Madison Medical Center

All Charges

Charge

Type

Setting

Price

SPLINT,FROG,LARGE

Facility

$45.00

Hospital Charge Code	2819830
Hospital Revenue Code	271
Rate for Payer: Cash Price	$40.50

SPLINT,FROG,LARGE

Facility

$45.00

Hospital Charge Code	2819830
Hospital Revenue Code	271
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

SPLINT,FROG,MEDIUM

Facility

$39.00

Hospital Charge Code	2819829
Hospital Revenue Code	271
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

SPLINT,FROG,MEDIUM

Facility

$39.00

Hospital Charge Code	2819829
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

SPLINT,FROG,SMALL

Facility

$65.00

Hospital Charge Code	2819828
Hospital Revenue Code	271
Rate for Payer: Cash Price	$58.50

SPLINT,FROG,SMALL

Facility

$65.00

Hospital Charge Code	2819828
Hospital Revenue Code	271
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

SPLINT KNEE EX-LARGE

Facility

$308.00

Hospital Charge Code	2819899
Hospital Revenue Code	271
Min. Negotiated Rate	$110.88
Max. Negotiated Rate	$219.91
Rate for Payer: Cash Price	$277.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$182.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$219.91
Rate for Payer: UnitedHealthcare Commercial	$205.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$110.88

SPLINT KNEE EX-LARGE

Facility

$308.00

Hospital Charge Code	2819899
Hospital Revenue Code	271
Rate for Payer: Cash Price	$277.20

SPLINT KNEE LARGE

Facility

$308.00

Hospital Charge Code	2819898
Hospital Revenue Code	271
Rate for Payer: Cash Price	$277.20

SPLINT KNEE LARGE

Facility

$308.00

Hospital Charge Code	2819898
Hospital Revenue Code	271
Min. Negotiated Rate	$110.88
Max. Negotiated Rate	$219.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$182.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$219.91
Rate for Payer: Cash Price	$277.20
Rate for Payer: UnitedHealthcare Commercial	$205.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$110.88

SPLINT KNEE MEDIUM

Facility

$308.00

Hospital Charge Code	2819900
Hospital Revenue Code	271
Min. Negotiated Rate	$110.88
Max. Negotiated Rate	$219.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$182.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$219.91
Rate for Payer: Cash Price	$277.20
Rate for Payer: UnitedHealthcare Commercial	$205.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$110.88

SPLINT KNEE MEDIUM

Facility

$308.00

Hospital Charge Code	2819900
Hospital Revenue Code	271
Rate for Payer: Cash Price	$277.20

SPLINT KNEE SMALL

Facility

$308.00

Hospital Charge Code	2819897
Hospital Revenue Code	271
Min. Negotiated Rate	$110.88
Max. Negotiated Rate	$219.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$182.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$219.91
Rate for Payer: Cash Price	$277.20
Rate for Payer: UnitedHealthcare Commercial	$205.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$110.88

SPLINT KNEE SMALL

Facility

$308.00

Hospital Charge Code	2819897
Hospital Revenue Code	271
Rate for Payer: Cash Price	$277.20

SPLINT. PLASTER

Facility

$21.00

Hospital Charge Code	2819433
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

SPLINT. PLASTER

Facility

$21.00

Hospital Charge Code	2819433
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

SPLINT/PLASTER 3 PER INCH SR315

Facility

$13.00

Hospital Charge Code	2819419
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

SPLINT/PLASTER 3 PER INCH SR315

Facility

$13.00

Hospital Charge Code	2819419
Hospital Revenue Code	271
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

SPLINT/PLASTER 4 PER INCH SR415

Facility

$15.00

Hospital Charge Code	2819418
Hospital Revenue Code	271
Rate for Payer: Cash Price	$13.50

SPLINT/PLASTER 4 PER INCH SR415

Facility

$15.00

Hospital Charge Code	2819418
Hospital Revenue Code	271
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

SPLINT/PLASTIC 2 FT

Facility

$58.00

Hospital Charge Code	2819420
Hospital Revenue Code	271
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

SPLINT/PLASTIC 2 FT

Facility

$58.00

Hospital Charge Code	2819420
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

SPLINT/PLASTIC 6, FT

Facility

$102.00

Hospital Charge Code	2819421
Hospital Revenue Code	271
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$72.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$60.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.83
Rate for Payer: Cash Price	$91.80
Rate for Payer: UnitedHealthcare Commercial	$68.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.72

SPLINT/PLASTIC 6, FT

Facility

$102.00

Hospital Charge Code	2819421
Hospital Revenue Code	271
Rate for Payer: Cash Price	$91.80

SPLINT SCOTCHCAST 3 X12

Facility

$24.00

Hospital Charge Code	2819434
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

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All Charges