Madison Medical Center

All Charges

Charge

Type

Setting

Price

4 VIEW ELBOW RT

Facility

$542.00

Service Code	CPT 73080
Hospital Charge Code	3214020
Hospital Revenue Code	320
Rate for Payer: Cash Price	$487.80

4 VIEW ELBOW RT

Facility

$542.00

Service Code	CPT 73080
Hospital Charge Code	3214020
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

4 VIEWS KNEE LT

Facility

$233.00

Service Code	CPT 73564
Hospital Charge Code	3214006
Hospital Revenue Code	320
Min. Negotiated Rate	$83.88
Max. Negotiated Rate	$213.62
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	$137.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$166.36
Rate for Payer: Cash Price	$209.70
Rate for Payer: Cash Price	$209.70
Rate for Payer: Cash Price	$209.70
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	$83.88

4 VIEWS KNEE LT

Facility

$233.00

Service Code	CPT 73564
Hospital Charge Code	3214006
Hospital Revenue Code	320
Rate for Payer: Cash Price	$209.70

4 VIEWS KNEE RT

Facility

$233.00

Service Code	CPT 73564
Hospital Charge Code	3214005
Hospital Revenue Code	320
Min. Negotiated Rate	$83.88
Max. Negotiated Rate	$213.62
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	$137.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$166.36
Rate for Payer: Cash Price	$209.70
Rate for Payer: Cash Price	$209.70
Rate for Payer: Cash Price	$209.70
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	$83.88

4 VIEWS KNEE RT

Facility

$233.00

Service Code	CPT 73564
Hospital Charge Code	3214005
Hospital Revenue Code	320
Rate for Payer: Cash Price	$209.70

4 VIEWS SHOULDER LT

Facility

$286.00

Service Code	CPT 73030
Hospital Charge Code	3214011
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$204.20
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	$169.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$204.20
Rate for Payer: Cash Price	$257.40
Rate for Payer: Cash Price	$257.40
Rate for Payer: Cash Price	$257.40
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	$102.96

4 VIEWS SHOULDER LT

Facility

$286.00

Service Code	CPT 73030
Hospital Charge Code	3214011
Hospital Revenue Code	320
Rate for Payer: Cash Price	$257.40

4 VIEWS SHOULDER RT

Facility

$286.00

Service Code	CPT 73030
Hospital Charge Code	3214010
Hospital Revenue Code	320
Rate for Payer: Cash Price	$257.40

4 VIEWS SHOULDER RT

Facility

$286.00

Service Code	CPT 73030
Hospital Charge Code	3214010
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$204.20
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	$169.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$204.20
Rate for Payer: Cash Price	$257.40
Rate for Payer: Cash Price	$257.40
Rate for Payer: Cash Price	$257.40
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	$102.96

5.0 BUGBEE ELECTRODE

Facility

$373.00

Hospital Charge Code	1216050
Hospital Revenue Code	271
Min. Negotiated Rate	$134.28
Max. Negotiated Rate	$266.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$220.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$266.32
Rate for Payer: Cash Price	$335.70
Rate for Payer: UnitedHealthcare Commercial	$248.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$134.28

5.0 BUGBEE ELECTRODE

Facility

$373.00

Hospital Charge Code	1216050
Hospital Revenue Code	271
Rate for Payer: Cash Price	$335.70

5.0MM ENDO TUBE--UNCUFFED

Facility

$178.00

Hospital Charge Code	285816
Hospital Revenue Code	270
Rate for Payer: Cash Price	$160.20

5.0MM ENDO TUBE--UNCUFFED

Facility

$178.00

Hospital Charge Code	285816
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

5.5MM ENDO TUBE--UNCUFFED

Facility

$178.00

Hospital Charge Code	285817
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

5.5MM ENDO TUBE--UNCUFFED

Facility

$178.00

Hospital Charge Code	285817
Hospital Revenue Code	270
Rate for Payer: Cash Price	$160.20

5CM RF ELECTRODE PROBE

Facility

$302.00

Hospital Charge Code	1216043
Hospital Revenue Code	360
Rate for Payer: Cash Price	$271.80

5CM RF ELECTRODE PROBE

Facility

$302.00

Hospital Charge Code	1216043
Hospital Revenue Code	360
Min. Negotiated Rate	$108.72
Max. Negotiated Rate	$201.43
Rate for Payer: Cash Price	$271.80
Rate for Payer: UnitedHealthcare Commercial	$201.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.72

5-HIAA 24HR UR

Facility

$87.00

Service Code	CPT 83497
Hospital Charge Code	2283498
Hospital Revenue Code	301
Rate for Payer: Cash Price	$78.30

5-HIAA 24HR UR

Facility

$87.00

Service Code	CPT 83497
Hospital Charge Code	2283498
Hospital Revenue Code	301
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$62.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.61
Rate for Payer: Aetna Medicare Advantage	$12.90
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: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cigna Commercial HMO & PPO	$12.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.42
Rate for Payer: Home State Health Plan Medicare Advantage	$12.90
Rate for Payer: Humana Commercial	$25.80
Rate for Payer: Humana Medicare Advantage	$12.90
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.32

5-HIAA PLASMA

Facility

$87.00

Service Code	CPT 83497
Hospital Charge Code	2283497
Hospital Revenue Code	301
Rate for Payer: Cash Price	$78.30

5-HIAA PLASMA

Facility

$87.00

Service Code	CPT 83497
Hospital Charge Code	2283497
Hospital Revenue Code	301
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$62.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.61
Rate for Payer: Aetna Medicare Advantage	$12.90
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: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cigna Commercial HMO & PPO	$12.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.42
Rate for Payer: Home State Health Plan Medicare Advantage	$12.90
Rate for Payer: Humana Commercial	$25.80
Rate for Payer: Humana Medicare Advantage	$12.90
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.32

5' NUCLEOTIDASE

Facility

$357.00

Service Code	CPT 83915
Hospital Charge Code	2283915
Hospital Revenue Code	301
Min. Negotiated Rate	$10.04
Max. Negotiated Rate	$254.90
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.04
Rate for Payer: Aetna Medicare Advantage	$11.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$211.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$254.90
Rate for Payer: Cash Price	$321.30
Rate for Payer: Cash Price	$321.30
Rate for Payer: Cash Price	$321.30
Rate for Payer: Cigna Commercial HMO & PPO	$11.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10.74
Rate for Payer: Home State Health Plan Medicare Advantage	$11.15
Rate for Payer: Humana Commercial	$22.30
Rate for Payer: Humana Medicare Advantage	$11.15
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$128.52

5' NUCLEOTIDASE

Facility

$357.00

Service Code	CPT 83915
Hospital Charge Code	2283915
Hospital Revenue Code	301
Rate for Payer: Cash Price	$321.30

5 OCL SPLINTING

Facility

$16.00

Hospital Charge Code	2816332
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

Know your out-of-pocket cost for care.

All Charges