Madison Medical Center

All Charges

Charge

Type

Setting

Price

SUCTION CURETTE

Facility

$58.00

Hospital Charge Code	2819360
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

SUCTION CURETTE

Facility

$58.00

Hospital Charge Code	2819360
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

SUCTION,HEYER SCHULTEE

Facility

$129.00

Hospital Charge Code	287858
Hospital Revenue Code	271
Rate for Payer: Cash Price	$116.10

SUCTION,HEYER SCHULTEE

Facility

$129.00

Hospital Charge Code	287858
Hospital Revenue Code	271
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

SUCTION KIT 14FR

Facility

$44.00

Hospital Charge Code	2819392
Hospital Revenue Code	272
Rate for Payer: Cash Price	$39.60

SUCTION KIT 14FR

Facility

$44.00

Hospital Charge Code	2819392
Hospital Revenue Code	272
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 MACHINE PER DAY

Facility

$208.00

Hospital Charge Code	2819802
Hospital Revenue Code	271
Rate for Payer: Cash Price	$187.20

SUCTION MACHINE PER DAY

Facility

$208.00

Hospital Charge Code	2819802
Hospital Revenue Code	271
Min. Negotiated Rate	$74.88
Max. Negotiated Rate	$148.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$123.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$148.51
Rate for Payer: Cash Price	$187.20
Rate for Payer: UnitedHealthcare Commercial	$138.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$74.88

SUCTION PROBE

Facility

$294.00

Hospital Charge Code	1211921
Hospital Revenue Code	271
Min. Negotiated Rate	$105.84
Max. Negotiated Rate	$209.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$174.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$209.92
Rate for Payer: Cash Price	$264.60
Rate for Payer: UnitedHealthcare Commercial	$196.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$105.84

SUCTION PROBE

Facility

$352.00

Hospital Charge Code	121192
Hospital Revenue Code	271
Rate for Payer: Cash Price	$316.80

SUCTION PROBE

Facility

$352.00

Hospital Charge Code	121192
Hospital Revenue Code	271
Min. Negotiated Rate	$126.72
Max. Negotiated Rate	$251.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$208.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$251.33
Rate for Payer: Cash Price	$316.80
Rate for Payer: UnitedHealthcare Commercial	$234.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$126.72

SUCTION PROBE

Facility

$294.00

Hospital Charge Code	1211921
Hospital Revenue Code	271
Rate for Payer: Cash Price	$264.60

SUCTION TUBING

Facility

$58.00

Hospital Charge Code	1820723
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

SUCTION TUBING

Facility

$58.00

Hospital Charge Code	1220723
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

SUCTION TUBING

Facility

$58.00

Hospital Charge Code	1220723
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

SUCTION TUBING

Facility

$58.00

Hospital Charge Code	1820723
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

SUCTION WOUND

Facility

$251.00

Hospital Charge Code	2819061
Hospital Revenue Code	271
Min. Negotiated Rate	$90.36
Max. Negotiated Rate	$179.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$179.21
Rate for Payer: Cash Price	$225.90
Rate for Payer: UnitedHealthcare Commercial	$167.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.36

SUCTION WOUND

Facility

$251.00

Hospital Charge Code	2819061
Hospital Revenue Code	271
Rate for Payer: Cash Price	$225.90

SUCTION YAN KAUER SET #8888505016

Facility

$39.00

Hospital Charge Code	2819394
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

SUCTION YAN KAUER SET #8888505016

Facility

$39.00

Hospital Charge Code	2819394
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

SUDOGEST 30MG TAB EMP

Facility

$10.00

Service Code	NDC 904505359
Hospital Charge Code	2622902
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$7.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.14
Rate for Payer: Cash Price	$9.00
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.60

SUDOGEST 30MG TAB EMP

Facility

$10.00

Service Code	NDC 904505359
Hospital Charge Code	2622902
Hospital Revenue Code	250
Rate for Payer: Cash Price	$9.00

SUFENTA INJ

Facility

$234.00

Hospital Charge Code	2058062
Hospital Revenue Code	370
Rate for Payer: Cash Price	$210.60

SUFENTA INJ

Facility

$234.00

Hospital Charge Code	2058062
Hospital Revenue Code	370
Min. Negotiated Rate	$84.24
Max. Negotiated Rate	$167.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$138.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.08
Rate for Payer: Cash Price	$210.60
Rate for Payer: UnitedHealthcare Commercial	$156.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.24

SULFACETAMIDE 10% OP SOL 15ML

Facility

$196.00

Service Code	NDC 2.4208E+10
Hospital Charge Code	2626289
Hospital Revenue Code	250
Rate for Payer: Cash Price	$176.40

Know your out-of-pocket cost for care.

All Charges