Madison Medical Center

All Charges

Charge

Type

Setting

Price

3D TOMO DIAG

Facility

$42.00

Service Code	CPT G0279
Hospital Charge Code	377766
Hospital Revenue Code	401
Rate for Payer: Cash Price	$37.80

3D TOMO SCREEN

Facility

$42.00

Service Code	CPT 77063
Hospital Charge Code	3777063
Hospital Revenue Code	403
Rate for Payer: Cash Price	$37.80

3D TOMO SCREEN

Facility

$42.00

Service Code	CPT 77063
Hospital Charge Code	3777063
Hospital Revenue Code	403
Min. Negotiated Rate	$24.86
Max. Negotiated Rate	$111.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$44.69
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: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$44.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$47.82
Rate for Payer: UnitedHealthcare Commercial	$111.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$44.69

3MMX 110MM APEX PINS

Facility

$389.00

Hospital Charge Code	127728
Hospital Revenue Code	271
Min. Negotiated Rate	$140.04
Max. Negotiated Rate	$277.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$230.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$277.75
Rate for Payer: Cash Price	$350.10
Rate for Payer: UnitedHealthcare Commercial	$259.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$140.04

3MMX 110MM APEX PINS

Facility

$389.00

Hospital Charge Code	127728
Hospital Revenue Code	271
Rate for Payer: Cash Price	$350.10

3S HEMI AWL

Facility

$285.00

Hospital Charge Code	123417
Hospital Revenue Code	271
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$203.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: UnitedHealthcare Commercial	$190.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$102.60

3S HEMI AWL

Facility

$285.00

Hospital Charge Code	123417
Hospital Revenue Code	271
Rate for Payer: Cash Price	$256.50

3S HEMI BROACH 5/M

Facility

$534.00

Hospital Charge Code	123223
Hospital Revenue Code	271
Min. Negotiated Rate	$192.24
Max. Negotiated Rate	$381.28
Rate for Payer: Cash Price	$480.60
Rate for Payer: UnitedHealthcare Commercial	$356.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$316.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$381.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$192.24

3S HEMI BROACH 5/M

Facility

$534.00

Hospital Charge Code	123223
Hospital Revenue Code	271
Rate for Payer: Cash Price	$480.60

3S HEMI TOE IMPLANT

Facility

$3,371.00

Hospital Charge Code	123444
Hospital Revenue Code	271
Min. Negotiated Rate	$1,213.56
Max. Negotiated Rate	$2,406.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,995.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,406.89
Rate for Payer: Cash Price	$3,033.90
Rate for Payer: UnitedHealthcare Commercial	$2,248.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,213.56

3S HEMI TOE IMPLANT

Facility

$3,371.00

Hospital Charge Code	123444
Hospital Revenue Code	271
Rate for Payer: Cash Price	$3,033.90

3 WAY STOP COCK TUBING

Facility

$87.00

Hospital Charge Code	2858114
Hospital Revenue Code	250
Min. Negotiated Rate	$31.32
Max. Negotiated Rate	$62.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$51.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.12
Rate for Payer: Cash Price	$78.30
Rate for Payer: UnitedHealthcare Commercial	$58.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.32

3 WAY STOP COCK TUBING

Facility

$87.00

Hospital Charge Code	2858114
Hospital Revenue Code	250
Rate for Payer: Cash Price	$78.30

3X8 TELFA PAD

Facility

$16.00

Hospital Charge Code	2820739
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

3X8 TELFA PAD

Facility

$16.00

Hospital Charge Code	2820739
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

4.0 MM BURRS

Facility

$347.00

Hospital Charge Code	127790
Hospital Revenue Code	271
Min. Negotiated Rate	$124.92
Max. Negotiated Rate	$247.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$205.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$247.76
Rate for Payer: Cash Price	$312.30
Rate for Payer: UnitedHealthcare Commercial	$231.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.92

4.0 MM BURRS

Facility

$347.00

Hospital Charge Code	127790
Hospital Revenue Code	271
Rate for Payer: Cash Price	$312.30

4.0MM ENDO TUBE--UNCUFFED

Facility

$178.00

Hospital Charge Code	285814
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

4.0MM ENDO TUBE--UNCUFFED

Facility

$178.00

Hospital Charge Code	285814
Hospital Revenue Code	270
Rate for Payer: Cash Price	$160.20

45MM, 15GA, I/O NEEDLE SET

Facility

$444.00

Hospital Charge Code	281058
Hospital Revenue Code	271
Min. Negotiated Rate	$159.84
Max. Negotiated Rate	$317.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$262.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$317.02
Rate for Payer: Cash Price	$399.60
Rate for Payer: UnitedHealthcare Commercial	$296.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$159.84

45MM, 15GA, I/O NEEDLE SET

Facility

$444.00

Hospital Charge Code	281058
Hospital Revenue Code	271
Rate for Payer: Cash Price	$399.60

4.5MM ENDO TUBE--UNCUFFED

Facility

$178.00

Hospital Charge Code	285815
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

4.5MM ENDO TUBE--UNCUFFED

Facility

$178.00

Hospital Charge Code	285815
Hospital Revenue Code	270
Rate for Payer: Cash Price	$160.20

4 VIEW ELBOW LT

Facility

$542.00

Service Code	CPT 73080
Hospital Charge Code	3214021
Hospital Revenue Code	320
Rate for Payer: Cash Price	$487.80

4 VIEW ELBOW LT

Facility

$542.00

Service Code	CPT 73080
Hospital Charge Code	3214021
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$386.99
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	$320.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$386.99
Rate for Payer: Cash Price	$487.80
Rate for Payer: Cash Price	$487.80
Rate for Payer: Cash Price	$487.80
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	$195.12

Know your out-of-pocket cost for care.

All Charges