Madison Medical Center

All Charges

Charge

Type

Setting

Price

SLIPPER FOAM CHILD

Facility

$10.00

Hospital Charge Code	2819356
Hospital Revenue Code	271
Rate for Payer: Cash Price	$9.00

SLIPPER FOAM CHILD

Facility

$10.00

Hospital Charge Code	2819356
Hospital Revenue Code	271
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$7.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.14
Rate for Payer: Cash Price	$9.00
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.60

SLIPPER, FOAM, LARGE

Facility

$22.00

Hospital Charge Code	2819358
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

SLIPPER, FOAM, LARGE

Facility

$22.00

Hospital Charge Code	2819358
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

SLIPPER, FOAM, MEDIUM

Facility

$22.00

Hospital Charge Code	2819357
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

SLIPPER, FOAM, MEDIUM

Facility

$22.00

Hospital Charge Code	2819357
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

SLIPPER FOAM XLG

Facility

$22.00

Hospital Charge Code	2819355
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

SLIPPER FOAM XLG

Facility

$22.00

Hospital Charge Code	2819355
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

SLIPPER FOAM XXL

Facility

$22.00

Hospital Charge Code	2819354
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

SLIPPER FOAM XXL

Facility

$22.00

Hospital Charge Code	2819354
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

SLNG,HANG CAST,ADULT

Facility

$101.00

Hospital Charge Code	2819812
Hospital Revenue Code	271
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

SLNG,HANG CAST,ADULT

Facility

$101.00

Hospital Charge Code	2819812
Hospital Revenue Code	271
Rate for Payer: Cash Price	$90.90

SLNG,HANG CAST,CHILD

Facility

$101.00

Hospital Charge Code	2819811
Hospital Revenue Code	271
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

SLNG,HANG CAST,CHILD

Facility

$101.00

Hospital Charge Code	2819811
Hospital Revenue Code	271
Rate for Payer: Cash Price	$90.90

SMALL JOINT INJ

Facility

$190.00

Service Code	CPT 20600
Hospital Charge Code	4420600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$171.00

SMALL JOINT INJ

Facility

$190.00

Service Code	CPT 20600
Hospital Charge Code	4420600
Hospital Revenue Code	521
Min. Negotiated Rate	$112.48
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$126.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SMALL JOINT INJECTION

Facility

$190.00

Service Code	CPT 20600
Hospital Charge Code	5420600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$171.00

SMALL JOINT INJECTION

Facility

$190.00

Service Code	CPT 20600
Hospital Charge Code	5420600
Hospital Revenue Code	521
Min. Negotiated Rate	$112.48
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$126.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SMALL POLYPECTOMY SNARE

Facility

$301.00

Hospital Charge Code	1219486
Hospital Revenue Code	360
Rate for Payer: Cash Price	$270.90

SMALL POLYPECTOMY SNARE

Facility

$301.00

Hospital Charge Code	1219486
Hospital Revenue Code	360
Min. Negotiated Rate	$108.36
Max. Negotiated Rate	$200.77
Rate for Payer: Cash Price	$270.90
Rate for Payer: UnitedHealthcare Commercial	$200.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.36

SM BOWEL SERIES

Facility

$832.00

Service Code	CPT 74250
Hospital Charge Code	322193
Hospital Revenue Code	320
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$594.05
Rate for Payer: Aetna Better Health Medicaid/QHP	$158.12
Rate for Payer: Aetna Medicare Advantage	$179.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$492.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$594.05
Rate for Payer: Cash Price	$748.80
Rate for Payer: Cash Price	$748.80
Rate for Payer: Cash Price	$748.80
Rate for Payer: Cigna Commercial HMO & PPO	$179.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$158.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$169.19
Rate for Payer: Home State Health Plan Medicare Advantage	$179.20
Rate for Payer: Humana Commercial	$358.40
Rate for Payer: Humana Medicare Advantage	$179.20
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$158.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$299.52

SM BOWEL SERIES

Facility

$832.00

Service Code	CPT 74250
Hospital Charge Code	322193
Hospital Revenue Code	320
Rate for Payer: Cash Price	$748.80

..SMITH AB - AEL

Facility

$261.00

Service Code	CPT 86235
Hospital Charge Code	228140
Hospital Revenue Code	302
Rate for Payer: Cash Price	$234.90

..SMITH AB - AEL

Facility

$261.00

Service Code	CPT 86235
Hospital Charge Code	228140
Hospital Revenue Code	302
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$186.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.14
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$154.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$186.35
Rate for Payer: Cash Price	$234.90
Rate for Payer: Cash Price	$234.90
Rate for Payer: Cash Price	$234.90
Rate for Payer: Cigna Commercial HMO & PPO	$17.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.27
Rate for Payer: Home State Health Plan Medicare Advantage	$17.93
Rate for Payer: Humana Commercial	$35.86
Rate for Payer: Humana Medicare Advantage	$17.93
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$93.96

SMITH AB - LABCORP

Facility

$261.00

Service Code	CPT 86235
Hospital Charge Code	228133
Hospital Revenue Code	302
Rate for Payer: Cash Price	$234.90

Know your out-of-pocket cost for care.

All Charges