Madison Medical Center

All Charges

Charge

Type

Setting

Price

SMITH AB - LABCORP

Facility

$261.00

Service Code	CPT 86235
Hospital Charge Code	228133
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

SMOKE EVACUATOR/LAP

Facility

$196.00

Hospital Charge Code	124000
Hospital Revenue Code	271
Rate for Payer: Cash Price	$176.40

SMOKE EVACUATOR/LAP

Facility

$196.00

Hospital Charge Code	124000
Hospital Revenue Code	271
Min. Negotiated Rate	$70.56
Max. Negotiated Rate	$139.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$116.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$139.94
Rate for Payer: Cash Price	$176.40
Rate for Payer: UnitedHealthcare Commercial	$130.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.56

SMOKING CESSATION COUNSELING >10 MIN

Facility

$60.00

Service Code	CPT 99407
Hospital Charge Code	9899407
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.00

SMOKING CESSATION COUNSELING >10 MIN

Facility

$60.00

Service Code	CPT 99407
Hospital Charge Code	9899407
Hospital Revenue Code	521
Min. Negotiated Rate	$30.39
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$33.77
Rate for Payer: Aetna Medicare Advantage	$38.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$38.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$36.13
Rate for Payer: Home State Health Plan Medicare Advantage	$38.28
Rate for Payer: Humana Commercial	$76.56
Rate for Payer: Humana Medicare Advantage	$38.28
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SMOKING CESSATION COUNSELING 3 - 9 MIN

Facility

$35.00

Service Code	CPT 99406
Hospital Charge Code	9899406
Hospital Revenue Code	521
Rate for Payer: Cash Price	$31.50

SMOKING CESSATION COUNSELING 3 - 9 MIN

Facility

$35.00

Service Code	CPT 99406
Hospital Charge Code	9899406
Hospital Revenue Code	521
Min. Negotiated Rate	$20.72
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$33.77
Rate for Payer: Aetna Medicare Advantage	$38.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cigna Commercial HMO & PPO	$38.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$36.13
Rate for Payer: Home State Health Plan Medicare Advantage	$38.28
Rate for Payer: Humana Commercial	$76.56
Rate for Payer: Humana Medicare Advantage	$38.28
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SMOKING/TOBACCO CESSATION >10MIN

Facility

$80.00

Service Code	CPT 99407
Hospital Charge Code	4299407
Hospital Revenue Code	521
Min. Negotiated Rate	$30.39
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$33.77
Rate for Payer: Aetna Medicare Advantage	$38.28
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: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna Commercial HMO & PPO	$38.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$36.13
Rate for Payer: Home State Health Plan Medicare Advantage	$38.28
Rate for Payer: Humana Commercial	$76.56
Rate for Payer: Humana Medicare Advantage	$38.28
Rate for Payer: UnitedHealthcare Commercial	$53.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SMOKING/TOBACCO CESSATION >10MIN

Facility

$80.00

Service Code	CPT 99407
Hospital Charge Code	4299407
Hospital Revenue Code	521
Rate for Payer: Cash Price	$72.00

SMOOTH MUSCLE ANTIBODY

Facility

$185.00

Service Code	CPT 86255
Hospital Charge Code	2286255
Hospital Revenue Code	301
Rate for Payer: Cash Price	$166.50

SMOOTH MUSCLE ANTIBODY

Facility

$185.00

Service Code	CPT 86255
Hospital Charge Code	2286255
Hospital Revenue Code	301
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$132.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.85
Rate for Payer: Aetna Medicare Advantage	$12.05
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	$12.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.61
Rate for Payer: Home State Health Plan Medicare Advantage	$12.05
Rate for Payer: Humana Commercial	$24.10
Rate for Payer: Humana Medicare Advantage	$12.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.60

SNARE ASSEMBLY, OVAL

Facility

$184.00

Hospital Charge Code	2819486
Hospital Revenue Code	271
Min. Negotiated Rate	$66.24
Max. Negotiated Rate	$131.38
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: UnitedHealthcare Commercial	$122.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.24

SNARE ASSEMBLY, OVAL

Facility

$184.00

Hospital Charge Code	2819486
Hospital Revenue Code	271
Rate for Payer: Cash Price	$165.60

SOD. BICARBONATE INJ

Facility

$125.00

Hospital Charge Code	2058052
Hospital Revenue Code	370
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$89.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: UnitedHealthcare Commercial	$83.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

SOD. BICARBONATE INJ

Facility

$125.00

Hospital Charge Code	2058052
Hospital Revenue Code	370
Rate for Payer: Cash Price	$112.50

SOD CITRATE/CITRIC ACID(BICITRA)SOL

Facility

$18.00

Service Code	NDC 4.6287E+10
Hospital Charge Code	2656199
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

SOD CITRATE/CITRIC ACID(BICITRA)SOL

Facility

$18.00

Service Code	NDC 4.6287E+10
Hospital Charge Code	2656199
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

SOD HYPOCHLOR (DAKINS SOL) 0.5% TOP SOL

Facility

$56.00

Service Code	NDC 436094616
Hospital Charge Code	2626459
Hospital Revenue Code	250
Rate for Payer: Cash Price	$50.40

SOD HYPOCHLOR (DAKINS SOL) 0.5% TOP SOL

Facility

$56.00

Service Code	NDC 436094616
Hospital Charge Code	2626459
Hospital Revenue Code	250
Min. Negotiated Rate	$20.16
Max. Negotiated Rate	$39.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$33.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.98
Rate for Payer: Cash Price	$50.40
Rate for Payer: UnitedHealthcare Commercial	$37.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.16

SODI, POTA, PHOS (PHOS NAK) 1.5GM PKT

Facility

$18.00

Service Code	NDC 6.0258E+10
Hospital Charge Code	2626466
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

SODI, POTA, PHOS (PHOS NAK) 1.5GM PKT

Facility

$18.00

Service Code	NDC 6.0258E+10
Hospital Charge Code	2626466
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

SODIUM

Facility

$110.00

Service Code	CPT 84295
Hospital Charge Code	2219122
Hospital Revenue Code	301
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$78.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.33
Rate for Payer: Aetna Medicare Advantage	$4.81
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: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$4.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.63
Rate for Payer: Home State Health Plan Medicare Advantage	$4.81
Rate for Payer: Humana Commercial	$9.62
Rate for Payer: Humana Medicare Advantage	$4.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

SODIUM

Facility

$110.00

Service Code	CPT 84295
Hospital Charge Code	2219122
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

SODIUM 24 HR URINE

Facility

$110.00

Service Code	CPT 84300
Hospital Charge Code	2284301
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

SODIUM 24 HR URINE

Facility

$110.00

Service Code	CPT 84300
Hospital Charge Code	2284301
Hospital Revenue Code	301
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$78.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.55
Rate for Payer: Aetna Medicare Advantage	$5.06
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: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$5.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.87
Rate for Payer: Home State Health Plan Medicare Advantage	$5.06
Rate for Payer: Humana Commercial	$10.12
Rate for Payer: Humana Medicare Advantage	$5.06
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

Know your out-of-pocket cost for care.

All Charges