Madison Medical Center

All Charges

Charge

Type

Setting

Price

ATTENDS, FITULTRA LARGE

Facility

$20.00

Hospital Charge Code	281842
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

ATTENDS, FITULTRA MEDIUM

Facility

$20.00

Hospital Charge Code	2819026
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

ATTENDS, FITULTRA MEDIUM

Facility

$20.00

Hospital Charge Code	2819026
Hospital Revenue Code	271
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

ATTENDS, FITULTRA XLARGE

Facility

$20.00

Hospital Charge Code	2819025
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

ATTENDS, FITULTRA XLARGE

Facility

$20.00

Hospital Charge Code	2819025
Hospital Revenue Code	271
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

ATTENDS/UNDERPADS-HIGH USE

Facility

$422.00

Hospital Charge Code	281825
Hospital Revenue Code	271
Rate for Payer: Cash Price	$379.80

ATTENDS/UNDERPADS-HIGH USE

Facility

$422.00

Hospital Charge Code	281825
Hospital Revenue Code	271
Min. Negotiated Rate	$151.92
Max. Negotiated Rate	$301.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$249.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$301.31
Rate for Payer: Cash Price	$379.80
Rate for Payer: UnitedHealthcare Commercial	$281.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$151.92

ATTENDS/UNDERPADS-LOW USE

Facility

$92.00

Hospital Charge Code	281800
Hospital Revenue Code	271
Rate for Payer: Cash Price	$82.80

ATTENDS/UNDERPADS-LOW USE

Facility

$92.00

Hospital Charge Code	281800
Hospital Revenue Code	271
Min. Negotiated Rate	$33.12
Max. Negotiated Rate	$65.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$54.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$65.69
Rate for Payer: Cash Price	$82.80
Rate for Payer: UnitedHealthcare Commercial	$61.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.12

ATTENDS/UNDERPADS-MED USE

Facility

$297.00

Hospital Charge Code	281805
Hospital Revenue Code	271
Min. Negotiated Rate	$106.92
Max. Negotiated Rate	$212.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$175.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$212.06
Rate for Payer: Cash Price	$267.30
Rate for Payer: UnitedHealthcare Commercial	$198.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$106.92

ATTENDS/UNDERPADS-MED USE

Facility

$297.00

Hospital Charge Code	281805
Hospital Revenue Code	271
Rate for Payer: Cash Price	$267.30

ATTENDS/UNDERPADS - VERY HIGH USE

Facility

$628.00

Hospital Charge Code	281845
Hospital Revenue Code	271
Min. Negotiated Rate	$226.08
Max. Negotiated Rate	$448.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$371.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$448.39
Rate for Payer: Cash Price	$565.20
Rate for Payer: UnitedHealthcare Commercial	$418.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$226.08

ATTENDS/UNDERPADS - VERY HIGH USE

Facility

$628.00

Hospital Charge Code	281845
Hospital Revenue Code	271
Rate for Payer: Cash Price	$565.20

AUREOBASDIIUM PULLULANS AB

Facility

$110.00

Service Code	CPT 86671
Hospital Charge Code	2286606
Hospital Revenue Code	305
Rate for Payer: Cash Price	$99.00

AUREOBASDIIUM PULLULANS AB

Facility

$110.00

Service Code	CPT 86671
Hospital Charge Code	2286606
Hospital Revenue Code	305
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$78.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.03
Rate for Payer: Aetna Medicare Advantage	$12.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$12.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.80
Rate for Payer: Home State Health Plan Medicare Advantage	$12.25
Rate for Payer: Humana Commercial	$24.50
Rate for Payer: Humana Medicare Advantage	$12.25
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC

Facility

$97,266.40

Service Code	MSDRG 016
Min. Negotiated Rate	$48,633.20
Max. Negotiated Rate	$97,266.40
Rate for Payer: Aetna Medicare Advantage	$48,633.20
Rate for Payer: Cigna Commercial HMO & PPO	$48,633.20
Rate for Payer: Home State Health Plan Medicare Advantage	$48,633.20
Rate for Payer: Humana Commercial	$97,266.40
Rate for Payer: Humana Medicare Advantage	$48,633.20

AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC

Facility

$89,370.34

Service Code	MSDRG 017
Min. Negotiated Rate	$44,685.17
Max. Negotiated Rate	$89,370.34
Rate for Payer: Aetna Medicare Advantage	$44,685.17
Rate for Payer: Cigna Commercial HMO & PPO	$44,685.17
Rate for Payer: Home State Health Plan Medicare Advantage	$44,685.17
Rate for Payer: Humana Commercial	$89,370.34
Rate for Payer: Humana Medicare Advantage	$44,685.17

AUTOVENT CIRCUIT TUBING

Facility

$70.00

Hospital Charge Code	182222
Hospital Revenue Code	271
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$49.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

AUTOVENT CIRCUIT TUBING

Facility

$70.00

Hospital Charge Code	182222
Hospital Revenue Code	271
Rate for Payer: Cash Price	$63.00

AUTO VENT VENTILATION CIRCUIT

Facility

$70.00

Hospital Charge Code	282222
Hospital Revenue Code	271
Rate for Payer: Cash Price	$63.00

AUTO VENT VENTILATION CIRCUIT

Facility

$70.00

Hospital Charge Code	282222
Hospital Revenue Code	271
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$49.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

AVO TOP CREAM 45 GM

Facility

$55.00

Service Code	NDC 1.3811E+10
Hospital Charge Code	2624770
Hospital Revenue Code	250
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

AVO TOP CREAM 45 GM

Facility

$55.00

Service Code	NDC 1.3811E+10
Hospital Charge Code	2624770
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

AVULSION OF NAIL

Facility

$160.00

Service Code	CPT 11730
Hospital Charge Code	4211730
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

AVULSION OF NAIL

Facility

$160.00

Service Code	CPT 11730
Hospital Charge Code	4211730
Hospital Revenue Code	521
Min. Negotiated Rate	$94.72
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$94.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$114.24
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$106.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges