Charge Code	2626414
Hospital Revenue Code	250
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$89.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: UnitedHealthcare Commercial	$84.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

20MEQ K++ IN NS 1000ML IV

Facility

$126.00

Service Code	HCPCS J3480
Hospital Charge Code	2626413
Hospital Revenue Code	250
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$89.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: UnitedHealthcare Commercial	$84.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

20MEQ K++ IN NS 1000ML IV

Facility

$126.00

Service Code	HCPCS J3480
Hospital Charge Code	2626413
Hospital Revenue Code	250
Rate for Payer: Cash Price	$113.40

2.0 MM ACCESORY KIT

Facility

$919.00

Hospital Charge Code	123331
Hospital Revenue Code	271
Min. Negotiated Rate	$330.84
Max. Negotiated Rate	$656.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$544.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$656.17
Rate for Payer: Cash Price	$827.10
Rate for Payer: UnitedHealthcare Commercial	$612.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$330.84

Know your out-of-pocket cost for care.

All Charges