Madison Medical Center

All Charges

Charge

Type

Setting

Price

SURGICEL

Facility

$448.00

Hospital Charge Code	1219809
Hospital Revenue Code	271
Rate for Payer: Cash Price	$403.20

SURGICEL 2 X 14

Facility

$448.00

Hospital Charge Code	2819809
Hospital Revenue Code	271
Rate for Payer: Cash Price	$403.20

SURGICEL 2 X 14

Facility

$448.00

Hospital Charge Code	2819809
Hospital Revenue Code	271
Min. Negotiated Rate	$161.28
Max. Negotiated Rate	$319.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$265.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$319.87
Rate for Payer: Cash Price	$403.20
Rate for Payer: UnitedHealthcare Commercial	$298.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$161.28

SURGI CLIP

Facility

$460.00

Hospital Charge Code	2819906
Hospital Revenue Code	271
Min. Negotiated Rate	$165.60
Max. Negotiated Rate	$328.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$272.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$328.44
Rate for Payer: Cash Price	$414.00
Rate for Payer: UnitedHealthcare Commercial	$306.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$165.60

SURGI CLIP

Facility

$460.00

Hospital Charge Code	2819906
Hospital Revenue Code	271
Rate for Payer: Cash Price	$414.00

SURGICLIP II #134053

Facility

$759.00

Hospital Charge Code	125353
Hospital Revenue Code	271
Rate for Payer: Cash Price	$683.10

SURGICLIP II #134053

Facility

$759.00

Hospital Charge Code	125353
Hospital Revenue Code	271
Min. Negotiated Rate	$273.24
Max. Negotiated Rate	$541.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$449.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$541.93
Rate for Payer: Cash Price	$683.10
Rate for Payer: UnitedHealthcare Commercial	$506.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$273.24

SURGI GRIP

Facility

$75.00

Hospital Charge Code	283853
Hospital Revenue Code	271
Rate for Payer: Cash Price	$67.50

SURGI GRIP

Facility

$75.00

Hospital Charge Code	283853
Hospital Revenue Code	271
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

SURGIGRIP 12MM

Facility

$70.00

Hospital Charge Code	2815362
Hospital Revenue Code	271
Rate for Payer: Cash Price	$63.00

SURGIGRIP 12MM

Facility

$70.00

Hospital Charge Code	2815362
Hospital Revenue Code	271
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$49.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

SURGITUBE TUBE GAUZE

Facility

$15.00

Hospital Charge Code	4070016
Hospital Revenue Code	271
Rate for Payer: Cash Price	$13.50

SURGITUBE TUBE GAUZE

Facility

$15.00

Hospital Charge Code	4070016
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

SURGITUBE TUBE GAUZE (SMALL BOXES)

Facility

$20.00

Hospital Charge Code	40205
Hospital Revenue Code	271
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

SURGITUBE TUBE GAUZE (SMALL BOXES)

Facility

$20.00

Hospital Charge Code	40205
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

SURGIWAND

Facility

$294.00

Hospital Charge Code	1219111
Hospital Revenue Code	271
Rate for Payer: Cash Price	$264.60

SURGIWAND

Facility

$294.00

Hospital Charge Code	1219111
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

SURG PATH COMP 88302

Facility

$174.00

Service Code	CPT 88302
Hospital Charge Code	2288305
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$124.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$33.67
Rate for Payer: Aetna Medicare Advantage	$38.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$103.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$124.24
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cigna Commercial HMO & PPO	$38.16
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$36.03
Rate for Payer: Home State Health Plan Medicare Advantage	$38.16
Rate for Payer: Humana Commercial	$76.32
Rate for Payer: Humana Medicare Advantage	$38.16
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.64

SURG PATH COMP 88302

Facility

$174.00

Service Code	CPT 88302
Hospital Charge Code	2288305
Hospital Revenue Code	305
Rate for Payer: Cash Price	$156.60

SURG PATH COMP 88305

Facility

$174.00

Service Code	CPT 88305
Hospital Charge Code	228800
Hospital Revenue Code	305
Rate for Payer: Cash Price	$156.60

SURG PATH COMP 88305

Facility

$174.00

Service Code	CPT 88305
Hospital Charge Code	228800
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$124.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$46.98
Rate for Payer: Aetna Medicare Advantage	$53.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$103.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$124.24
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cigna Commercial HMO & PPO	$53.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$46.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$50.27
Rate for Payer: Home State Health Plan Medicare Advantage	$53.24
Rate for Payer: Humana Commercial	$106.48
Rate for Payer: Humana Medicare Advantage	$53.24
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$46.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.64

SURG PATH IHC STAIN

Facility

$354.00

Service Code	CPT 88342
Hospital Charge Code	229303
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$348.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$153.58
Rate for Payer: Aetna Medicare Advantage	$174.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$209.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$252.76
Rate for Payer: Cash Price	$318.60
Rate for Payer: Cash Price	$318.60
Rate for Payer: Cash Price	$318.60
Rate for Payer: Cigna Commercial HMO & PPO	$174.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$153.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$164.33
Rate for Payer: Home State Health Plan Medicare Advantage	$174.06
Rate for Payer: Humana Commercial	$348.12
Rate for Payer: Humana Medicare Advantage	$174.06
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$153.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$127.44

SURG PATH IHC STAIN

Facility

$354.00

Service Code	CPT 88342
Hospital Charge Code	229303
Hospital Revenue Code	301
Rate for Payer: Cash Price	$318.60

SURG TECH COMP 88312

Facility

$189.00

Service Code	CPT 88312
Hospital Charge Code	228801
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$134.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$46.98
Rate for Payer: Aetna Medicare Advantage	$53.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$111.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$134.95
Rate for Payer: Cash Price	$170.10
Rate for Payer: Cash Price	$170.10
Rate for Payer: Cash Price	$170.10
Rate for Payer: Cigna Commercial HMO & PPO	$53.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$46.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$50.27
Rate for Payer: Home State Health Plan Medicare Advantage	$53.24
Rate for Payer: Humana Commercial	$106.48
Rate for Payer: Humana Medicare Advantage	$53.24
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$46.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.04

SURG TECH COMP 88312

Facility

$189.00

Service Code	CPT 88312
Hospital Charge Code	228801
Hospital Revenue Code	305
Rate for Payer: Cash Price	$170.10

Know your out-of-pocket cost for care.

All Charges