Madison Medical Center

All Charges

Charge

Type

Setting

Price

SODIUM CHLOR INH SOL 0.9% 3ML NEB TX

Facility

$32.00

Service Code	HCPCS J7608
Hospital Charge Code	2626445
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

SODIUM CHL PF 0.9% 10ML INJ VIAL

Facility

$48.00

Service Code	HCPCS A4216
Hospital Charge Code	2626540
Hospital Revenue Code	250
Rate for Payer: Cash Price	$43.20

SODIUM CHL PF 0.9% 10ML INJ VIAL

Facility

$48.00

Service Code	HCPCS A4216
Hospital Charge Code	2626540
Hospital Revenue Code	250
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

SODIUM CHL PF 0.9% 2ML INJ VIAL

Facility

$55.00

Service Code	HCPCS A4216
Hospital Charge Code	2621453
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

SODIUM CHL PF 0.9% 2ML INJ VIAL

Facility

$55.00

Service Code	HCPCS A4216
Hospital Charge Code	2621453
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

SODIUM FLUORIDE 1.1% GEL 60GM EMP

Facility

$65.00

Service Code	NDC 1E+11
Hospital Charge Code	2625175
Hospital Revenue Code	250
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

SODIUM FLUORIDE 1.1% GEL 60GM EMP

Facility

$65.00

Service Code	NDC 1E+11
Hospital Charge Code	2625175
Hospital Revenue Code	250
Rate for Payer: Cash Price	$58.50

SODIUM STOOL

Facility

$127.00

Service Code	CPT 84302
Hospital Charge Code	2284302
Hospital Revenue Code	301
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$90.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.37
Rate for Payer: Aetna Medicare Advantage	$4.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$90.68
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cigna Commercial HMO & PPO	$4.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.68
Rate for Payer: Home State Health Plan Medicare Advantage	$4.86
Rate for Payer: Humana Commercial	$9.72
Rate for Payer: Humana Medicare Advantage	$4.86
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.72

SODIUM STOOL

Facility

$127.00

Service Code	CPT 84302
Hospital Charge Code	2284302
Hospital Revenue Code	301
Rate for Payer: Cash Price	$114.30

SODIUM URINE RANDOM

Facility

$32.00

Service Code	CPT 84300
Hospital Charge Code	2221211
Hospital Revenue Code	307
Rate for Payer: Cash Price	$28.80

SODIUM URINE RANDOM

Facility

$32.00

Service Code	CPT 84300
Hospital Charge Code	2221211
Hospital Revenue Code	307
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$22.85
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	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
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	$11.52

SODIUM URINE RANDOM

Facility

$32.00

Service Code	CPT 84300
Hospital Charge Code	2284300
Hospital Revenue Code	301
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$22.85
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	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
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	$11.52

SODIUM URINE RANDOM

Facility

$32.00

Service Code	CPT 84300
Hospital Charge Code	2284300
Hospital Revenue Code	301
Rate for Payer: Cash Price	$28.80

SOD POLYSTYR (KAYEXALATE)15G/60MLSUS

Facility

$96.00

Service Code	NDC 4.6287E+10
Hospital Charge Code	2626337
Hospital Revenue Code	250
Min. Negotiated Rate	$34.56
Max. Negotiated Rate	$68.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$68.54
Rate for Payer: Cash Price	$86.40
Rate for Payer: UnitedHealthcare Commercial	$64.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.56

SOD POLYSTYR (KAYEXALATE)15G/60MLSUS

Facility

$96.00

Service Code	NDC 4.6287E+10
Hospital Charge Code	2626337
Hospital Revenue Code	250
Rate for Payer: Cash Price	$86.40

SOF-TAPE (STRAPPING)

Facility

$21.00

Hospital Charge Code	2819247
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

SOF-TAPE (STRAPPING)

Facility

$21.00

Hospital Charge Code	2819247
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

SOFT TISSUE NECK

Facility

$529.00

Service Code	CPT 70360
Hospital Charge Code	3219111
Hospital Revenue Code	320
Rate for Payer: Cash Price	$476.10

SOFT TISSUE NECK

Facility

$529.00

Service Code	CPT 70360
Hospital Charge Code	3219111
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$377.71
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$313.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$377.71
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$190.44

SOFT TISSUE PROCEDURES WITH CC

Facility

$31,031.06

Service Code	MSDRG 501
Min. Negotiated Rate	$15,515.53
Max. Negotiated Rate	$31,031.06
Rate for Payer: Aetna Medicare Advantage	$15,515.53
Rate for Payer: Cigna Commercial HMO & PPO	$15,515.53
Rate for Payer: Home State Health Plan Medicare Advantage	$15,515.53
Rate for Payer: Humana Commercial	$31,031.06
Rate for Payer: Humana Medicare Advantage	$15,515.53

SOFT TISSUE PROCEDURES WITH MCC

Facility

$53,394.44

Service Code	MSDRG 500
Min. Negotiated Rate	$26,697.22
Max. Negotiated Rate	$53,394.44
Rate for Payer: Aetna Medicare Advantage	$26,697.22
Rate for Payer: Cigna Commercial HMO & PPO	$26,697.22
Rate for Payer: Home State Health Plan Medicare Advantage	$26,697.22
Rate for Payer: Humana Commercial	$53,394.44
Rate for Payer: Humana Medicare Advantage	$26,697.22

SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility

$24,706.98

Service Code	MSDRG 502
Min. Negotiated Rate	$12,353.49
Max. Negotiated Rate	$24,706.98
Rate for Payer: Aetna Medicare Advantage	$12,353.49
Rate for Payer: Cigna Commercial HMO & PPO	$12,353.49
Rate for Payer: Home State Health Plan Medicare Advantage	$12,353.49
Rate for Payer: Humana Commercial	$24,706.98
Rate for Payer: Humana Medicare Advantage	$12,353.49

SOFTWICK

Facility

$16.00

Hospital Charge Code	2819817
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
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: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

SOFTWICK

Facility

$16.00

Hospital Charge Code	2819817
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

SOLIFENACIN (VESICARE) 10MG TAB EMP

Facility

$51.00

Service Code	NDC 5.0228E+10
Hospital Charge Code	2623900
Hospital Revenue Code	250
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$36.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$36.41
Rate for Payer: Cash Price	$45.90
Rate for Payer: UnitedHealthcare Commercial	$34.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.36

Know your out-of-pocket cost for care.

All Charges