Madison Medical Center

All Charges

Charge

Type

Setting

Price

PEDIATRIC AMBU BAG

Facility

$52.00

Hospital Charge Code	4500228
Hospital Revenue Code	271
Rate for Payer: Cash Price	$46.80

PEDIATRIC CO2 DETECTOR

Facility

$91.00

Hospital Charge Code	285251
Hospital Revenue Code	271
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$64.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: UnitedHealthcare Commercial	$60.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

PEDIATRIC CO2 DETECTOR

Facility

$91.00

Hospital Charge Code	285251
Hospital Revenue Code	271
Rate for Payer: Cash Price	$81.90

PEDIATRIC ET TUBE HOLDER

Facility

$112.00

Hospital Charge Code	2800348
Hospital Revenue Code	271
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$79.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: UnitedHealthcare Commercial	$74.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

PEDIATRIC ET TUBE HOLDER

Facility

$112.00

Hospital Charge Code	2800348
Hospital Revenue Code	271
Rate for Payer: Cash Price	$100.80

PEDIATRIC MASK (AEROSOL)

Facility

$13.00

Hospital Charge Code	4500443
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

PEDIATRIC MASK (AEROSOL)

Facility

$13.00

Hospital Charge Code	4500443
Hospital Revenue Code	271
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

PEDIATRIC NASAL CANNULA

Facility

$13.00

Hospital Charge Code	4500419
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

PEDIATRIC NASAL CANNULA

Facility

$13.00

Hospital Charge Code	4500419
Hospital Revenue Code	271
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

PEDIATRIC NON REBREATHER MASK

Facility

$13.00

Hospital Charge Code	4500461
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

PEDIATRIC NON REBREATHER MASK

Facility

$13.00

Hospital Charge Code	4500461
Hospital Revenue Code	271
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

PEDIATRIC OXYGEN MASK

Facility

$13.00

Hospital Charge Code	4500439
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

PEDIATRIC OXYGEN MASK

Facility

$13.00

Hospital Charge Code	4500439
Hospital Revenue Code	271
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

PEDIATRIC TRACHEOSTOMY MASK

Facility

$3.00

Hospital Charge Code	4500431
Hospital Revenue Code	271
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$2.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2.14
Rate for Payer: Cash Price	$2.70
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.08

PEDIATRIC TRACHEOSTOMY MASK

Facility

$3.00

Hospital Charge Code	4500431
Hospital Revenue Code	271
Rate for Payer: Cash Price	$2.70

PEDI RES ELECTRODE

Facility

$288.00

Hospital Charge Code	28021501
Hospital Revenue Code	271
Rate for Payer: Cash Price	$259.20

PEDI RES ELECTRODE

Facility

$288.00

Hospital Charge Code	28021501
Hospital Revenue Code	271
Min. Negotiated Rate	$103.68
Max. Negotiated Rate	$205.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$170.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$205.63
Rate for Payer: Cash Price	$259.20
Rate for Payer: UnitedHealthcare Commercial	$192.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.68

PED URINE COLLECTOR

Facility

$22.00

Hospital Charge Code	2816427
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

PED URINE COLLECTOR

Facility

$22.00

Hospital Charge Code	2816427
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

PEEP VALVE, ADJUSTABLE

Facility

$14.00

Hospital Charge Code	451900
Hospital Revenue Code	271
Rate for Payer: Cash Price	$12.60

PEEP VALVE, ADJUSTABLE

Facility

$14.00

Hospital Charge Code	451900
Hospital Revenue Code	271
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$10.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.00
Rate for Payer: Cash Price	$12.60
Rate for Payer: UnitedHealthcare Commercial	$9.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04

PEG 3350 (MIRALAX) 17GM PKT EMP 30

Facility

$32.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2624863
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

PEG 3350 (MIRALAX) 17GM PKT EMP 30

Facility

$32.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2624863
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

PEG 3350 (MIRALAX) 17GM PKT MIX

Facility

$32.00

Service Code	NDC 6.2559E+10
Hospital Charge Code	2626370
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

PEG 3350 (MIRALAX) 17GM PKT MIX

Facility

$32.00

Service Code	NDC 6.2559E+10
Hospital Charge Code	2626370
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

Know your out-of-pocket cost for care.

All Charges