Madison Medical Center

All Charges

Charge

Type

Setting

Price

SARS-COV-2 AB TOTAL (LABCORP 164090)

Facility

$158.00

Service Code	CPT 87635
Hospital Charge Code	2286773
Hospital Revenue Code	302
Rate for Payer: Cash Price	$142.20

SARS-COV-2 TOTAL ANTIBODES

Facility

$158.00

Service Code	CPT 86769
Hospital Charge Code	2286772
Hospital Revenue Code	301
Rate for Payer: Cash Price	$142.20

SARS-COV-2 TOTAL ANTIBODES

Facility

$158.00

Service Code	CPT 86769
Hospital Charge Code	2286772
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$112.81
Rate for Payer: Aetna Better Health Medicaid/QHP	$37.92
Rate for Payer: Aetna Medicare Advantage	$42.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$93.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$112.81
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cigna Commercial HMO & PPO	$42.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$37.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$40.57
Rate for Payer: Home State Health Plan Medicare Advantage	$42.13
Rate for Payer: Humana Commercial	$84.26
Rate for Payer: Humana Medicare Advantage	$42.13
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$37.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.88

SAWS AND DRILL TRAY

Facility

$706.00

Hospital Charge Code	129109
Hospital Revenue Code	360
Rate for Payer: Cash Price	$635.40

SAWS AND DRILL TRAY

Facility

$706.00

Hospital Charge Code	129109
Hospital Revenue Code	360
Min. Negotiated Rate	$254.16
Max. Negotiated Rate	$470.90
Rate for Payer: Cash Price	$635.40
Rate for Payer: UnitedHealthcare Commercial	$470.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$254.16

SB SWING BED - PRIVATE P

Facility

$850.00

Hospital Charge Code	30000006
Hospital Revenue Code	160
Min. Negotiated Rate	$742.00
Max. Negotiated Rate	$1,593.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$742.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$742.00
Rate for Payer: Cash Price	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,519.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,593.00

SCABIES EXAM

Facility

$280.00

Service Code	CPT 87169
Hospital Charge Code	2287220
Hospital Revenue Code	306
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$199.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.88
Rate for Payer: Aetna Medicare Advantage	$4.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$165.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$199.92
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cigna Commercial HMO & PPO	$4.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.15
Rate for Payer: Home State Health Plan Medicare Advantage	$4.31
Rate for Payer: Humana Commercial	$8.62
Rate for Payer: Humana Medicare Advantage	$4.31
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$100.80

SCABIES EXAM

Facility

$280.00

Service Code	CPT 87169
Hospital Charge Code	2287220
Hospital Revenue Code	306
Rate for Payer: Cash Price	$252.00

SCALPEL DISPOSABLE #10

Facility

$21.00

Hospital Charge Code	2819011
Hospital Revenue Code	271
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

SCALPEL DISPOSABLE #10

Facility

$21.00

Hospital Charge Code	2819011
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

SCALPEL DISPOSABLE #11

Facility

$21.00

Hospital Charge Code	2819284
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

SCALPEL DISPOSABLE #11

Facility

$21.00

Hospital Charge Code	2819284
Hospital Revenue Code	271
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

SCALPEL DISPOSABLE #15

Facility

$21.00

Hospital Charge Code	2819024
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

SCALPEL DISPOSABLE #15

Facility

$21.00

Hospital Charge Code	2819024
Hospital Revenue Code	271
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

SCAPEL BLADES

Facility

$16.00

Hospital Charge Code	2819283
Hospital Revenue Code	271
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

SCAPEL BLADES

Facility

$16.00

Hospital Charge Code	2819283
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

SCAPULA LT

Facility

$465.00

Service Code	CPT 73010
Hospital Charge Code	3219118
Hospital Revenue Code	320
Rate for Payer: Cash Price	$418.50

SCAPULA LT

Facility

$465.00

Service Code	CPT 73010
Hospital Charge Code	3219118
Hospital Revenue Code	320
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$332.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$275.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$332.01
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$167.40

SCAPULA RT

Facility

$465.00

Service Code	CPT 73010
Hospital Charge Code	3219117
Hospital Revenue Code	320
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$332.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$275.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$332.01
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$167.40

SCAPULA RT

Facility

$465.00

Service Code	CPT 73010
Hospital Charge Code	3219117
Hospital Revenue Code	320
Rate for Payer: Cash Price	$418.50

SCD KNEE LENGTH SLEEVE LARGE #9789

Facility

$171.00

Hospital Charge Code	90000176
Hospital Revenue Code	271
Rate for Payer: Cash Price	$153.90

SCD KNEE LENGTH SLEEVE LARGE #9789

Facility

$171.00

Hospital Charge Code	90000176
Hospital Revenue Code	271
Min. Negotiated Rate	$61.56
Max. Negotiated Rate	$122.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$101.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$122.09
Rate for Payer: Cash Price	$153.90
Rate for Payer: UnitedHealthcare Commercial	$114.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.56

SCD KNEE LENGTH SLEEVE MEDIUM #9529

Facility

$105.00

Hospital Charge Code	90000175
Hospital Revenue Code	271
Rate for Payer: Cash Price	$94.50

SCD KNEE LENGTH SLEEVE MEDIUM #9529

Facility

$105.00

Hospital Charge Code	90000175
Hospital Revenue Code	271
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$74.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: UnitedHealthcare Commercial	$70.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.80

SCHIZOAFFECTIVE DISORDERS

Facility

$17,257.29

Service Code	APR-DRG 7612
Min. Negotiated Rate	$17,257.29
Max. Negotiated Rate	$17,257.29
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,257.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,257.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,257.29
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,257.29

Know your out-of-pocket cost for care.

All Charges