Madison Medical Center

All Charges

Charge

Type

Setting

Price

WOUND VAC PUMP <50CM

Facility

$321.00

Service Code	CPT 97605
Hospital Charge Code	2897605
Hospital Revenue Code	272
Min. Negotiated Rate	$115.56
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	$190.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$229.19
Rate for Payer: Cash Price	$288.90
Rate for Payer: Cash Price	$288.90
Rate for Payer: Cash Price	$288.90
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$180.86
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	$214.11
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$115.56

WOUND VAC PUMP <50CM

Facility

$321.00

Service Code	CPT 97605
Hospital Charge Code	2897605
Hospital Revenue Code	272
Rate for Payer: Cash Price	$288.90

WOUND VAC PUMP >50CM

Facility

$321.00

Service Code	CPT 97606
Hospital Charge Code	2897606
Hospital Revenue Code	272
Rate for Payer: Cash Price	$288.90

WOUND VAC PUMP >50CM

Facility

$321.00

Service Code	CPT 97606
Hospital Charge Code	2897606
Hospital Revenue Code	272
Min. Negotiated Rate	$115.56
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	$190.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$229.19
Rate for Payer: Cash Price	$288.90
Rate for Payer: Cash Price	$288.90
Rate for Payer: Cash Price	$288.90
Rate for Payer: Cigna Commercial HMO & PPO	$415.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$366.45
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	$214.11
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$115.56

WRIST XRAY LT

Facility

$452.00

Service Code	CPT 73110
Hospital Charge Code	3223130
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$322.73
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	$267.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$322.73
Rate for Payer: Cash Price	$406.80
Rate for Payer: Cash Price	$406.80
Rate for Payer: Cash Price	$406.80
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	$162.72

WRIST XRAY LT

Facility

$452.00

Service Code	CPT 73110
Hospital Charge Code	3223130
Hospital Revenue Code	320
Rate for Payer: Cash Price	$406.80

WRIST XRAY RT

Facility

$452.00

Service Code	CPT 73110
Hospital Charge Code	3223129
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$322.73
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	$267.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$322.73
Rate for Payer: Cash Price	$406.80
Rate for Payer: Cash Price	$406.80
Rate for Payer: Cash Price	$406.80
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	$162.72

WRIST XRAY RT

Facility

$452.00

Service Code	CPT 73110
Hospital Charge Code	3223129
Hospital Revenue Code	320
Rate for Payer: Cash Price	$406.80

XEROFORM DRESSING

Facility

$39.00

Hospital Charge Code	2824220
Hospital Revenue Code	271
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

XEROFORM DRESSING

Facility

$39.00

Hospital Charge Code	2824220
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

XL TROCAR

Facility

$648.00

Hospital Charge Code	1269129
Hospital Revenue Code	272
Rate for Payer: Cash Price	$583.20

XL TROCAR

Facility

$648.00

Hospital Charge Code	1269129
Hospital Revenue Code	272
Min. Negotiated Rate	$233.28
Max. Negotiated Rate	$462.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$383.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$462.67
Rate for Payer: Cash Price	$583.20
Rate for Payer: UnitedHealthcare Commercial	$432.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$233.28

XOPENEX HFA MPI 200 DOSE INH EMP

Facility

$142.00

Service Code	NDC 6.3402E+10
Hospital Charge Code	2623576
Hospital Revenue Code	250
Min. Negotiated Rate	$51.12
Max. Negotiated Rate	$101.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$84.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$101.39
Rate for Payer: Cash Price	$127.80
Rate for Payer: UnitedHealthcare Commercial	$94.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.12

XOPENEX HFA MPI 200 DOSE INH EMP

Facility

$142.00

Service Code	NDC 6.3402E+10
Hospital Charge Code	2623576
Hospital Revenue Code	250
Rate for Payer: Cash Price	$127.80

X-PRESS SINUS BALLOON

Facility

$3,215.00

Hospital Charge Code	125111
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,893.50

X-PRESS SINUS BALLOON

Facility

$3,215.00

Hospital Charge Code	125111
Hospital Revenue Code	272
Min. Negotiated Rate	$1,157.40
Max. Negotiated Rate	$2,295.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,903.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,295.51
Rate for Payer: Cash Price	$2,893.50
Rate for Payer: UnitedHealthcare Commercial	$2,144.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,157.40

X-RAY COPIES

Facility

$7.00

Hospital Charge Code	321138
Hospital Revenue Code	320
Rate for Payer: Cash Price	$6.30

X-RAY COPIES

Facility

$7.00

Hospital Charge Code	321138
Hospital Revenue Code	320
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$175.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.00
Rate for Payer: Cash Price	$6.30
Rate for Payer: Cash Price	$6.30
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.52

XRAY FINGER PROF COMPONENT 3 VIEWS

Facility

$45.00

Service Code	CPT 73130
Hospital Charge Code	9873130
Hospital Revenue Code	521
Rate for Payer: Cash Price	$40.50

XRAY FINGER PROF COMPONENT 3 VIEWS

Facility

$45.00

Service Code	CPT 73130
Hospital Charge Code	9873130
Hospital Revenue Code	521
Min. Negotiated Rate	$26.64
Max. Negotiated Rate	$177.82
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	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$70.61
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	$30.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

X-RAY SPONGE

Facility

$42.00

Hospital Charge Code	1224440
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

X-RAY SPONGE

Facility

$42.00

Hospital Charge Code	1224440
Hospital Revenue Code	271
Rate for Payer: Cash Price	$37.80

XYLOCAINE4TOP 5-18-99

Facility

$30.00

Service Code	NDC 54350547
Hospital Charge Code	2655426
Hospital Revenue Code	250
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$21.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: UnitedHealthcare Commercial	$20.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

XYLOCAINE4TOP 5-18-99

Facility

$30.00

Service Code	NDC 54350547
Hospital Charge Code	2655426
Hospital Revenue Code	250
Rate for Payer: Cash Price	$27.00

Y BLOOD TUBING

Facility

$58.00

Hospital Charge Code	2858110
Hospital Revenue Code	250
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

Know your out-of-pocket cost for care.

All Charges