Madison Medical Center

All Charges

Charge

Type

Setting

Price

22GX7 SPINAL NEEDLE

Facility

$28.00

Hospital Charge Code	2824477
Hospital Revenue Code	270
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

22GX7 SPINAL NEEDLE

Facility

$28.00

Hospital Charge Code	2824477
Hospital Revenue Code	270
Rate for Payer: Cash Price	$25.20

22MM VALVED TEE ADP

Facility

$5.00

Hospital Charge Code	4524487
Hospital Revenue Code	271
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$3.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3.57
Rate for Payer: Cash Price	$4.50
Rate for Payer: UnitedHealthcare Commercial	$3.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.80

22MM VALVED TEE ADP

Facility

$5.00

Hospital Charge Code	4524487
Hospital Revenue Code	271
Rate for Payer: Cash Price	$4.50

23MM ANCHORW/SUTUREAND NEEDLES 1CONIX ST

Facility

$766.00

Hospital Charge Code	123422
Hospital Revenue Code	271
Rate for Payer: Cash Price	$689.40

23MM ANCHORW/SUTUREAND NEEDLES 1CONIX ST

Facility

$766.00

Hospital Charge Code	123422
Hospital Revenue Code	271
Min. Negotiated Rate	$275.76
Max. Negotiated Rate	$546.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$453.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$546.92
Rate for Payer: Cash Price	$689.40
Rate for Payer: UnitedHealthcare Commercial	$510.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$275.76

250CC STERILH2 O

Facility

$21.00

Hospital Charge Code	289369
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

250CC STERILH2 O

Facility

$21.00

Hospital Charge Code	289369
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

25GX3.5 SPINAL NEEDLE

Facility

$16.00

Hospital Charge Code	2824465
Hospital Revenue Code	270
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Cash Price	$14.40
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: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

25GX3.5 SPINAL NEEDLE

Facility

$16.00

Hospital Charge Code	2824465
Hospital Revenue Code	270
Rate for Payer: Cash Price	$14.40

25GX4.69 SPINAL NEEDLE

Facility

$24.00

Hospital Charge Code	2824459
Hospital Revenue Code	270
Rate for Payer: Cash Price	$21.60

25GX4.69 SPINAL NEEDLE

Facility

$24.00

Hospital Charge Code	2824459
Hospital Revenue Code	270
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

25-HYDROXY VITAMIN D2 + D3 FRACTIONATED

Facility

$244.00

Service Code	CPT 82306
Hospital Charge Code	221949
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$174.22
Rate for Payer: Aetna Better Health Medicaid/QHP	$26.64
Rate for Payer: Aetna Medicare Advantage	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$144.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.22
Rate for Payer: Cash Price	$219.60
Rate for Payer: Cash Price	$219.60
Rate for Payer: Cash Price	$219.60
Rate for Payer: Cigna Commercial HMO & PPO	$29.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28.50
Rate for Payer: Home State Health Plan Medicare Advantage	$29.60
Rate for Payer: Humana Commercial	$59.20
Rate for Payer: Humana Medicare Advantage	$29.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$87.84

25-HYDROXY VITAMIN D2 + D3 FRACTIONATED

Facility

$244.00

Service Code	CPT 82306
Hospital Charge Code	221949
Hospital Revenue Code	301
Rate for Payer: Cash Price	$219.60

25MM 15GA, I/O NEEDLE SET

Facility

$480.00

Hospital Charge Code	281421
Hospital Revenue Code	271
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$342.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$284.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$342.72
Rate for Payer: Cash Price	$432.00
Rate for Payer: UnitedHealthcare Commercial	$320.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$172.80

25MM 15GA, I/O NEEDLE SET

Facility

$480.00

Hospital Charge Code	281421
Hospital Revenue Code	271
Rate for Payer: Cash Price	$432.00

2.5MM ENDO TUBE--UNCUFFED

Facility

$178.00

Hospital Charge Code	285811
Hospital Revenue Code	270
Min. Negotiated Rate	$64.08
Max. Negotiated Rate	$127.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: UnitedHealthcare Commercial	$118.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

2.5MM ENDO TUBE--UNCUFFED

Facility

$178.00

Hospital Charge Code	285811
Hospital Revenue Code	270
Rate for Payer: Cash Price	$160.20

2.6 DRILL BIT

Facility

$718.00

Hospital Charge Code	123321
Hospital Revenue Code	271
Min. Negotiated Rate	$258.48
Max. Negotiated Rate	$512.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$425.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$512.65
Rate for Payer: Cash Price	$646.20
Rate for Payer: UnitedHealthcare Commercial	$478.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$258.48

2.6 DRILL BIT

Facility

$718.00

Hospital Charge Code	123321
Hospital Revenue Code	271
Rate for Payer: Cash Price	$646.20

2.7 DRILL BIT

Facility

$677.00

Hospital Charge Code	123323
Hospital Revenue Code	271
Rate for Payer: Cash Price	$609.30

2.7 DRILL BIT

Facility

$677.00

Hospital Charge Code	123323
Hospital Revenue Code	271
Min. Negotiated Rate	$243.72
Max. Negotiated Rate	$483.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$400.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$483.38
Rate for Payer: Cash Price	$609.30
Rate for Payer: UnitedHealthcare Commercial	$451.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$243.72

27GX3.5 SPINAL NEEDLE

Facility

$40.00

Hospital Charge Code	2824472
Hospital Revenue Code	270
Rate for Payer: Cash Price	$36.00

27GX3.5 SPINAL NEEDLE

Facility

$40.00

Hospital Charge Code	2824472
Hospital Revenue Code	270
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

2.7X16mm BONE SCREW

Facility

$452.00

Hospital Charge Code	123322
Hospital Revenue Code	271
Min. Negotiated Rate	$162.72
Max. Negotiated Rate	$322.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$267.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$322.73
Rate for Payer: Cash Price	$406.80
Rate for Payer: UnitedHealthcare Commercial	$301.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$162.72

Know your out-of-pocket cost for care.

All Charges