Madison Medical Center

All Charges

Charge

Type

Setting

Price

SUTURE-ABDOM WALL, EVISCER OR DEHISCENCE

Professional

Both

$1,209.00

Service Code	CPT 49900
Hospital Charge Code	4149900
Hospital Revenue Code	975
Min. Negotiated Rate	$423.15
Max. Negotiated Rate	$756.99
Rate for Payer: Aetna Commercial/Medicare Advantage	$756.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$621.79
Rate for Payer: Cash Price	$1,088.10
Rate for Payer: Cash Price	$1,088.10
Rate for Payer: Cigna Commercial HMO & PPO	$756.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$621.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$683.97
Rate for Payer: Home State Health Plan Medicare Advantage	$756.99
Rate for Payer: Optum Medicare Advantage	$423.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$621.79

SUTURE, CHROMIC GUT 0, #L114G

Facility

$20.00

Hospital Charge Code	2819051
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

SUTURE, CHROMIC GUT 0, #L114G

Facility

$20.00

Hospital Charge Code	2819051
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

SUTURE, CHROMIC GUT P-3, #1654G

Facility

$35.00

Hospital Charge Code	2819059
Hospital Revenue Code	271
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

SUTURE, CHROMIC GUT P-3, #1654G

Facility

$35.00

Hospital Charge Code	2819059
Hospital Revenue Code	271
Rate for Payer: Cash Price	$31.50

SUTURE, ETHILON 3-0 BLK MONO PS-2 18

Facility

$22.00

Hospital Charge Code	2819081
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

SUTURE, ETHILON 3-0 BLK MONO PS-2 18

Facility

$22.00

Hospital Charge Code	2819081
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

SUTURE ETHILON 3.0, PS-1: 1663G

Facility

$20.00

Hospital Charge Code	2819038
Hospital Revenue Code	272
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

SUTURE ETHILON 3.0, PS-1: 1663G

Facility

$20.00

Hospital Charge Code	2819038
Hospital Revenue Code	272
Rate for Payer: Cash Price	$18.00

SUTURE, ETHILON 4-0 BLK MONO PS-2

Facility

$12.00

Hospital Charge Code	2819084
Hospital Revenue Code	271
Rate for Payer: Cash Price	$10.80

SUTURE, ETHILON 4-0 BLK MONO PS-2

Facility

$12.00

Hospital Charge Code	2819084
Hospital Revenue Code	271
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$8.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$8.57
Rate for Payer: Cash Price	$10.80
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.32

SUTURE ETHILON 4.0, FS2--662G

Facility

$43.00

Hospital Charge Code	2819036
Hospital Revenue Code	272
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

SUTURE ETHILON 4.0, FS2--662G

Facility

$43.00

Hospital Charge Code	2819036
Hospital Revenue Code	272
Rate for Payer: Cash Price	$38.70

SUTURE ETHILON 4.0, P3--699G

Facility

$43.00

Hospital Charge Code	2819035
Hospital Revenue Code	272
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

SUTURE ETHILON 4.0, P3--699G

Facility

$43.00

Hospital Charge Code	2819035
Hospital Revenue Code	272
Rate for Payer: Cash Price	$38.70

SUTURE ETHILON 5.0, FS-2: 661G

Facility

$13.00

Hospital Charge Code	2819040
Hospital Revenue Code	272
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

SUTURE ETHILON 5.0, FS-2: 661G

Facility

$13.00

Hospital Charge Code	2819040
Hospital Revenue Code	272
Rate for Payer: Cash Price	$11.70

SUTURE ETHILON 5.0, P3--698G

Facility

$43.00

Hospital Charge Code	2819022
Hospital Revenue Code	272
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

SUTURE ETHILON 5.0, P3--698G

Facility

$43.00

Hospital Charge Code	2819022
Hospital Revenue Code	272
Rate for Payer: Cash Price	$38.70

SUTURE ETHILON 5.0, PS-2: 1666G

Facility

$20.00

Hospital Charge Code	2819039
Hospital Revenue Code	272
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

SUTURE ETHILON 5.0, PS-2: 1666G

Facility

$20.00

Hospital Charge Code	2819039
Hospital Revenue Code	272
Rate for Payer: Cash Price	$18.00

SUTURE, ETHILON 6-0, PS-4

Facility

$21.00

Hospital Charge Code	2819069
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

SUTURE, ETHILON 6-0, PS-4

Facility

$21.00

Hospital Charge Code	2819069
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

SUTURE, MONOCRYL 4-0 #Y462H

Facility

$42.00

Hospital Charge Code	2819082
Hospital Revenue Code	271
Rate for Payer: Cash Price	$37.80

SUTURE, MONOCRYL 4-0 #Y462H

Facility

$42.00

Hospital Charge Code	2819082
Hospital Revenue Code	271
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

Know your out-of-pocket cost for care.

All Charges