Madison Medical Center

All Charges

Charge

Type

Setting

Price

NEBULIZER TREATMENT SUBSEQ

Facility

$50.00

Service Code	CPT 94664
Hospital Charge Code	9894665
Hospital Revenue Code	412
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

NEBULIZER TREATMENT SUBSEQUENT

Facility

$53.00

Service Code	CPT 94664
Hospital Charge Code	4194665
Hospital Revenue Code	412
Min. Negotiated Rate	$19.08
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$31.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.84
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$35.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.08

NEBULIZER TREATMENT SUBSEQUENT

Facility

$50.00

Service Code	CPT 94665
Hospital Charge Code	5294665
Hospital Revenue Code	521
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NEBULIZER TREATMENT SUBSEQUENT

Facility

$50.00

Service Code	CPT 94665
Hospital Charge Code	5294665
Hospital Revenue Code	521
Rate for Payer: Cash Price	$45.00

NEBULIZER TREATMENT SUBSEQUENT

Facility

$53.00

Service Code	CPT 94664
Hospital Charge Code	4194665
Hospital Revenue Code	412
Rate for Payer: Cash Price	$47.70

NEB-U-MIST

Facility

$333.00

Service Code	CPT 94640
Hospital Charge Code	4500342
Hospital Revenue Code	412
Min. Negotiated Rate	$119.88
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$197.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$237.76
Rate for Payer: Cash Price	$299.70
Rate for Payer: Cash Price	$299.70
Rate for Payer: Cash Price	$299.70
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$222.11
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$119.88

NEB-U-MIST

Facility

$333.00

Service Code	CPT 94640
Hospital Charge Code	4500342
Hospital Revenue Code	412
Rate for Payer: Cash Price	$299.70

NEB U SET-UP

Facility

$165.00

Hospital Charge Code	4500341
Hospital Revenue Code	271
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$117.81
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: UnitedHealthcare Commercial	$110.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

NEB U SET-UP

Facility

$165.00

Hospital Charge Code	4500341
Hospital Revenue Code	271
Rate for Payer: Cash Price	$148.50

NEDDLE, BIOPSY DISP

Facility

$223.00

Hospital Charge Code	2814250
Hospital Revenue Code	271
Rate for Payer: Cash Price	$200.70

NEDDLE, BIOPSY DISP

Facility

$223.00

Hospital Charge Code	2814250
Hospital Revenue Code	271
Min. Negotiated Rate	$80.28
Max. Negotiated Rate	$159.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$132.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$159.22
Rate for Payer: Cash Price	$200.70
Rate for Payer: UnitedHealthcare Commercial	$148.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$80.28

NEEDLE BIOPSY .

Facility

$308.00

Service Code	CPT 38505
Hospital Charge Code	4138505
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$3,374.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,488.83
Rate for Payer: Aetna Medicare Advantage	$1,687.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$182.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$219.91
Rate for Payer: Cash Price	$277.20
Rate for Payer: Cash Price	$277.20
Rate for Payer: Cash Price	$277.20
Rate for Payer: Cash Price	$277.20
Rate for Payer: Cigna Commercial HMO & PPO	$1,687.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,339.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,593.05
Rate for Payer: Home State Health Plan Medicare Advantage	$1,687.37
Rate for Payer: Humana Commercial	$3,374.74
Rate for Payer: Humana Medicare Advantage	$1,687.37
Rate for Payer: UnitedHealthcare Commercial	$205.44
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NEEDLE BIOPSY .

Facility

$308.00

Service Code	CPT 38505
Hospital Charge Code	4138505
Hospital Revenue Code	521
Rate for Payer: Cash Price	$277.20

NEEDLE, BIO W/ULTRASOUND

Facility

$537.00

Service Code	CPT 93970
Hospital Charge Code	352998
Hospital Revenue Code	402
Rate for Payer: Cash Price	$483.30

NEEDLE, BIO W/ULTRASOUND

Facility

$537.00

Service Code	CPT 93970
Hospital Charge Code	352998
Hospital Revenue Code	402
Min. Negotiated Rate	$193.32
Max. Negotiated Rate	$487.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$317.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$383.42
Rate for Payer: Cash Price	$483.30
Rate for Payer: Cash Price	$483.30
Rate for Payer: Cash Price	$483.30
Rate for Payer: Cash Price	$483.30
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.32

NEEDLE HUBER 20GA X 1

Facility

$106.00

Hospital Charge Code	2814253
Hospital Revenue Code	272
Rate for Payer: Cash Price	$95.40

NEEDLE HUBER 20GA X 1

Facility

$106.00

Hospital Charge Code	2814253
Hospital Revenue Code	272
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$75.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: UnitedHealthcare Commercial	$70.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

NEEDLE HUBER 20GA X 3/4

Facility

$106.00

Hospital Charge Code	2814251
Hospital Revenue Code	272
Rate for Payer: Cash Price	$95.40

NEEDLE HUBER 20GA X 3/4

Facility

$106.00

Hospital Charge Code	2814251
Hospital Revenue Code	272
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$75.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: UnitedHealthcare Commercial	$70.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

NEEDLE LOCALIZATION W/PACK

Facility

$448.00

Service Code	CPT 19290
Hospital Charge Code	374276
Hospital Revenue Code	320
Min. Negotiated Rate	$161.28
Max. Negotiated Rate	$319.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$265.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$319.87
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cash Price	$403.20
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$161.28

NEEDLE LOCALIZATION W/PACK

Facility

$448.00

Service Code	CPT 19290
Hospital Charge Code	374276
Hospital Revenue Code	320
Rate for Payer: Cash Price	$403.20

NEEDLE LOC. AND EXC.

Professional

Both

$521.00

Service Code	CPT 19126
Hospital Charge Code	4119126
Hospital Revenue Code	975
Min. Negotiated Rate	$121.01
Max. Negotiated Rate	$182.35
Rate for Payer: Aetna Commercial/Medicare Advantage	$140.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$121.01
Rate for Payer: Cash Price	$468.90
Rate for Payer: Cash Price	$468.90
Rate for Payer: Cigna Commercial HMO & PPO	$140.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$121.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$133.11
Rate for Payer: Home State Health Plan Medicare Advantage	$140.01
Rate for Payer: Optum Medicare Advantage	$182.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$121.01

NEEDLE, MICROLITE SUCTION 20 GA ENT

Facility

$58.00

Hospital Charge Code	125359
Hospital Revenue Code	271
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

NEEDLE, MICROLITE SUCTION 20 GA ENT

Facility

$58.00

Hospital Charge Code	125359
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

NEEDLE, SPINAL

Facility

$121.00

Hospital Charge Code	2814282
Hospital Revenue Code	271
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

Know your out-of-pocket cost for care.

All Charges