Madison Medical Center

All Charges

Charge

Type

Setting

Price

SUCCINYLCHOLINE 200MG/10ML INJ MDV

Facility

$133.00

Service Code	HCPCS J0330
Hospital Charge Code	2626334
Hospital Revenue Code	250
Min. Negotiated Rate	$47.88
Max. Negotiated Rate	$94.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$78.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$94.96
Rate for Payer: Cash Price	$119.70
Rate for Payer: UnitedHealthcare Commercial	$88.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.88

SUCCINYLCHOLINE FLO PAC

Facility

$91.00

Hospital Charge Code	201017
Hospital Revenue Code	370
Rate for Payer: Cash Price	$81.90

SUCCINYLCHOLINE FLO PAC

Facility

$91.00

Hospital Charge Code	201017
Hospital Revenue Code	370
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$64.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: UnitedHealthcare Commercial	$60.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

SUCCINYLCHOLINE INJ

Facility

$75.00

Service Code	CPT J0330
Hospital Charge Code	201100
Hospital Revenue Code	370
Rate for Payer: Cash Price	$67.50

SUCCINYLCHOLINE INJ

Facility

$75.00

Service Code	CPT J0330
Hospital Charge Code	201100
Hospital Revenue Code	370
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

SUCRALFATE 1GM TAB EMP

Facility

$21.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2621993
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

SUCRALFATE 1GM TAB EMP

Facility

$21.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2621993
Hospital Revenue Code	250
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

SUCRALFATE (CARAFATE) 1GM/10ML SUSP

Facility

$51.00

Service Code	NDC 121074710
Hospital Charge Code	2626617
Hospital Revenue Code	250
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$36.41
Rate for Payer: Cash Price	$45.90
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: UnitedHealthcare Commercial	$34.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.36

SUCRALFATE (CARAFATE) 1GM/10ML SUSP

Facility

$51.00

Service Code	NDC 121074710
Hospital Charge Code	2626617
Hospital Revenue Code	250
Rate for Payer: Cash Price	$45.90

SUCRALFATE (CARAFATE) 1GM TAB

Facility

$21.00

Service Code	NDC 2.9033E+10
Hospital Charge Code	2656230
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

SUCRALFATE (CARAFATE) 1GM TAB

Facility

$21.00

Service Code	NDC 2.9033E+10
Hospital Charge Code	2656230
Hospital Revenue Code	250
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

SUCT CATH MUCUS TRAP

Facility

$22.00

Hospital Charge Code	2819742
Hospital Revenue Code	271
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

SUCT CATH MUCUS TRAP

Facility

$22.00

Hospital Charge Code	2819742
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

SUCTION

Facility

$152.00

Service Code	CPT 94664
Hospital Charge Code	4500365
Hospital Revenue Code	412
Rate for Payer: Cash Price	$136.80

SUCTION

Facility

$152.00

Service Code	CPT 94664
Hospital Charge Code	4500365
Hospital Revenue Code	412
Min. Negotiated Rate	$54.72
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	$89.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$108.53
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
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	$101.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.72

SUCTION CANNISTER

Facility

$63.00

Hospital Charge Code	2819396
Hospital Revenue Code	271
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

SUCTION CANNISTER

Facility

$63.00

Hospital Charge Code	2819396
Hospital Revenue Code	271
Rate for Payer: Cash Price	$56.70

SUCTION CATH 18 FR

Facility

$28.00

Hospital Charge Code	2819393
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

SUCTION CATH 18 FR

Facility

$28.00

Hospital Charge Code	2819393
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

SUCTION CATH 6FR.

Facility

$22.00

Hospital Charge Code	2819386
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

SUCTION CATH 6FR.

Facility

$22.00

Hospital Charge Code	2819386
Hospital Revenue Code	271
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

SUCTION CATHAETER

Facility

$44.00

Hospital Charge Code	2819388
Hospital Revenue Code	270
Rate for Payer: Cash Price	$39.60

SUCTION CATHAETER

Facility

$44.00

Hospital Charge Code	2819388
Hospital Revenue Code	270
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

SUCTION COAGULATOR 10FR

Facility

$58.00

Hospital Charge Code	1251110
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

SUCTION COAGULATOR 10FR

Facility

$58.00

Hospital Charge Code	1251110
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

Know your out-of-pocket cost for care.

All Charges