Madison Medical Center

All Charges

Charge

Type

Setting

Price

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC

Facility

$18,578.72

Service Code	MSDRG 537
Min. Negotiated Rate	$9,289.36
Max. Negotiated Rate	$18,578.72
Rate for Payer: Aetna Medicare Advantage	$9,289.36
Rate for Payer: Cigna Commercial HMO & PPO	$9,289.36
Rate for Payer: Home State Health Plan Medicare Advantage	$9,289.36
Rate for Payer: Humana Commercial	$18,578.72
Rate for Payer: Humana Medicare Advantage	$9,289.36

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC

Facility

$14,917.90

Service Code	MSDRG 538
Min. Negotiated Rate	$7,458.95
Max. Negotiated Rate	$14,917.90
Rate for Payer: Aetna Medicare Advantage	$7,458.95
Rate for Payer: Cigna Commercial HMO & PPO	$7,458.95
Rate for Payer: Home State Health Plan Medicare Advantage	$7,458.95
Rate for Payer: Humana Commercial	$14,917.90
Rate for Payer: Humana Medicare Advantage	$7,458.95

SPRITE SODA (ALL) EA. CAN

Facility

$13.00

Hospital Charge Code	2819485
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

SPRITE SODA (ALL) EA. CAN

Facility

$13.00

Hospital Charge Code	2819485
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

SP SEMI-PRIVATE S

Facility

$800.00

Hospital Charge Code	30000005
Hospital Revenue Code	120
Min. Negotiated Rate	$742.00
Max. Negotiated Rate	$1,754.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$742.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$742.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: UnitedHealthcare Commercial	$1,519.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,754.00

SP SEMI-PRIVATE S

Facility

$800.00

Hospital Charge Code	30000005
Hospital Revenue Code	110
Min. Negotiated Rate	$185.00
Max. Negotiated Rate	$1,754.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$185.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: UnitedHealthcare Commercial	$1,519.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,754.00

SPUTUM INDUCTION

Facility

$168.00

Service Code	CPT 94640
Hospital Charge Code	4500360
Hospital Revenue Code	460
Min. Negotiated Rate	$60.48
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$99.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$119.95
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$112.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.48

SPUTUM INDUCTION

Facility

$168.00

Service Code	CPT 94640
Hospital Charge Code	4500360
Hospital Revenue Code	460
Rate for Payer: Cash Price	$151.20

.SSA-60 ENA ANTIBODY

Facility

$113.00

Service Code	CPT 86235
Hospital Charge Code	2286240
Hospital Revenue Code	302
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$80.68
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	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
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	$40.68

.SSA-60 ENA ANTIBODY

Facility

$113.00

Service Code	CPT 86235
Hospital Charge Code	2286240
Hospital Revenue Code	302
Rate for Payer: Cash Price	$101.70

SSA ANTIBODY

Facility

$113.00

Service Code	CPT 86235
Hospital Charge Code	2286236
Hospital Revenue Code	302
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$80.68
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	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
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	$40.68

SSA ANTIBODY

Facility

$113.00

Service Code	CPT 86235
Hospital Charge Code	2286236
Hospital Revenue Code	302
Rate for Payer: Cash Price	$101.70

SSB ANTIBODY

Facility

$113.00

Service Code	CPT 86235
Hospital Charge Code	2286237
Hospital Revenue Code	302
Rate for Payer: Cash Price	$101.70

SSB ANTIBODY

Facility

$113.00

Service Code	CPT 86235
Hospital Charge Code	2286237
Hospital Revenue Code	302
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$80.68
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	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
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	$40.68

STAPLER, 3M SKIN DS-5

Facility

$43.00

Hospital Charge Code	288032
Hospital Revenue Code	271
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

STAPLER, 3M SKIN DS-5

Facility

$43.00

Hospital Charge Code	288032
Hospital Revenue Code	271
Rate for Payer: Cash Price	$38.70

STATLOCK PICC DEVICE

Facility

$28.00

Hospital Charge Code	280222
Hospital Revenue Code	271
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

STATLOCK PICC DEVICE

Facility

$28.00

Hospital Charge Code	280222
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

STAT-PADZ (DEFIBRILLATOR)

Facility

$168.00

Hospital Charge Code	288033
Hospital Revenue Code	271
Min. Negotiated Rate	$60.48
Max. Negotiated Rate	$119.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$99.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$119.95
Rate for Payer: Cash Price	$151.20
Rate for Payer: UnitedHealthcare Commercial	$112.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.48

STAT-PADZ (DEFIBRILLATOR)

Facility

$168.00

Hospital Charge Code	288033
Hospital Revenue Code	271
Rate for Payer: Cash Price	$151.20

ST DISCHARGE ATTENTION FUNCTIONAL

Facility

$4.00

Hospital Charge Code	479167
Hospital Revenue Code	441
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

ST DISCHARGE ATTENTION FUNCTIONAL

Facility

$4.00

Hospital Charge Code	479167
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST DISCHARGE MEMORY FUNCTIONAL

Facility

$4.00

Hospital Charge Code	479170
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST DISCHARGE MEMORY FUNCTIONAL

Facility

$4.00

Hospital Charge Code	479170
Hospital Revenue Code	441
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

ST DISCHARGE MOTOR SPEECH FUNTIONAL

Facility

$4.00

Hospital Charge Code	479158
Hospital Revenue Code	441
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

Know your out-of-pocket cost for care.

All Charges