Madison Medical Center

All Charges

Charge

Type

Setting

Price

ARTHROGRAM KNEE LT

Facility

$789.00

Service Code	CPT 73580
Hospital Charge Code	3253140
Hospital Revenue Code	320
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$712.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$314.49
Rate for Payer: Aetna Medicare Advantage	$356.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$467.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$563.35
Rate for Payer: Cash Price	$710.10
Rate for Payer: Cash Price	$710.10
Rate for Payer: Cash Price	$710.10
Rate for Payer: Cigna Commercial HMO & PPO	$356.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$314.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$336.50
Rate for Payer: Home State Health Plan Medicare Advantage	$356.43
Rate for Payer: Humana Commercial	$712.86
Rate for Payer: Humana Medicare Advantage	$356.43
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$284.04

ARTHROGRAM KNEE LT

Facility

$789.00

Service Code	CPT 73580
Hospital Charge Code	3253140
Hospital Revenue Code	320
Rate for Payer: Cash Price	$710.10

ARTHROGRAM KNEE RT

Facility

$789.00

Service Code	CPT 73580
Hospital Charge Code	3253139
Hospital Revenue Code	320
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$712.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$314.49
Rate for Payer: Aetna Medicare Advantage	$356.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$467.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$563.35
Rate for Payer: Cash Price	$710.10
Rate for Payer: Cash Price	$710.10
Rate for Payer: Cash Price	$710.10
Rate for Payer: Cigna Commercial HMO & PPO	$356.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$314.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$336.50
Rate for Payer: Home State Health Plan Medicare Advantage	$356.43
Rate for Payer: Humana Commercial	$712.86
Rate for Payer: Humana Medicare Advantage	$356.43
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$284.04

ARTHROGRAM KNEE RT

Facility

$789.00

Service Code	CPT 73580
Hospital Charge Code	3253139
Hospital Revenue Code	320
Rate for Payer: Cash Price	$710.10

ARTHROGRAM SHOULDER LT

Facility

$759.00

Service Code	CPT 73040
Hospital Charge Code	3253137
Hospital Revenue Code	320
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$712.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$314.49
Rate for Payer: Aetna Medicare Advantage	$356.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$449.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$541.93
Rate for Payer: Cash Price	$683.10
Rate for Payer: Cash Price	$683.10
Rate for Payer: Cash Price	$683.10
Rate for Payer: Cigna Commercial HMO & PPO	$356.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$314.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$336.50
Rate for Payer: Home State Health Plan Medicare Advantage	$356.43
Rate for Payer: Humana Commercial	$712.86
Rate for Payer: Humana Medicare Advantage	$356.43
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$273.24

ARTHROGRAM SHOULDER LT

Facility

$759.00

Service Code	CPT 73040
Hospital Charge Code	3253137
Hospital Revenue Code	320
Rate for Payer: Cash Price	$683.10

ARTHROSCOPE(EQUIPMENT CHARGE)

Facility

$1,419.00

Hospital Charge Code	1211813
Hospital Revenue Code	360
Min. Negotiated Rate	$510.84
Max. Negotiated Rate	$946.47
Rate for Payer: Cash Price	$1,277.10
Rate for Payer: UnitedHealthcare Commercial	$946.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$510.84

ARTHROSCOPE(EQUIPMENT CHARGE)

Facility

$1,419.00

Hospital Charge Code	1211813
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,277.10

ARTHROSCOPY SYNOVECTOMY LTD

Professional

Both

$3,300.00

Service Code	CPT 29875
Hospital Charge Code	9329875
Hospital Revenue Code	975
Min. Negotiated Rate	$375.51
Max. Negotiated Rate	$1,155.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$442.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$375.51
Rate for Payer: Cash Price	$2,970.00
Rate for Payer: Cash Price	$2,970.00
Rate for Payer: Cigna Commercial HMO & PPO	$442.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$375.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$413.06
Rate for Payer: Home State Health Plan Medicare Advantage	$442.73
Rate for Payer: Optum Medicare Advantage	$1,155.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$375.51

ARTHROSCOPY W MENISCECTOMY

Professional

Both

$4,470.00

Service Code	CPT 29881
Hospital Charge Code	9329881
Hospital Revenue Code	975
Min. Negotiated Rate	$409.55
Max. Negotiated Rate	$1,564.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$481.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$409.55
Rate for Payer: Cash Price	$4,023.00
Rate for Payer: Cash Price	$4,023.00
Rate for Payer: Cigna Commercial HMO & PPO	$481.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$409.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$450.50
Rate for Payer: Home State Health Plan Medicare Advantage	$481.35
Rate for Payer: Optum Medicare Advantage	$1,564.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$409.55

ARTHROTOMY, ANKLE, INC EXPL D&R W/REM FB

Facility

$315.00

Service Code	CPT 27610
Hospital Charge Code	5227610
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$6,685.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,949.54
Rate for Payer: Aetna Medicare Advantage	$3,342.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$186.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$224.91
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cigna Commercial HMO & PPO	$3,342.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,654.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,156.01
Rate for Payer: Home State Health Plan Medicare Advantage	$3,342.87
Rate for Payer: Humana Commercial	$6,685.74
Rate for Payer: Humana Medicare Advantage	$3,342.87
Rate for Payer: UnitedHealthcare Commercial	$210.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,949.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ARTHROTOMY, ANKLE, INC EXPL D&R W/REM FB

Facility

$315.00

Service Code	CPT 27610
Hospital Charge Code	5227610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$283.50

ARTIFICIAL TEARS OINT

Facility

$40.00

Hospital Charge Code	2058026
Hospital Revenue Code	370
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

ARTIFICIAL TEARS OINT

Facility

$40.00

Hospital Charge Code	2058026
Hospital Revenue Code	370
Rate for Payer: Cash Price	$36.00

ASCORBIC ACID INJ 500 MG/ML 50 ML VIAL

Facility

$40.00

Service Code	CPT J3420
Hospital Charge Code	4103420
Hospital Revenue Code	521
Rate for Payer: Cash Price	$36.00

ASCORBIC ACID INJ 500 MG/ML 50 ML VIAL

Facility

$40.00

Service Code	CPT J3420
Hospital Charge Code	4103420
Hospital Revenue Code	521
Min. Negotiated Rate	$23.68
Max. Negotiated Rate	$173.53
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: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ASCORBIC ACID (VITAMIN C) 500MG TAB

Facility

$18.00

Service Code	NDC 904052361
Hospital Charge Code	2696427
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

ASCORBIC ACID (VITAMIN C) 500MG TAB

Facility

$18.00

Service Code	NDC 904052361
Hospital Charge Code	2696427
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

ASCORBIC ACID(VIT C)500MG/ML50MLINJ

Facility

$140.00

Service Code	HCPCS J3420
Hospital Charge Code	2626462
Hospital Revenue Code	250
Rate for Payer: Cash Price	$126.00

ASCORBIC ACID(VIT C)500MG/ML50MLINJ

Facility

$140.00

Service Code	HCPCS J3420
Hospital Charge Code	2626462
Hospital Revenue Code	250
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$99.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$82.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$99.96
Rate for Payer: Cash Price	$126.00
Rate for Payer: UnitedHealthcare Commercial	$93.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$50.40

ASMANEX TWISTHALER INH EMP

Facility

$664.00

Service Code	NDC 7.8206E+10
Hospital Charge Code	2627126
Hospital Revenue Code	250
Rate for Payer: Cash Price	$597.60

ASMANEX TWISTHALER INH EMP

Facility

$664.00

Service Code	NDC 7.8206E+10
Hospital Charge Code	2627126
Hospital Revenue Code	250
Min. Negotiated Rate	$239.04
Max. Negotiated Rate	$474.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$393.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$474.10
Rate for Payer: Cash Price	$597.60
Rate for Payer: UnitedHealthcare Commercial	$442.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$239.04

ASO ANTIBODY

Facility

$121.00

Service Code	CPT 86060
Hospital Charge Code	221167
Hospital Revenue Code	301
Rate for Payer: Cash Price	$108.90

ASO ANTIBODY

Facility

$121.00

Service Code	CPT 86060
Hospital Charge Code	221167
Hospital Revenue Code	301
Min. Negotiated Rate	$6.57
Max. Negotiated Rate	$86.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.57
Rate for Payer: Aetna Medicare Advantage	$7.30
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: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cigna Commercial HMO & PPO	$7.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.03
Rate for Payer: Home State Health Plan Medicare Advantage	$7.30
Rate for Payer: Humana Commercial	$14.60
Rate for Payer: Humana Medicare Advantage	$7.30
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$43.56

.ASPERGILLUS FLAVUS AB

Facility

$36.00

Service Code	CPT 86606
Hospital Charge Code	2286603
Hospital Revenue Code	305
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$30.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.55
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$25.70
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial HMO & PPO	$15.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.50
Rate for Payer: Home State Health Plan Medicare Advantage	$15.05
Rate for Payer: Humana Commercial	$30.10
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.96

Know your out-of-pocket cost for care.

All Charges