Madison Medical Center

All Charges

Charge

Type

Setting

Price

CARVEDILOL (COREG) 6.25MG TAB

Facility

$22.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2626366
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

CARVEDILOL (COREG) 6.25MG TAB EMP

Facility

$15.00

Service Code	NDC 93013501
Hospital Charge Code	2697225
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

CARVEDILOL (COREG) 6.25MG TAB EMP

Facility

$15.00

Service Code	NDC 93013501
Hospital Charge Code	2697225
Hospital Revenue Code	250
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

CAST BOOT EX-SMALL

Facility

$149.00

Hospital Charge Code	283003
Hospital Revenue Code	271
Min. Negotiated Rate	$53.64
Max. Negotiated Rate	$106.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$106.39
Rate for Payer: Cash Price	$134.10
Rate for Payer: UnitedHealthcare Commercial	$99.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.64

CAST BOOT EX-SMALL

Facility

$149.00

Hospital Charge Code	283003
Hospital Revenue Code	271
Rate for Payer: Cash Price	$134.10

CAST BOOT LARGE

Facility

$149.00

Hospital Charge Code	283010
Hospital Revenue Code	271
Min. Negotiated Rate	$53.64
Max. Negotiated Rate	$106.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$106.39
Rate for Payer: Cash Price	$134.10
Rate for Payer: UnitedHealthcare Commercial	$99.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.64

CAST BOOT LARGE

Facility

$149.00

Hospital Charge Code	283010
Hospital Revenue Code	271
Rate for Payer: Cash Price	$134.10

CAST BOOT MEDIUM

Facility

$149.00

Hospital Charge Code	283008
Hospital Revenue Code	271
Rate for Payer: Cash Price	$134.10

CAST BOOT MEDIUM

Facility

$149.00

Hospital Charge Code	283008
Hospital Revenue Code	271
Min. Negotiated Rate	$53.64
Max. Negotiated Rate	$106.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$106.39
Rate for Payer: Cash Price	$134.10
Rate for Payer: UnitedHealthcare Commercial	$99.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.64

CAST BOOT SMALL

Facility

$149.00

Hospital Charge Code	283005
Hospital Revenue Code	271
Rate for Payer: Cash Price	$134.10

CAST BOOT SMALL

Facility

$149.00

Hospital Charge Code	283005
Hospital Revenue Code	271
Min. Negotiated Rate	$53.64
Max. Negotiated Rate	$106.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$106.39
Rate for Payer: Cash Price	$134.10
Rate for Payer: UnitedHealthcare Commercial	$99.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.64

CAST, LONG ARM

Facility

$596.00

Hospital Charge Code	283015
Hospital Revenue Code	271
Min. Negotiated Rate	$214.56
Max. Negotiated Rate	$425.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$352.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$425.54
Rate for Payer: Cash Price	$536.40
Rate for Payer: UnitedHealthcare Commercial	$397.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$214.56

CAST, LONG ARM

Facility

$596.00

Hospital Charge Code	283015
Hospital Revenue Code	271
Rate for Payer: Cash Price	$536.40

CAST, LONG LEG

Facility

$1,008.00

Hospital Charge Code	283016
Hospital Revenue Code	271
Min. Negotiated Rate	$362.88
Max. Negotiated Rate	$719.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$596.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$719.71
Rate for Payer: Cash Price	$907.20
Rate for Payer: UnitedHealthcare Commercial	$672.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$362.88

CAST, LONG LEG

Facility

$1,008.00

Hospital Charge Code	283016
Hospital Revenue Code	271
Rate for Payer: Cash Price	$907.20

CAST PADDING(UNSTERILE) 4 X40

Facility

$16.00

Hospital Charge Code	2823330
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

CAST PADDING(UNSTERILE) 4 X40

Facility

$16.00

Hospital Charge Code	2823330
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

CAST REINFORCEMENT

Facility

$93.00

Hospital Charge Code	283011
Hospital Revenue Code	271
Rate for Payer: Cash Price	$83.70

CAST REINFORCEMENT

Facility

$93.00

Hospital Charge Code	283011
Hospital Revenue Code	271
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$66.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: UnitedHealthcare Commercial	$62.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

CAST REMOVAL

Facility

$43.00

Hospital Charge Code	283012
Hospital Revenue Code	271
Rate for Payer: Cash Price	$38.70

CAST REMOVAL

Facility

$43.00

Hospital Charge Code	283012
Hospital Revenue Code	271
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

CAST, SHORT FIBERGLASS

Facility

$504.00

Hospital Charge Code	283018
Hospital Revenue Code	271
Min. Negotiated Rate	$181.44
Max. Negotiated Rate	$359.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$298.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$359.86
Rate for Payer: Cash Price	$453.60
Rate for Payer: UnitedHealthcare Commercial	$336.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$181.44

CAST, SHORT FIBERGLASS

Facility

$504.00

Hospital Charge Code	283018
Hospital Revenue Code	271
Rate for Payer: Cash Price	$453.60

CAST, SHORT LEG

Facility

$752.00

Hospital Charge Code	283017
Hospital Revenue Code	271
Min. Negotiated Rate	$270.72
Max. Negotiated Rate	$536.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$445.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$536.93
Rate for Payer: Cash Price	$676.80
Rate for Payer: UnitedHealthcare Commercial	$501.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$270.72

CAST, SHORT LEG

Facility

$752.00

Hospital Charge Code	283017
Hospital Revenue Code	271
Rate for Payer: Cash Price	$676.80

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