Madison Medical Center

All Charges

Charge

Type

Setting

Price

CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC

Facility

$18,649.12

Service Code	MSDRG 788
Min. Negotiated Rate	$9,324.56
Max. Negotiated Rate	$18,649.12
Rate for Payer: Aetna Medicare Advantage	$9,324.56
Rate for Payer: Cigna Commercial HMO & PPO	$9,324.56
Rate for Payer: Home State Health Plan Medicare Advantage	$9,324.56
Rate for Payer: Humana Commercial	$18,649.12
Rate for Payer: Humana Medicare Advantage	$9,324.56

CESAREAN SECTION WITH STERILIZATION

Facility

$21,514.93

Service Code	APR-DRG 5393
Min. Negotiated Rate	$21,514.93
Max. Negotiated Rate	$21,514.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$21,514.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21,514.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21,514.93
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21,514.93

CESAREAN SECTION WITH STERILIZATION

Facility

$9,367.28

Service Code	APR-DRG 5392
Min. Negotiated Rate	$9,367.28
Max. Negotiated Rate	$9,367.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,367.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,367.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,367.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,367.28

CESAREAN SECTION WITH STERILIZATION

Facility

$7,134.07

Service Code	APR-DRG 5391
Min. Negotiated Rate	$7,134.07
Max. Negotiated Rate	$7,134.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,134.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,134.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,134.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,134.07

CESAREAN SECTION WITH STERILIZATION

Facility

$37,187.33

Service Code	APR-DRG 5394
Min. Negotiated Rate	$37,187.33
Max. Negotiated Rate	$37,187.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$37,187.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$37,187.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37,187.33
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$37,187.33

CESAREAN SECTION WITH STERILIZATION WITH CC

Facility

$20,234.40

Service Code	MSDRG 784
Min. Negotiated Rate	$10,117.20
Max. Negotiated Rate	$20,234.40
Rate for Payer: Aetna Medicare Advantage	$10,117.20
Rate for Payer: Cigna Commercial HMO & PPO	$10,117.20
Rate for Payer: Home State Health Plan Medicare Advantage	$10,117.20
Rate for Payer: Humana Commercial	$20,234.40
Rate for Payer: Humana Medicare Advantage	$10,117.20

CESAREAN SECTION WITH STERILIZATION WITH MCC

Facility

$42,169.96

Service Code	MSDRG 783
Min. Negotiated Rate	$21,084.98
Max. Negotiated Rate	$42,169.96
Rate for Payer: Aetna Medicare Advantage	$21,084.98
Rate for Payer: Cigna Commercial HMO & PPO	$21,084.98
Rate for Payer: Home State Health Plan Medicare Advantage	$21,084.98
Rate for Payer: Humana Commercial	$42,169.96
Rate for Payer: Humana Medicare Advantage	$21,084.98

CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC

Facility

$18,633.48

Service Code	MSDRG 785
Min. Negotiated Rate	$9,316.74
Max. Negotiated Rate	$18,633.48
Rate for Payer: Aetna Medicare Advantage	$9,316.74
Rate for Payer: Cigna Commercial HMO & PPO	$9,316.74
Rate for Payer: Home State Health Plan Medicare Advantage	$9,316.74
Rate for Payer: Humana Commercial	$18,633.48
Rate for Payer: Humana Medicare Advantage	$9,316.74

CESI WITH CT FLUORO GUIDANCE

Professional

Both

$1,200.00

Service Code	CPT 62321
Hospital Charge Code	4162310
Hospital Revenue Code	975
Min. Negotiated Rate	$91.77
Max. Negotiated Rate	$420.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$91.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$201.39
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cigna Commercial HMO & PPO	$91.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$201.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$221.53
Rate for Payer: Home State Health Plan Medicare Advantage	$91.77
Rate for Payer: Optum Medicare Advantage	$420.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$201.39

CESI WITH CT FLURO GUIDE

Professional

Both

$1,200.00

Service Code	CPT 62321
Hospital Charge Code	4162321
Hospital Revenue Code	975
Min. Negotiated Rate	$91.77
Max. Negotiated Rate	$420.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$91.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$201.39
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cigna Commercial HMO & PPO	$91.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$201.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$221.53
Rate for Payer: Home State Health Plan Medicare Advantage	$91.77
Rate for Payer: Optum Medicare Advantage	$420.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$201.39

CESI WITHOUT CT FLURO GUIDE

Professional

Both

$1,000.00

Service Code	CPT 62320
Hospital Charge Code	4162320
Hospital Revenue Code	975
Min. Negotiated Rate	$84.62
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$84.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$141.48
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cigna Commercial HMO & PPO	$84.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$141.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$155.63
Rate for Payer: Home State Health Plan Medicare Advantage	$84.62
Rate for Payer: Optum Medicare Advantage	$350.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$141.48

CETACAINE TOP ANESTH SPR SINGLE DOSE 5GM

Facility

$161.00

Service Code	NDC 1.0223E+10
Hospital Charge Code	2622827
Hospital Revenue Code	250
Rate for Payer: Cash Price	$144.90

CETACAINE TOP ANESTH SPR SINGLE DOSE 5GM

Facility

$161.00

Service Code	NDC 1.0223E+10
Hospital Charge Code	2622827
Hospital Revenue Code	250
Min. Negotiated Rate	$57.96
Max. Negotiated Rate	$114.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$95.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$114.95
Rate for Payer: Cash Price	$144.90
Rate for Payer: UnitedHealthcare Commercial	$107.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$57.96

CETACAINE TOPICAL ANESTHETIC SPRAY

Facility

$67.00

Service Code	NDC 1.0223E+10
Hospital Charge Code	2618200
Hospital Revenue Code	250
Rate for Payer: Cash Price	$60.30

CETACAINE TOPICAL ANESTHETIC SPRAY

Facility

$67.00

Service Code	NDC 1.0223E+10
Hospital Charge Code	2618200
Hospital Revenue Code	250
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

CETIRIZINE 10MG TAB EMP (ZYRTEC)

Facility

$43.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2697321
Hospital Revenue Code	250
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

CETIRIZINE 10MG TAB EMP (ZYRTEC)

Facility

$43.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2697321
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

CETIRIZINE 5MG/5ML ORAL SOL 473ML EMP

Facility

$43.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2622828
Hospital Revenue Code	250
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

CETIRIZINE 5MG/5ML ORAL SOL 473ML EMP

Facility

$43.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2622828
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

CETIRIZINE (ZYRTEC) 1MG/ML 5ML SYR

Facility

$20.00

Service Code	NDC 5.4838E+10
Hospital Charge Code	2626290
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

CETIRIZINE (ZYRTEC) 1MG/ML 5ML SYR

Facility

$20.00

Service Code	NDC 5.4838E+10
Hospital Charge Code	2626290
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

CETIRIZINE (ZYRTEC) TAB 10MG UD

Facility

$22.00

Service Code	NDC 904671746
Hospital Charge Code	2626261
Hospital Revenue Code	250
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

CETIRIZINE (ZYRTEC) TAB 10MG UD

Facility

$22.00

Service Code	NDC 904671746
Hospital Charge Code	2626261
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

CETIRIZ/PSE ER 5MG/120 MG TAB EMP #12

Facility

$43.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2625180
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

CETIRIZ/PSE ER 5MG/120 MG TAB EMP #12

Facility

$43.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2625180
Hospital Revenue Code	250
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

Know your out-of-pocket cost for care.

All Charges