Madison Medical Center

All Charges

Charge

Type

Setting

Price

SERUM Fe/TIBC

Facility

$41.00

Service Code	CPT 83550
Hospital Charge Code	4283550
Hospital Revenue Code	521
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.87
Rate for Payer: Aetna Medicare Advantage	$8.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.27
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cigna Commercial HMO & PPO	$8.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.42
Rate for Payer: Home State Health Plan Medicare Advantage	$8.74
Rate for Payer: Humana Commercial	$17.48
Rate for Payer: Humana Medicare Advantage	$8.74
Rate for Payer: UnitedHealthcare Commercial	$27.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SERV CHG COLLAR RIG

Facility

$62.00

Hospital Charge Code	2819017
Hospital Revenue Code	271
Rate for Payer: Cash Price	$55.80

SERV CHG COLLAR RIG

Facility

$62.00

Hospital Charge Code	2819017
Hospital Revenue Code	271
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$44.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: UnitedHealthcare Commercial	$41.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

SERVICES PROVIDED ON AN ER BASIS OUT OF

Facility

$110.00

Service Code	CPT 99060
Hospital Charge Code	4299060
Hospital Revenue Code	521
Rate for Payer: Cash Price	$99.00

SERVICES PROVIDED ON AN ER BASIS OUT OF

Facility

$110.00

Service Code	CPT 99060
Hospital Charge Code	4299060
Hospital Revenue Code	521
Min. Negotiated Rate	$65.12
Max. Negotiated Rate	$173.53
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: UnitedHealthcare Commercial	$73.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SERVICES PROV IN OFFICE AFTER HOURS

Facility

$80.00

Service Code	CPT 99050
Hospital Charge Code	9899050
Hospital Revenue Code	521
Rate for Payer: Cash Price	$72.00

SERVICES PROV IN OFFICE AFTER HOURS

Facility

$80.00

Service Code	CPT 99050
Hospital Charge Code	9899050
Hospital Revenue Code	521
Min. Negotiated Rate	$47.36
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: UnitedHealthcare Commercial	$53.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SEVELAMER CARB (RENVELA) 800MG TAB

Facility

$25.00

Service Code	NDC 5.8468E+10
Hospital Charge Code	2626522
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$17.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.85
Rate for Payer: Cash Price	$22.50
Rate for Payer: UnitedHealthcare Commercial	$16.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.00

SEVELAMER CARB (RENVELA) 800MG TAB

Facility

$25.00

Service Code	NDC 5.8468E+10
Hospital Charge Code	2626522
Hospital Revenue Code	250
Rate for Payer: Cash Price	$22.50

SEVOFLURANE (ULTANE) INH SOL 250ML ANEST

Facility

$3,274.00

Service Code	NDC 6.6794E+10
Hospital Charge Code	2697306
Hospital Revenue Code	250
Rate for Payer: Cash Price	$2,946.60

SEVOFLURANE (ULTANE) INH SOL 250ML ANEST

Facility

$3,274.00

Service Code	NDC 6.6794E+10
Hospital Charge Code	2697306
Hospital Revenue Code	250
Min. Negotiated Rate	$1,178.64
Max. Negotiated Rate	$2,337.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,938.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,337.64
Rate for Payer: Cash Price	$2,946.60
Rate for Payer: UnitedHealthcare Commercial	$2,183.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,178.64

SEX HORMONE BINDING GLOBULIN

Facility

$185.00

Service Code	CPT 84270
Hospital Charge Code	2284270
Hospital Revenue Code	301
Rate for Payer: Cash Price	$166.50

SEX HORMONE BINDING GLOBULIN

Facility

$185.00

Service Code	CPT 84270
Hospital Charge Code	2284270
Hospital Revenue Code	301
Min. Negotiated Rate	$19.56
Max. Negotiated Rate	$132.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.56
Rate for Payer: Aetna Medicare Advantage	$21.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$109.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.09
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cigna Commercial HMO & PPO	$21.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.93
Rate for Payer: Home State Health Plan Medicare Advantage	$21.73
Rate for Payer: Humana Commercial	$43.46
Rate for Payer: Humana Medicare Advantage	$21.73
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.60

SGL-LUMEN VENOUS CATH

Facility

$309.00

Hospital Charge Code	2820013
Hospital Revenue Code	271
Rate for Payer: Cash Price	$278.10

SGL-LUMEN VENOUS CATH

Facility

$309.00

Hospital Charge Code	2820013
Hospital Revenue Code	271
Min. Negotiated Rate	$111.24
Max. Negotiated Rate	$220.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$182.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$220.63
Rate for Payer: Cash Price	$278.10
Rate for Payer: UnitedHealthcare Commercial	$206.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$111.24

SHAMPOO NO RINSE

Facility

$39.00

Hospital Charge Code	2819220
Hospital Revenue Code	271
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

SHAMPOO NO RINSE

Facility

$39.00

Hospital Charge Code	2819220
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

SHAVE BIOPSY LESION 1.1 TO 2.0 CM

Facility

$184.00

Service Code	CPT 11307
Hospital Charge Code	5411307
Hospital Revenue Code	521
Rate for Payer: Cash Price	$165.60

SHAVE BIOPSY LESION 1.1 TO 2.0 CM

Facility

$184.00

Service Code	CPT 11307
Hospital Charge Code	5411307
Hospital Revenue Code	521
Min. Negotiated Rate	$108.93
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	$108.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$131.38
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cash Price	$165.60
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	$122.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVE FACE .6 TO 1.0

Facility

$225.00

Service Code	CPT 11311
Hospital Charge Code	9711311
Hospital Revenue Code	521
Min. Negotiated Rate	$133.20
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	$133.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$160.65
Rate for Payer: Cash Price	$202.50
Rate for Payer: Cash Price	$202.50
Rate for Payer: Cash Price	$202.50
Rate for Payer: Cash Price	$202.50
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	$150.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVE FACE .6 TO 1.0

Facility

$225.00

Service Code	CPT 11311
Hospital Charge Code	9711311
Hospital Revenue Code	521
Rate for Payer: Cash Price	$202.50

SHAVING EPIDERMAL/DERMAL LES .6 TO 1 CM

Facility

$220.00

Service Code	CPT 11311
Hospital Charge Code	9811311
Hospital Revenue Code	521
Rate for Payer: Cash Price	$198.00

SHAVING EPIDERMAL/DERMAL LES .6 TO 1 CM

Facility

$220.00

Service Code	CPT 11311
Hospital Charge Code	9811311
Hospital Revenue Code	521
Min. Negotiated Rate	$130.24
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	$130.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$157.08
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
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	$146.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING EPI OR DERM LES 1.1 TO 2.0 CM SC

Facility

$230.00

Service Code	CPT 11307
Hospital Charge Code	9811307
Hospital Revenue Code	521
Rate for Payer: Cash Price	$207.00

SHAVING EPI OR DERM LES 1.1 TO 2.0 CM SC

Facility

$230.00

Service Code	CPT 11307
Hospital Charge Code	9811307
Hospital Revenue Code	521
Min. Negotiated Rate	$136.16
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	$136.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$164.22
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
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	$153.41
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