Madison Medical Center

All Charges

Charge

Type

Setting

Price

WARMING BLANKET

Facility

$58.00

Hospital Charge Code	2024486
Hospital Revenue Code	370
Rate for Payer: Cash Price	$52.20

WART DESTRUCTION ANY METHOD

Facility

$115.00

Service Code	CPT 17110
Hospital Charge Code	98171100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$103.50

WART DESTRUCTION ANY METHOD

Facility

$115.00

Service Code	CPT 17110
Hospital Charge Code	98171100
Hospital Revenue Code	521
Min. Negotiated Rate	$68.08
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$68.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$82.11
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$76.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

WASHCLOTHS DISP.

Facility

$15.00

Hospital Charge Code	2823010
Hospital Revenue Code	271
Rate for Payer: Cash Price	$13.50

WASHCLOTHS DISP.

Facility

$15.00

Hospital Charge Code	2823010
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

WATER VIEW SINUSES

Facility

$302.00

Service Code	CPT 70210
Hospital Charge Code	3213999
Hospital Revenue Code	320
Rate for Payer: Cash Price	$271.80

WATER VIEW SINUSES

Facility

$302.00

Service Code	CPT 70210
Hospital Charge Code	3213999
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$215.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$178.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$215.63
Rate for Payer: Cash Price	$271.80
Rate for Payer: Cash Price	$271.80
Rate for Payer: Cash Price	$271.80
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.72

WEBRIL 2 IN

Facility

$16.00

Hospital Charge Code	2823333
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

WEBRIL 2 IN

Facility

$16.00

Hospital Charge Code	2823333
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

WEBRIL 3 IN

Facility

$21.00

Hospital Charge Code	2823334
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

WEBRIL 3 IN

Facility

$21.00

Hospital Charge Code	2823334
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

WEBRIL 4 IN

Facility

$21.00

Hospital Charge Code	2823335
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

WEBRIL 4 IN

Facility

$21.00

Hospital Charge Code	2823335
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

WEBRIL 6 IN

Facility

$28.00

Hospital Charge Code	2823336
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

WEBRIL 6 IN

Facility

$28.00

Hospital Charge Code	2823336
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

WECK CELLS

Facility

$21.00

Hospital Charge Code	1269065
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

WECK CELLS

Facility

$21.00

Hospital Charge Code	1269065
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

WEDGE EXCISION OF TOENAIL

Professional

Both

$66.00

Service Code	CPT 11720
Hospital Charge Code	4111720
Hospital Revenue Code	975
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$26.87
Rate for Payer: Aetna Commercial/Medicare Advantage	$12.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$24.43
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cigna Commercial HMO & PPO	$12.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26.87
Rate for Payer: Home State Health Plan Medicare Advantage	$12.48
Rate for Payer: Optum Medicare Advantage	$23.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24.43

WEDGE EXC NAIL BED

Facility

$250.00

Service Code	CPT 11765
Hospital Charge Code	9811765
Hospital Revenue Code	521
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$830.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$366.45
Rate for Payer: Aetna Medicare Advantage	$415.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial HMO & PPO	$415.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$329.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$392.10
Rate for Payer: Home State Health Plan Medicare Advantage	$415.32
Rate for Payer: Humana Commercial	$830.64
Rate for Payer: Humana Medicare Advantage	$415.32
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

WEDGE EXC NAIL BED

Facility

$250.00

Service Code	CPT 11765
Hospital Charge Code	9811765
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

WEGOVY 1.5MG TAB

Facility

$137.00

Service Code	NDC 1E+11
Hospital Charge Code	2627150
Hospital Revenue Code	250
Min. Negotiated Rate	$49.32
Max. Negotiated Rate	$97.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$81.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$97.82
Rate for Payer: Cash Price	$123.30
Rate for Payer: UnitedHealthcare Commercial	$91.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$49.32

WEGOVY 1.5MG TAB

Facility

$137.00

Service Code	NDC 1E+11
Hospital Charge Code	2627150
Hospital Revenue Code	250
Rate for Payer: Cash Price	$123.30

WEGOVY 25MG TAB

Facility

$137.00

Service Code	NDC 1E+11
Hospital Charge Code	2627153
Hospital Revenue Code	250
Rate for Payer: Cash Price	$123.30

WEGOVY 25MG TAB

Facility

$137.00

Service Code	NDC 1E+11
Hospital Charge Code	2627153
Hospital Revenue Code	250
Min. Negotiated Rate	$49.32
Max. Negotiated Rate	$97.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$81.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$97.82
Rate for Payer: Cash Price	$123.30
Rate for Payer: UnitedHealthcare Commercial	$91.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$49.32

WEGOVY 4MG TAB

Facility

$137.00

Service Code	NDC 1E+11
Hospital Charge Code	2627151
Hospital Revenue Code	250
Rate for Payer: Cash Price	$123.30

Know your out-of-pocket cost for care.

All Charges