Madison Medical Center

All Charges

Charge

Type

Setting

Price

2.7X16mm BONE SCREW

Facility

$452.00

Hospital Charge Code	123322
Hospital Revenue Code	271
Rate for Payer: Cash Price	$406.80

2.7x20mm BONE SCREW

Facility

$452.00

Hospital Charge Code	123318
Hospital Revenue Code	271
Min. Negotiated Rate	$162.72
Max. Negotiated Rate	$322.73
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: UnitedHealthcare Commercial	$301.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$162.72

2.7x20mm BONE SCREW

Facility

$452.00

Hospital Charge Code	123318
Hospital Revenue Code	271
Rate for Payer: Cash Price	$406.80

2D ECHO READING ONLY

Facility

$400.00

Service Code	CPT 93306
Hospital Charge Code	9693306
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,116.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$492.57
Rate for Payer: Aetna Medicare Advantage	$558.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$236.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$285.60
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cigna Commercial HMO & PPO	$558.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$443.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$527.05
Rate for Payer: Home State Health Plan Medicare Advantage	$558.25
Rate for Payer: Humana Commercial	$1,116.50
Rate for Payer: Humana Medicare Advantage	$558.25
Rate for Payer: UnitedHealthcare Commercial	$266.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$492.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

2D ECHO READING ONLY

Facility

$400.00

Service Code	CPT 93306
Hospital Charge Code	9693306
Hospital Revenue Code	521
Rate for Payer: Cash Price	$360.00

(2) MISSED ABORTION D&C

Facility

$813.00

Service Code	CPT 59821
Hospital Charge Code	4259821
Rate for Payer: Cash Price	$731.70

2 VIEW ANKLE LT

Facility

$418.00

Service Code	CPT 73600
Hospital Charge Code	3273601
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$298.45
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	$247.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$298.45
Rate for Payer: Cash Price	$376.20
Rate for Payer: Cash Price	$376.20
Rate for Payer: Cash Price	$376.20
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	$150.48

2 VIEW ANKLE LT

Facility

$418.00

Service Code	CPT 73600
Hospital Charge Code	3273601
Hospital Revenue Code	320
Rate for Payer: Cash Price	$376.20

2 VIEW ANKLE RT

Facility

$418.00

Service Code	CPT 73600
Hospital Charge Code	3273600
Hospital Revenue Code	320
Rate for Payer: Cash Price	$376.20

2 VIEW ANKLE RT

Facility

$418.00

Service Code	CPT 73600
Hospital Charge Code	3273600
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$298.45
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	$247.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$298.45
Rate for Payer: Cash Price	$376.20
Rate for Payer: Cash Price	$376.20
Rate for Payer: Cash Price	$376.20
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	$150.48

2 VIEW FOOT LT

Facility

$417.00

Service Code	CPT 73620
Hospital Charge Code	3273621
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$297.74
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	$246.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$297.74
Rate for Payer: Cash Price	$375.30
Rate for Payer: Cash Price	$375.30
Rate for Payer: Cash Price	$375.30
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	$150.12

2 VIEW FOOT LT

Facility

$417.00

Service Code	CPT 73620
Hospital Charge Code	3273621
Hospital Revenue Code	320
Rate for Payer: Cash Price	$375.30

2 VIEW FOOT RT

Facility

$417.00

Service Code	CPT 73620
Hospital Charge Code	3273620
Hospital Revenue Code	320
Rate for Payer: Cash Price	$375.30

2 VIEW FOOT RT

Facility

$417.00

Service Code	CPT 73620
Hospital Charge Code	3273620
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$297.74
Rate for Payer: Humana Commercial	$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	$246.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$297.74
Rate for Payer: Cash Price	$375.30
Rate for Payer: Cash Price	$375.30
Rate for Payer: Cash Price	$375.30
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 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	$150.12

2 VIEW HAND LT

Facility

$449.00

Service Code	CPT 73120
Hospital Charge Code	3273121
Hospital Revenue Code	320
Rate for Payer: Cash Price	$404.10

2 VIEW HAND LT

Facility

$449.00

Service Code	CPT 73120
Hospital Charge Code	3273121
Hospital Revenue Code	320
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$320.59
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$265.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$320.59
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$161.64

2 VIEW HAND RT

Facility

$449.00

Service Code	CPT 73120
Hospital Charge Code	3273120
Hospital Revenue Code	320
Rate for Payer: Cash Price	$404.10

2 VIEW HAND RT

Facility

$449.00

Service Code	CPT 73120
Hospital Charge Code	3273120
Hospital Revenue Code	320
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$320.59
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$265.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$320.59
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$161.64

3.0MM ENDO TUBE--UNCUFFED

Facility

$178.00

Hospital Charge Code	285812
Hospital Revenue Code	270
Min. Negotiated Rate	$64.08
Max. Negotiated Rate	$127.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: UnitedHealthcare Commercial	$118.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

3.0MM ENDO TUBE--UNCUFFED

Facility

$178.00

Hospital Charge Code	285812
Hospital Revenue Code	270
Rate for Payer: Cash Price	$160.20

3.0MM INSTRUMENT KIT (STERILE)

Facility

$1,485.00

Hospital Charge Code	123390
Hospital Revenue Code	271
Min. Negotiated Rate	$534.60
Max. Negotiated Rate	$1,060.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$879.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,060.29
Rate for Payer: Cash Price	$1,336.50
Rate for Payer: UnitedHealthcare Commercial	$990.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$534.60

3.0MM INSTRUMENT KIT (STERILE)

Facility

$1,485.00

Hospital Charge Code	123390
Hospital Revenue Code	271
Rate for Payer: Cash Price	$1,336.50

3.5MM ENDO TUBE--UNCUFFED

Facility

$178.00

Hospital Charge Code	285813
Hospital Revenue Code	270
Rate for Payer: Cash Price	$160.20

3.5MM ENDO TUBE--UNCUFFED

Facility

$178.00

Hospital Charge Code	285813
Hospital Revenue Code	270
Min. Negotiated Rate	$64.08
Max. Negotiated Rate	$127.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: UnitedHealthcare Commercial	$118.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

3D TOMO DIAG

Facility

$42.00

Service Code	CPT G0279
Hospital Charge Code	377766
Hospital Revenue Code	401
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$111.00
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: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$111.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

Know your out-of-pocket cost for care.

All Charges