Madison Medical Center

All Charges

Charge

Type

Setting

Price

SKIN ULCERS

Facility

$8,036.99

Service Code	APR-DRG 3801
Min. Negotiated Rate	$8,036.99
Max. Negotiated Rate	$8,036.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,036.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,036.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,036.99
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,036.99

SKIN ULCERS

Facility

$10,746.27

Service Code	APR-DRG 3802
Min. Negotiated Rate	$10,746.27
Max. Negotiated Rate	$10,746.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,746.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,746.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,746.27
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,746.27

SKIN ULCERS WITH CC

Facility

$22,209.34

Service Code	MSDRG 593
Min. Negotiated Rate	$11,104.67
Max. Negotiated Rate	$22,209.34
Rate for Payer: Aetna Medicare Advantage	$11,104.67
Rate for Payer: Cigna Commercial HMO & PPO	$11,104.67
Rate for Payer: Home State Health Plan Medicare Advantage	$11,104.67
Rate for Payer: Humana Commercial	$22,209.34
Rate for Payer: Humana Medicare Advantage	$11,104.67

SKIN ULCERS WITH MCC

Facility

$33,980.14

Service Code	MSDRG 592
Min. Negotiated Rate	$16,990.07
Max. Negotiated Rate	$33,980.14
Rate for Payer: Aetna Medicare Advantage	$16,990.07
Rate for Payer: Cigna Commercial HMO & PPO	$16,990.07
Rate for Payer: Home State Health Plan Medicare Advantage	$16,990.07
Rate for Payer: Humana Commercial	$33,980.14
Rate for Payer: Humana Medicare Advantage	$16,990.07

SKIN ULCERS WITHOUT CC/MCC

Facility

$17,209.40

Service Code	MSDRG 594
Min. Negotiated Rate	$8,604.70
Max. Negotiated Rate	$17,209.40
Rate for Payer: Aetna Medicare Advantage	$8,604.70
Rate for Payer: Cigna Commercial HMO & PPO	$8,604.70
Rate for Payer: Home State Health Plan Medicare Advantage	$8,604.70
Rate for Payer: Humana Commercial	$17,209.40
Rate for Payer: Humana Medicare Advantage	$8,604.70

SKULL 2 VIEW

Facility

$465.00

Service Code	CPT 70250
Hospital Charge Code	322179
Hospital Revenue Code	320
Rate for Payer: Cash Price	$418.50

SKULL 2 VIEW

Facility

$465.00

Service Code	CPT 70250
Hospital Charge Code	322179
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

SKULL X-RAY

Facility

$633.00

Service Code	CPT 70260
Hospital Charge Code	3219103
Hospital Revenue Code	320
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$451.96
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	$374.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$451.96
Rate for Payer: Cash Price	$569.70
Rate for Payer: Cash Price	$569.70
Rate for Payer: Cash Price	$569.70
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	$227.88

SKULL X-RAY

Facility

$633.00

Service Code	CPT 70260
Hospital Charge Code	3219103
Hospital Revenue Code	320
Rate for Payer: Cash Price	$569.70

SLIMPLEX 360 NEEDLE

Facility

$54.00

Hospital Charge Code	2824441
Hospital Revenue Code	270
Rate for Payer: Cash Price	$48.60

SLIMPLEX 360 NEEDLE

Facility

$54.00

Hospital Charge Code	2824441
Hospital Revenue Code	270
Min. Negotiated Rate	$19.44
Max. Negotiated Rate	$38.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$31.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$38.56
Rate for Payer: Cash Price	$48.60
Rate for Payer: UnitedHealthcare Commercial	$36.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.44

SLIMPLEX A NEEDLE

Facility

$67.00

Hospital Charge Code	2824458
Hospital Revenue Code	270
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

SLIMPLEX A NEEDLE

Facility

$67.00

Hospital Charge Code	2824458
Hospital Revenue Code	270
Rate for Payer: Cash Price	$60.30

SLING ARM CHILD

Facility

$67.00

Hospital Charge Code	2819001
Hospital Revenue Code	271
Rate for Payer: Cash Price	$60.30

SLING ARM CHILD

Facility

$67.00

Hospital Charge Code	2819001
Hospital Revenue Code	271
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

SLING ARM LARGE

Facility

$67.00

Hospital Charge Code	2819003
Hospital Revenue Code	271
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

SLING ARM LARGE

Facility

$67.00

Hospital Charge Code	2819003
Hospital Revenue Code	271
Rate for Payer: Cash Price	$60.30

SLING ARM MED

Facility

$67.00

Hospital Charge Code	2819020
Hospital Revenue Code	271
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

SLING ARM MED

Facility

$67.00

Hospital Charge Code	2819020
Hospital Revenue Code	271
Rate for Payer: Cash Price	$60.30

SLING ARM SMALL

Facility

$67.00

Hospital Charge Code	2819002
Hospital Revenue Code	271
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

SLING ARM SMALL

Facility

$67.00

Hospital Charge Code	2819002
Hospital Revenue Code	271
Rate for Payer: Cash Price	$60.30

SLING ARM XLARGE

Facility

$67.00

Hospital Charge Code	2819004
Hospital Revenue Code	271
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

SLING ARM XLARGE

Facility

$67.00

Hospital Charge Code	2819004
Hospital Revenue Code	271
Rate for Payer: Cash Price	$60.30

SLING, SWATH

Facility

$174.00

Hospital Charge Code	2819810
Hospital Revenue Code	271
Min. Negotiated Rate	$62.64
Max. Negotiated Rate	$124.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$103.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$124.24
Rate for Payer: Cash Price	$156.60
Rate for Payer: UnitedHealthcare Commercial	$116.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.64

SLING, SWATH

Facility

$174.00

Hospital Charge Code	2819810
Hospital Revenue Code	271
Rate for Payer: Cash Price	$156.60

Know your out-of-pocket cost for care.

All Charges