Madison Medical Center

All Charges

Charge

Type

Setting

Price

SUTURE OF SMALL INTESTINE FOR PERFORATIO

Professional

Both

$2,923.00

Service Code	CPT 44603
Hospital Charge Code	4144603
Hospital Revenue Code	975
Min. Negotiated Rate	$1,023.05
Max. Negotiated Rate	$1,430.98
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,430.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$1,218.14
Rate for Payer: Cash Price	$2,630.70
Rate for Payer: Cash Price	$2,630.70
Rate for Payer: Cigna Commercial HMO & PPO	$1,430.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,218.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,339.95
Rate for Payer: Home State Health Plan Medicare Advantage	$1,430.98
Rate for Payer: Optum Medicare Advantage	$1,023.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,218.14

SUTURE, O SILK A306H

Facility

$22.00

Hospital Charge Code	2818058
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, O SILK A306H

Facility

$22.00

Hospital Charge Code	2818058
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

SUTURE, O SILK FSL #678G

Facility

$24.00

Hospital Charge Code	2819058
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

SUTURE, O SILK FSL #678G

Facility

$24.00

Hospital Charge Code	2819058
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

SUTURE, O VICRYL J334H

Facility

$24.00

Hospital Charge Code	2829073
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

SUTURE, O VICRYL J334H

Facility

$24.00

Hospital Charge Code	2829073
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

SUTURE, PDS II, 0 TP-1, #Z991G

Facility

$32.00

Hospital Charge Code	2819053
Hospital Revenue Code	271
Rate for Payer: Cash Price	$28.80

SUTURE, PDS II, 0 TP-1, #Z991G

Facility

$32.00

Hospital Charge Code	2819053
Hospital Revenue Code	271
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

SUTURE, PDS II, 1 CT-1, #Z347H

Facility

$16.00

Hospital Charge Code	2819054
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

SUTURE, PDS II, 1 CT-1, #Z347H

Facility

$16.00

Hospital Charge Code	2819054
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

SUTURE, PROLENE 2-0 CT-2, #8411H

Facility

$15.00

Hospital Charge Code	2819055
Hospital Revenue Code	271
Rate for Payer: Cash Price	$13.50

SUTURE, PROLENE 2-0 CT-2, #8411H

Facility

$15.00

Hospital Charge Code	2819055
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

SUTURE, PROLENE 2-0 SH, #8833H

Facility

$16.00

Hospital Charge Code	2819056
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

SUTURE, PROLENE 2-0 SH, #8833H

Facility

$16.00

Hospital Charge Code	2819056
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

SUTURE PROLENE 4.0, P3--8699G

Facility

$43.00

Hospital Charge Code	2819037
Hospital Revenue Code	272
Rate for Payer: Cash Price	$38.70

SUTURE PROLENE 4.0, P3--8699G

Facility

$43.00

Hospital Charge Code	2819037
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, PROLENE 4-0 PS2 8682G

Facility

$24.00

Hospital Charge Code	2819067
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

SUTURE, PROLENE 4-0 PS2 8682G

Facility

$24.00

Hospital Charge Code	2819067
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

SUTURE, PROLENE 4-0 RB-1, #8871H

Facility

$16.00

Hospital Charge Code	2819057
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

SUTURE, PROLENE 4-0 RB-1, #8871H

Facility

$16.00

Hospital Charge Code	2819057
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

SUTURE PROLENE 5.0, P3--8698G

Facility

$43.00

Hospital Charge Code	2819077
Hospital Revenue Code	272
Rate for Payer: Cash Price	$38.70

SUTURE PROLENE 5.0, P3--8698G

Facility

$43.00

Hospital Charge Code	2819077
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 REMOVAL SET

Facility

$58.00

Hospital Charge Code	2819807
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

SUTURE REMOVAL SET

Facility

$58.00

Hospital Charge Code	2819807
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

Know your out-of-pocket cost for care.

All Charges