Madison Medical Center

All Charges

Charge

Type

Setting

Price

SYRINGE 10CC

Facility

$20.00

Hospital Charge Code	2824444
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

SYRINGE 10CC

Facility

$20.00

Hospital Charge Code	2824444
Hospital Revenue Code	272
Rate for Payer: Cash Price	$18.00

SYRINGE 20CC

Facility

$20.00

Hospital Charge Code	80000339
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

SYRINGE 20CC

Facility

$20.00

Hospital Charge Code	80000339
Hospital Revenue Code	272
Rate for Payer: Cash Price	$18.00

SYRINGE 3CC

Facility

$20.00

Hospital Charge Code	80000341
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

SYRINGE 3CC

Facility

$20.00

Hospital Charge Code	80000341
Hospital Revenue Code	272
Rate for Payer: Cash Price	$18.00

SYRINGE 3CC W/ 22G 1-1/2 NEEDLE

Facility

$20.00

Hospital Charge Code	2819009
Hospital Revenue Code	272
Rate for Payer: Cash Price	$18.00

SYRINGE 3CC W/ 22G 1-1/2 NEEDLE

Facility

$20.00

Hospital Charge Code	2819009
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

SYRINGE 3CC W/ 22G 1-1/2 NEEDLE

Facility

$20.00

Hospital Charge Code	2698384
Hospital Revenue Code	272
Rate for Payer: Cash Price	$18.00

SYRINGE 3CC W/ 22G 1-1/2 NEEDLE

Facility

$20.00

Hospital Charge Code	2698384
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

SYRINGE 5CC

Facility

$20.00

Hospital Charge Code	80000338
Hospital Revenue Code	272
Rate for Payer: Cash Price	$18.00

SYRINGE 5CC

Facility

$20.00

Hospital Charge Code	80000338
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

SYRINGE 60CC

Facility

$20.00

Hospital Charge Code	80000340
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

SYRINGE 60CC

Facility

$20.00

Hospital Charge Code	80000340
Hospital Revenue Code	272
Rate for Payer: Cash Price	$18.00

SYRINGE 60CC W/CATHETER TIP

Facility

$21.00

Hospital Charge Code	283055
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

SYRINGE 60CC W/CATHETER TIP

Facility

$21.00

Hospital Charge Code	283055
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

SYRINGE ASCEPTO 3 OZ

Facility

$42.00

Hospital Charge Code	2819443
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

SYRINGE ASCEPTO 3 OZ

Facility

$42.00

Hospital Charge Code	2819443
Hospital Revenue Code	271
Rate for Payer: Cash Price	$37.80

SYRINGES-ALL SIZE EA

Facility

$16.00

Hospital Charge Code	2819911
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

SYRINGES-ALL SIZE EA

Facility

$16.00

Hospital Charge Code	2819911
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

SYRINGE TOOMEY 70CC

Facility

$28.00

Hospital Charge Code	2819912
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

SYRINGE TOOMEY 70CC

Facility

$28.00

Hospital Charge Code	2819912
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

T3 REVERSE

Facility

$107.00

Service Code	CPT 84482
Hospital Charge Code	2284482
Hospital Revenue Code	301
Min. Negotiated Rate	$14.18
Max. Negotiated Rate	$76.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.18
Rate for Payer: Aetna Medicare Advantage	$15.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cigna Commercial HMO & PPO	$15.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.17
Rate for Payer: Home State Health Plan Medicare Advantage	$15.76
Rate for Payer: Humana Commercial	$31.52
Rate for Payer: Humana Medicare Advantage	$15.76
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

T3 REVERSE

Facility

$107.00

Service Code	CPT 84482
Hospital Charge Code	2284482
Hospital Revenue Code	301
Rate for Payer: Cash Price	$96.30

T3 TOTAL

Facility

$113.00

Service Code	CPT 84480
Hospital Charge Code	2284480
Hospital Revenue Code	301
Rate for Payer: Cash Price	$101.70

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All Charges