Madison Medical Center

All Charges

Charge

Type

Setting

Price

ST GOAL SPOKEN LANGUAGE FUNCTIONAL LIM

Facility

$4.00

Hospital Charge Code	479160
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 GOAL SWALLOWING FUNCTIONAL LIM

Facility

$4.00

Hospital Charge Code	478997
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 GOAL SWALLOWING FUNCTIONAL LIM

Facility

$4.00

Hospital Charge Code	478997
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST GOAL VOICE FUNCTIONAL LIMITATION

Facility

$4.00

Hospital Charge Code	479172
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST GOAL VOICE FUNCTIONAL LIMITATION

Facility

$4.00

Hospital Charge Code	479172
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 INITAIL VOICE FUNCTIONAL LIMIT

Facility

$4.00

Hospital Charge Code	479171
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 INITAIL VOICE FUNCTIONAL LIMIT

Facility

$4.00

Hospital Charge Code	479171
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST INITIAL ATTENTION FUNCTIONAL LIM

Facility

$4.00

Hospital Charge Code	479165
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 INITIAL ATTENTION FUNCTIONAL LIM

Facility

$4.00

Hospital Charge Code	479165
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST INITIAL MEMORY FUNCTIONAL LIM

Facility

$4.00

Hospital Charge Code	479168
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST INITIAL MEMORY FUNCTIONAL LIM

Facility

$4.00

Hospital Charge Code	479168
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 INITIAL MOTOR SPEECH FUNCTIONAL LIM

Facility

$4.00

Hospital Charge Code	478999
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST INITIAL MOTOR SPEECH FUNCTIONAL LIM

Facility

$4.00

Hospital Charge Code	478999
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 INITIAL OTHER SPEECH LANGUAGE PATH

Facility

$4.00

Hospital Charge Code	479174
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 INITIAL OTHER SPEECH LANGUAGE PATH

Facility

$4.00

Hospital Charge Code	479174
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST INITIAL SPOKEN LANGUAGE COMP

Facility

$4.00

Hospital Charge Code	479159
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 INITIAL SPOKEN LANGUAGE COMP

Facility

$4.00

Hospital Charge Code	479159
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST INITIAL SPOKEN LANGUAGE EXP

Facility

$4.00

Hospital Charge Code	479162
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST INITIAL SPOKEN LANGUAGE EXP

Facility

$4.00

Hospital Charge Code	479162
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

STIOLTO RESPIMAT INH 60 DOSE EMP

Facility

$367.00

Service Code	NDC 597015561
Hospital Charge Code	2624470
Hospital Revenue Code	250
Min. Negotiated Rate	$132.12
Max. Negotiated Rate	$262.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$217.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$262.04
Rate for Payer: Cash Price	$330.30
Rate for Payer: UnitedHealthcare Commercial	$244.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$132.12

STIOLTO RESPIMAT INH 60 DOSE EMP

Facility

$367.00

Service Code	NDC 597015561
Hospital Charge Code	2624470
Hospital Revenue Code	250
Rate for Payer: Cash Price	$330.30

STOCKINET 4X60--(SURG)

Facility

$22.00

Hospital Charge Code	2819454
Hospital Revenue Code	272
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

STOCKINET 4X60--(SURG)

Facility

$22.00

Hospital Charge Code	2819454
Hospital Revenue Code	272
Rate for Payer: Cash Price	$19.80

STOCKINET 6

Facility

$21.00

Hospital Charge Code	2819450
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

STOCKINET 6

Facility

$21.00

Hospital Charge Code	2819450
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

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