Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

2.0 MM INSTRUMENT KIT( STERILE)

Facility

$1,485.00

Hospital Charge Code	123391
Hospital Revenue Code	271
Rate for Payer: Cash Price	$1,336.50

2.0 MM INSTRUMENT KIT( STERILE)

Facility

$1,485.00

Hospital Charge Code	123391
Hospital Revenue Code	271
Min. Negotiated Rate	$534.60
Max. Negotiated Rate	$1,060.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$879.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,060.29
Rate for Payer: Cash Price	$1,336.50
Rate for Payer: UnitedHealthcare Commercial	$990.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$534.60

2.0MMK-WIRE 0.8MMX100MM ASNIS MICRO

Facility

$174.00

Hospital Charge Code	123428
Hospital Revenue Code	271
Min. Negotiated Rate	$62.64
Max. Negotiated Rate	$124.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$103.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$124.24
Rate for Payer: Cash Price	$156.60
Rate for Payer: UnitedHealthcare Commercial	$116.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.64

2.0MMK-WIRE 0.8MMX100MM ASNIS MICRO

Facility

$174.00

Hospital Charge Code	123428
Hospital Revenue Code	271
Rate for Payer: Cash Price	$156.60

20MMX1.7MM CANNULATED DRIL

Facility

$791.00

Hospital Charge Code	123424
Hospital Revenue Code	271
Min. Negotiated Rate	$284.76
Max. Negotiated Rate	$564.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$468.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$564.77
Rate for Payer: Cash Price	$711.90
Rate for Payer: UnitedHealthcare Commercial	$527.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$284.76

20MMX1.7MM CANNULATED DRIL

Facility

$791.00

Hospital Charge Code	123424
Hospital Revenue Code	271
Rate for Payer: Cash Price	$711.90

2-0 PROLENE CT-2

Facility

$7.00

Hospital Charge Code	2819094
Hospital Revenue Code	272
Rate for Payer: Cash Price	$6.30

2-0 PROLENE CT-2

Facility

$7.00

Hospital Charge Code	2819094
Hospital Revenue Code	272
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$5.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.00
Rate for Payer: Cash Price	$6.30
Rate for Payer: UnitedHealthcare Commercial	$4.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.52

21-HYDROXYLASE AUTOANTIBODIES

Facility

$217.00

Service Code	CPT 83519
Hospital Charge Code	2283400
Hospital Revenue Code	301
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$154.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.56
Rate for Payer: Aetna Medicare Advantage	$18.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$128.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$154.94
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cigna Commercial HMO & PPO	$18.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.72
Rate for Payer: Home State Health Plan Medicare Advantage	$18.40
Rate for Payer: Humana Commercial	$36.80
Rate for Payer: Humana Medicare Advantage	$18.40
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$78.12

21-HYDROXYLASE AUTOANTIBODIES

Facility

$217.00

Service Code	CPT 83519
Hospital Charge Code	2283400
Hospital Revenue Code	301
Rate for Payer: Cash Price	$195.30

22G 10CMX10MM CANNULA NEEDLE

Facility

$55.00

Hospital Charge Code	2824486
Hospital Revenue Code	270
Rate for Payer: Cash Price	$49.50

22G 10CMX10MM CANNULA NEEDLE

Facility

$55.00

Hospital Charge Code	2824486
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

22G 10CMX5MM CANNULA NEEDLE

Facility

$55.00

Hospital Charge Code	2824483
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

22G 10CMX5MM CANNULA NEEDLE

Facility

$55.00

Hospital Charge Code	2824483
Hospital Revenue Code	270
Rate for Payer: Cash Price	$49.50

22G 5CMX5MM CANNULA NEEDLE

Facility

$55.00

Hospital Charge Code	2824485
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

22G 5CMX5MM CANNULA NEEDLE

Facility

$55.00

Hospital Charge Code	2824485
Hospital Revenue Code	270
Rate for Payer: Cash Price	$49.50

22GX1.5 SPINAL NEEDLE

Facility

$16.00

Hospital Charge Code	2824473
Hospital Revenue Code	270
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

22GX1.5 SPINAL NEEDLE

Facility

$16.00

Hospital Charge Code	2824473
Hospital Revenue Code	270
Rate for Payer: Cash Price	$14.40

22GX2.5 SPINAL NEEDLE

Facility

$16.00

Hospital Charge Code	2824471
Hospital Revenue Code	270
Rate for Payer: Cash Price	$14.40

22GX2.5 SPINAL NEEDLE

Facility

$16.00

Hospital Charge Code	2824471
Hospital Revenue Code	270
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

22GX3.5 SPINAL NEEDLE

Facility

$40.00

Hospital Charge Code	2824467
Hospital Revenue Code	270
Rate for Payer: Cash Price	$36.00

22GX3.5 SPINAL NEEDLE

Facility

$40.00

Hospital Charge Code	2824467
Hospital Revenue Code	270
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
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: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

22GX5 SPINAL NEEDLE #405148

Facility

$28.00

Hospital Charge Code	2824470
Hospital Revenue Code	270
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

22GX5 SPINAL NEEDLE #405148

Facility

$28.00

Hospital Charge Code	2824470
Hospital Revenue Code	270
Rate for Payer: Cash Price	$25.20

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